The Efficacy of Human Amniotic Membrane Transplantation in the Management of Different Ocular Surface Disorders

The efficacy of human amniotic membrane transplantation in the management of different ocular surface disorders. Study centre It is a single centre study conducted at Sankar Foundation Eye Hospital, Visakhapatnam Type of study Prospective study. Study design Non-randomized, interventional. Study Population All the patients, who were diagnosed with various ocular surface disorders and not responding to maximum medical treatment, and needed ocular surface reconstruction/surgical treatment were selected for the present study by applying the spectrum of ocular inclusion and exclusion criteria. Sample Size- Sixty two patients with OSD of various etiologies, who underwent AMT, were included in this study which was done from May 2014 to June 2015 INCLUSION CRITERIA Primary progressive pterygium with 2 mm or more infiltration of cornea, recurrent pterygium, Chemical injury, Neurotrophic corneal ulcer, Systemic mucocutaneous disorders, Symptomatic bullous keratopathy, Persistant epithelial defect, Ocular neoplasia, Moorens ulcer EXCLUSION CRITERIA Infective ulcers, Minimal defect due to injury or mucocutaneous lesions tending to heal with medical management. Methodology A clearance from the Institutional Research Board of Sankar Foundation Eye Hospital and Institute of Ophthalmology was obtained prior to the commencement of the study. Participants were enrolled after prior informed consent. Study Definitions All patients were examined on postoperative day 1, then at the end of the first week, second week, and monthly thereafter. The subjective symptoms of patients, such as pain, were recorded at every follow-up examination. Pain was evaluated using a 5-point scale from Lim-Bon-siong et. al15 A total of 62 patients with different ocular surface disorders (fig10) were operated with AMT during our study period. The outcome following AMT in different ocular surface disorders was studied in terms of relieving pain, irritation, and ocular discomfort, reducing inflammation of the ocular surface, in promoting epithelialization and preventing recurrence. In this study, AMT was performed most commonly for primary pterygium (n=32, 51.6 %) followed by chemical injury. Ocular surface neoplasia and persistent epithelial defects not responding to conventional treatment underwent AMT. Bullous keratopathy and PBK were less commonly opted for AMT. Results Majority of the patients (37.09 %) in the preoperative period have a best corrected visual acuity of 6/36 to 6/18 whereas more than half of the patients (58.06 %) have a best corrected visual acuity of 6/12 or better in the post operative period. Only one patient of chemical injury, in the preoperative period had a best corrected corrected visual acuity of PL+ PR accurate which improved to 5/60 following AMT.3 patients (4.83 %) had a visual acuity of HM to CFCF preoperatively, 2 of them had chemical injury and one patient with psudophakic bullous keratopathy. More than half of the eyes (64.5 %) had a BCVA of 6/36 or better preoperatively, which indicates that ocular surface disorders can affect vision to a lesser extent. Only 2 patients had BCVA of CFCF. following AMT in our study.86 % of the patients had no pain, postoperatively after one month. Complications Significant reduction of symptoms like ocular pain, is observed in cases of PED, Moorens ulcer, chemical injury and PBK. There is moderate improvement in visual acuity following AMT for different indications. It is observed that the recurrence rate in primary pterygium is less than that in recurrent pterygium cases following AMT. In cases with chemical injury, AMT relieves pain, suppresses inflammation, promotes epithelialization, and prevents tissue necrosis with scarring sequelae and resulting vision loss. In cases with PED and Moorens ulcer not responding to medical treatment, it reduces pain and inflammation and it promotes epithelialization and healing. In cases with Ocular surface neoplasia undergoing excision biopsy, AMT covers the bare sclera and acts as a shield and prevents stromal melting. In PBK cases, it causes significant and rapid healing from pain. In severe cases of OCP, AMT combined with lamellar patch graft is more successful than AMT alone.