Effects of Temporary Amniotic Membrane Patch after Surgical Excision of Primary Pterygium

PURPOSE: To investigate the clinical results, recurrence rates, and recurrence-related risk factors of temporary amniotic membrane patch (TAMP) after excision of primary pterygium. METHODS: Recurrence grade was evaluated for 73 eyes with a mean follow-up of 15.5 months (range 9 to 56 months). Surgical results were classified into surgical success (G0/G1), conjunctival recurrence (G2), and corneal recurrence (G3). Recurrence rates were analyzed based on gender, age, Tan's preoperative grading system, horizontal and vertical length of the preoperative pterygium, the corneal involvement size of the preoperative pterygium, planned or unplanned removal of amniotic membrane, and epithelial healing time. Using Kaplan-Meier survival analysis, the cumulative proportion of integrated G0/G1 was evaluated. RESULTS: In the postoperative grading, 58 (79.5%) and 9 (12.3%) eyes were graded as clinically recurrence-free G0 and G1, respectively; 4 (5.5%) and 2 (2.7%) eyes were graded as clinically recurrence-occurred G2 and G3, respectively. The cumulative proportion of integrated recurrence-free G0/G1 at 24 months after surgery was 0.83 +/- 0.08. T3 of Tan's preoperative grading system was identified as the only risk factor for recurrence above G1 through multivariate logistic regression analysis (p = 0.02). CONCLUSIONS: The recurrence rate of the present TAMP study showed better results in comparison with 9.1 to 56.1% of recurrence rates in other studies. The TAMP has advantages of surgical procedure with ease, low complications, and low recurrence rates. Therefore, after surgical excision of primary pterygium, the authors concluded the TAMP is highly recommended for good clinical outcomes and low recurrence rates.

Efficacy of the Sutureless Amniotic Membrane Patch for the Treatment of Ocular Surface Disorders

PURPOSE: To evaluate the efficacy of the sutureless amniotic membrane (AM) patch for the treatment of ocular surface disorders. METHODS: A sutureless AM patch using a silicone ring was utilized to treat neurotrophic ulcer, persistent epithelial defect (PED), Shield ulcer, chemical injury and Stevens-Johnson syndrome. Primary outcome was the time to complete corneal and conjunctival epithelialization. Secondary outcome was the number of repeated insertions and complications of the inserted ring. RESULTS: Neurotrophic ulcer was observed in 4 eyes, PED in 2 eyes, Shield ulcer in 1 eye, chemical injury in 4 eyes and Stevens-Johnson syndrome in 4 eyes. The mean (SD) time to complete epithelialization was 13 (7.2) days (6-20 days) in neurotrophic ulcer, 17.5 (7.7) days (12-23) in PED, 5 days in Shield ulcer, 10.6 (6.6) days (3-15) in chemical injury and 13.5 (0.7) days (13-14) in Stevens-Johnson syndrome. There were no protrusion or mechanical trauma of the inserted ring. In 1 case of neurotrophic ulcer and 1 refractory case of chemical injury, repeated insertion was performed due to incomplete healing after dissolution of the AM. In 2 eyes with Stevens-Johnson syndrome, repeated insertion was necessary with heavy accumulation of inflammatory debris on the AM. No symblepharon or fornix contracture was found in chemical injury or Stevens-Johnson syndrome patients. CONCLUSIONS: The sutureless AM patch using a silicone ring was shown to be effective and safe for the treatment of ocular surface disorders. The patch can help surgeons avoid suture-related trauma to the ocular surface during the acute inflammatory period.

Comparison of Permanent Amniotic Membrane Transplantation and Temporary Amniotic Membrane Patch after Primary Pterygium Excision

PURPOSE: To compare the clinical results, recurrence rates, and recurrence-related risk factors of permanent amniotic membrane transplantation (PAMT, group 1) and temporary amniotic membrane patch (TAMP, group 2) after excision of primary pterygium. METHODS: Recurrence grades were evaluated for 66 eyes (T1, T2, and T3; 0, 32, and 34 eyes, respectively) in group 1 and 73 eyes (T1, T2, and T3; 2, 42, and 29 eyes, respectively) in group 2. Surgical results were classified into surgical success (G0 or G1), conjunctival recurrence (G2), and corneal recurrence (G3). Recurrence rates were analyzed based on gender, age, Tan's preoperative grading system, horizontal and vertical length of the preoperative pterygium, the corneal involvement size of the preoperative pterygium, and epithelial healing time. RESULTS: In the postoperative grading, 3 eyes (4.5%) and 1 eye (1.5%) in group 1, and 4 eyes (5.5%) and 2 eyes (2.7%) in group 2 were graded as clinically recurrence-occurred G2 and G3, respectively. There was no statistically significant difference in recurrence-occurred G2 and G3 cases between the two groups (p = 0.62). No risk factors of clinically significant G2 and G3 recurrence were identified in either group by Cox proportional hazards survival regression analysis. CONCLUSIONS: The results of the present study suggest that PAMT tends to lower the recurrence rate compared to TAMP because the PAMT group had more T3 eyes than the TAMP group, although the two groups showed no statistically significant difference in clinically significant recurrence after pterygium excision.

Treatment of Epithelial Ingrowth after Laser in Situ Keratomilusis Using Amniotic Membrane Patch

PURPOSE: To present the result of a new technique for compressing the flap with amniotic membrane patch to manage epithelial ingrowth following a lacerated or microperforated flap near the visual axis during laser in situ keratomileusis (LASIK) surgery. METHODS: Four patients having epithelial ingrowth involving the visual axis were treated as follows: Under a surgical microscope, 3~5 landmark sutures were located at the margin of the flap and the flap was lifted carefully. After removing epithelial cells, preplaced corneal sutures were tied to fix the flap and a prepared amniotic membrane patch was tightly sutured to the sclera to compress the entire cornea. The amniotic membrane overlay was maintained for about a week and then removed. RESULTS: All four eyes achieved a best corrected visual acuity of 20/25 or better and no eyes have shown signs of recurrence within 3 months. CONCLUSIONS: Amniotic membrane patch can be a useful way to secure the flap in the treatment of epithelial ingrowth threatening the visual axis, especially when direct sutures are deemed difficult.

Treatment of Epithelial Ingrowth after Laser in Situ Keratomilusis Using Amniotic Membrane Patch

PURPOSE: To present the result of a new technique for compressing the flap with amniotic membrane patch to manage epithelial ingrowth following a lacerated or microperforated flap near the visual axis during laser in situ keratomileusis (LASIK) surgery. METHODS: Four patients having epithelial ingrowth involving the visual axis were treated as follows: Under a surgical microscope, 3~5 landmark sutures were located at the margin of the flap and the flap was lifted carefully. After removing epithelial cells, preplaced corneal sutures were tied to fix the flap and a prepared amniotic membrane patch was tightly sutured to the sclera to compress the entire cornea. The amniotic membrane overlay was maintained for about a week and then removed. RESULTS: All four eyes achieved a best corrected visual acuity of 20/25 or better and no eyes have shown signs of recurrence within 3 months. CONCLUSIONS: Amniotic membrane patch can be a useful way to secure the flap in the treatment of epithelial ingrowth threatening the visual axis, especially when direct sutures are deemed difficult.

The Effect of Amniotic Membrane Patch in Wound Healing of Skin Defect / 대한피부과학회지

BACKGROUND: Amniotic membrane contains basement membrane components and several growth factor proteins. Therefore, transplantation of amniotic membrane might help epithelialization. OBJECTIVE: The purpose of this study was to compare efficacies of amniotic membrane patches (amniotic group), polyurethane film (TegadermTM, 3M, USA: wet group), and nonadherent dressing (dry group) in wound healing. METHOD: Six rabbits were included in this study. We made wound defects on the back of each rabbit. Amniotic membrane patches (amniotic group) was applied to each wound defect in the first group, polyurethane film (TegadermTM, 3M, USA: wet group) to the second group, and nonadherent dressings (dry group) to the third group. We compared the time taken for each wound defect to heal, and the gross and histopathologic change of the wound defect from baseline, over time. RESULTS: The results were as follows: 1. In the early phase, the amniotic membrane patch (amniotic group) resulted in a faster healing time than either the polyurethane film (TegadermTM, 3M, USA: wet group) or the nonadherent dressing (dry group). 2. On day 10, all groups achieved histological epithelialization. 3. In the late phase, the amniotic membrane patch (amniotic group) might inhibit collagen fiber arrangement and development of skin appendages. CONCLUSION: The amniotic membrane patch is effective in the treatment of rabbit wound defects. It can serve as a biological dressing in the early phase of wound defects.