Jagadish Prasad Rout, Pramod Kumar Sharma, Swati Samikshya, Ravindra Kumar Chowdhury, Kanhei Charan Tudu
BACKGROUND Human amniotic membrane (AM) is the inner layer of the fetal membranes and consist of the epithelium, basement membrane and stroma. The AM has anti-inflammatory, anti-fibrotic, anti-angiogenic as well as anti-microbial properties. Because of its transparent structure, lack of immunogenicity and the ability to provide an excellent substrate for growth, migration and adhesion of epithelial corneal and conjunctival cells, it can be used for ocular surface reconstruction in many ocular pathologies including corneal disorders associated with limbal stem cell deficiency, surgeries for conjunctival reconstruction, as a carrier for ex vivo expansion of limbal epithelial cells, glaucoma surgeries and scleral melts and perforations. AM transplantation is a very useful armamentarium in the hands of the ophthalmic surgeons for treating a variety of ocular surface disorders caused by various Chemical, acids and alkali and also endogenous causes like severe dry eye, Steven Johnson Syndrome etc affect the ocular surface as it is a very sensitive and dynamic structure. The aim of the study is to evaluate the efficacy of Non-Preserved Human Amniotic Membrane Transplantation in ocular surface disorders with respect to re-epithelialisation, corneal clarity, degree of neovascularisation and visual outcome and compare its efficacy with that of preserved Amniotic Membrane Transplant. MATERIALS AND METHODS 40 eyes of 36 patients were subjected to amniotic membrane transplant from July 2016 to January 2018. Non-preserved amniotic membrane was employed to cover corneal ulceration due to dry eye syndrome (12 eyes), non-healing corneal ulcers (12 eyes), corneal epithelial defect due to Steven Johnson Syndrome (8 eyes), conjunctiva and corneal epithelial defect due to alkali burn (8 eyes). Amniotic membrane sutured to surrounding conjunctiva using 10-0 silk with interrupted suture. Patients were followed up to 6 months. Sutures removed on 31st day of transplant. RESULTS Out of 40 eyes of 36 patients with mean age group of 32.5 years, non-healing corneal ulcer (8 eyes; 20%), dry eye syndrome (8 eyes; 20%) and Steven Johnson syndrome (4 eyes; 10%) showed resolution of epithelial defect and stabilization of neo vascularisation. 4 eyes (10%) of alkali burn responded favourably but retransplantation of Amniotic membrane to 2nd eye (10%) of the same patient, on 45th day had to be done. Over all 4 eyes of Steven Johnson syndrome, 4 eyes of dry eye syndrome, 4 eyes of persistent sterile corneal ulcer failed due to unrelated bacterial keratitis. Corneal clarity and improved visual acuity were observed in 60% of patients on day 31st. Transplantation in 16 eyes (40%) failed and was sent to higher center for further management. CONCLUSION Non-preserved human amniotic membrane transplantation is a safe and equipotent procedure as compared to preserved amniotic membrane in ocular surface reconstruction where facilities for preservation are not available and continuing medical management bears higher risk.
