A Clinical Research On Amniotic Membrane Transplantation (AMT) In Treating Immunologic Ocular Surface Diseases And Corneal Ulcerous Perforation

Objective To evaluate the efficacy , safety and localization of amniotic membrane transplantation (AMT) in treating immunologic ocular surface diseases and corneal ulcerous perforation. Methods We have observed four groups of patients, who underwent AMT for their ocular disease. (1) 24 patients (30eyes) with local Mooren' s ulcer were treated with AMT combined with conjunctival excision , follow up ranged 5-30 months. (2) 8 patients (sixteen eyes) with vernal keratoconjunctivitis (VKC), characterized by giant papillae (GP) on the upper tarsal conjunctiva, underwent resection and cryotherapy associated with AMT. The follow up ranged 3-22months. (3) 20 eyes (10 patients ) with VKC, characterized by gelatinous swellings (papillae) at the limbus, underwent annular bubble conjunctival excision associated with AMT. The follow up ranged 5-21months. (4) 6 eyes (6 patients) were treated with multilayer amniotic membrane transplantation for corneal perforation associated with ulceration. The follow up ranged 5-19 months. Results (1) After operation, symptoms subsided remarkably and immediately in all patients. Corneal melts were controlled. 2 months later, the corneal thickless was increased, transparence and vision were improved . During follow up, no severe complications or recurrence was noted. (2) Corneal shield ulcers and superficial punctuate keratitis healed during the first week after surgery and did not recur . 14 eyes (87. 5 %) were symptom-free 1 month after surgery, no GP ectropion trichiasis and other complications were found, but the blood vessels of upper tarsal conjunctiva could not be seen clearly , a little conjunctival scar was observed. Recurrence of GP was observed in 2 eyes (12.5 % ) , with reduced area and lessened irritation symptom comparing with preoperation. Among them, one eye was treated by 1% cyclosporine eyedrops with improvement, but the other eye with no improvement, and underwent second surgery with additionalprocedure, in which a cotton patch soaked in fluorouracil was applied on the supratarsal after resection and cryotherapy . 6 months after this treatment the patient had no symptoms and GP had not recurred. (3) After operation, symptoms subsided remarkably; snuff color gelatinous protuberance at the limbus were cleaned away by operation and did not recur during the follow-up. Corneal superficial punctuate keratitis (11 eyes) and corneal ulcers (3 eyes) healed during the first week after surgery and did not recur . Postoperative conjunctival congestion was gradually lessened, and in 19 eyes it could not be noted 1 month after surgery, and the conjunctiva around the limbus, where AMT was performed, was whiter than the normal . The conjunctival congestion in 1 eye lasted for about 5 months accompanied with a little of itch, and this eye was treated by eyedrops with improvement but recurrence several times. No severe complications had been observed during the follow-up . (4) The anterior chamber reformed at the first postoperative day in all patients, and kept in normal depth in the follow-up time. The outermost patch of the AM dissolved in 1 week after surgery, and the epithelialization of the AM grafts was observed in the 3 weeks after surgery. During the first postoperative month the corneal thickness at the perforation site graduallyincreased, and the stromal inflammatory cell invasions surrounding the corneal ulcer were gradually subsided. 2 months postoperatively, the ulcer healed with scar tissue with neovascularization; the corneal thickness of the ulcer area was stable and recovered almost normal, and the surfaces appeared smooth . The vision was not improved in all patients after operation. During-follow up, no severe complications or recurrence of ulceration was noted. Conclusions: (1) Amniotic membrane transplantation combined with conjunctival peritomy for the treatment of local Mooren' s ulcer. (2) Resection and cryotherapy combine with amniotic membrane transplantation for the treatment of vernal keratoconjunctivitis with giant papillae. (3) Annular bubble conjunctival excision combined with amniotic membrane transplantation for the treatment of vernal keratoconjunctivitis with gelatinous swellings (papillae) at the limbus. (4) Multilayer amniotic membrane transplantation for the managenment of corneal perforation associated with ulceration are all effective safe and economic .But the patients should be selected AMT should be applied to those patients (1) who suffered the local Mooren' s ulcer, which involved 30°-l20° corneal limbus. (2) who suffered the vernal keratoconjunctivitis(VKC) , characterized by giantpapillae (GP) on the upper tarsal conjunctiva , or characterized by gelatinous swellings(papillae) at the limbus. These patient had severe symptoms and had medical treatment with no or a little improvement. (3) who suffered the corneal perforation associated with ulceration. AMT may be top-priority when the corneal perforation is small and in the periphery, or the coneal tissue is not available. But the ulcer and the perforation healed with scar after AMT, and a subsequent procedure, such as penetrating keratoplasty (PKP), may be needed to improve the vision. Multilayer amniotic membrane transplantation may increase the success rate of subsequent keratoplasty by suppressing inflammation.