Wet bio-amniotic membrane plugging combined with transplantation in the treatment of small corneal perforations

ABSTRACT Purpose: Wet bio-amniotic membrane plugging combined with transplantation is a novel option that combined amniotic membrane plugging with amniotic membrane transplantation for the treatment of small corneal perforations. This study aimed to evaluate the efficacy of wet bio-amniotic membrane plugging in the treatment of small corneal perforations and compared it with that of the penetrating keratoplasty procedure. Methods: Forty patients (41 eyes) with small corneal perforations <3 mm in diameter treated at our hospital between July 2018 and January 2021 were retrospectively included. Among them, 21 eyes were treated with wet bio-amniotic membrane plugging (wet bio-amniotic membrane plugging group), and 20 eyes were treated with penetrating keratoplasty procedure (penetrating keratoplasty procedure group). The best-corrected visual acuity, anterior chamber formation, corneal thickness, primary disease control, postoperative complications, and graft survival rate were assessed. Results: No significant difference in baseline characteristics was found between the wet bio-amniotic membrane plugging and penetrating keratoplasty procedure groups (p>0.05). The postoperative control rates of primary diseases in the wet bio-amniotic membrane plugging and penetrating keratoplasty procedure groups were 95.2% and 90.0%, respectively (p=0.481). Visual acuity was improved 6 months after the operation in the wet bio-amniotic membrane plugging group and was improved at postoperative 1 month in the penetrating keratoplasty procedure group. The formation time of the anterior chamber in the wet bio-amniotic membrane plugging group was significantly shorter than that in the penetrating keratoplasty procedure group (p=0.023). The corneal thickness of the two groups significantly increased 12 months after the operation; however, the degree of thickening in the penetrating keratoplasty procedure group was higher than that in the wet bio-amniotic membrane plugging group (p<0.001). During the follow-up, postoperative complications were not different between the two groups (p>0.999). Conclusion: The results suggest that wet bio-amniotic membrane plugging is effective and safe in the treatment of small corneal perforations. Thus, it can be used as an emergency treatment alternative to penetrating keratoplasty procedure for small corneal perforations.

Effect of biological amniotic membrane soaked in pirfenidone on scar formation after glaucoma filtration surgery in rabbit eyes / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the application of biological amniotic membrane soaked in pirfenidone(PFD)and to evaluate its anti-scarring effect and toxic side effects on glaucoma model of rabbit eyes.METHODS: The right eyes of 72 healthy New Zealand white rabbits were randomly divided into 0.5%PFD+ biological amniotic membrane group, biological amniotic membrane group, mitomycin C(MMC)group and blank control group after the glaucoma model was established by anterior chamber injection of compound carbomer solution, and 18 rabbits in each group underwent trabeculectomy, in which the 0.5% PFD+ biological amniotic membrane group was placed with 0.5% PFD solution-soaked biological amniotic membrane under the scleral flap, and the biological amniotic membrane group was placed with normal saline-soaked rehydrated biological amniotic membrane under the scleral flap. In the MMC group, a cotton pad soaked in MMC was placed under the scleral flap for 3 min and immediately rinsed with normal saline, while the blank control group received no implant after the scleral flap was made. The intraocular pressure(IOP), filtration blebs, toxic side effects and complications were evaluated, and the histopathological changes in the filtration area were observed by hematoxylin-eosin(HE), Masson staining and immunohistochemical staining.RESULTS: The mean IOP at 14, 21 and 28 d after trabeculectomy were 0.5%PFD+ biological amniotic membrane group&#x0026;#x003C;MMC group&#x0026;#x003C;biological amniotic membrane group&#x0026;#x003C;blank control group(all P&#x0026;#x003C;0.05). At 28 d after trabeculectomy, 0.5%PFD+ biological amniotic membrane group had the best effect of anti-inflammatory hyperplasia and inhibition of collagen formation, the highest survival rate of filtration blebs, and the inflammatory reaction was mild.CONCLUSION: Biological amniotic membrane soaked in pirfenidone has more obvious anti-scarring effect on glaucoma model, with less toxic side effects and good safety.

Membranas amnióticas y su aplicación en el tratamiento de quemaduras: una revisión sistemática exploratoria

Las quemaduras son un problema de interés en salud pública ya que generan un alto índice de morbimortalidad a nivel mundial, las quemaduras térmicas son las más prevalentes y pueden alterar la integridad anatómica, funcional y estética de la piel, aspectos fundamentales para la autoestima del paciente y su capacidad para reintegrarse a la sociedad. Al revisar la literatura sobre el tratamiento de estas afecciones encontramos diversos tratamientos, entre ellos el uso de membrana amniótica humana, la cual ha tenido un impacto importante en el manejo de quemaduras al funcionar como andamio biológico con cualidades regenerativas y antiinflamatorias. El presente artículo tiene como objetivo sintetizar la información actual que describe las aplicaciones de membranas amnióticas humanas en quemaduras, realizamos una revisión exploratoria sistemática de la literatura desde 2010 hasta 2021.

Burns are a problem of interest in public health since they generate a high rate of morbidity and mortality worldwide, thermal burns are the most prevalent and can alter the anatomical, functional and aesthetic integrity of the skin, fundamental aspects for the patient's self-esteem and their ability to reintegrate into society. At review literature about the treatment of these conditions, we find various treatments, including the use of human amniotic membrane, which has had a significant impact on burn management by functioning as a biological scaffold with regenerative and anti-inflammatory qualities. The present article aims to synthesize the current information that describes the applications of human amniotic membranes in burns. We carry out a systematic exploratory review of the literature from 2010 to 2021.

Preparation and uses of amniotic membrane for ocular surface reconstruction

Background: The use of human amniotic membrane transplantation is rapidly increasing for the management of various ocular surface disorders. Despite its numerous advantages, amniotic membrane is not widely available due to the lack of awareness among ophthalmologists regarding its preparation and preservation techniques. Purpose: To provide an instructional video demonstrating the technique of harvesting, preparation, preservation of human amniotic membrane, and its uses in the management of ocular surface diseases. Synopsis: The amniotic membrane is the innermost layer of the human placenta. Properties of the amniotic membrane, like the presence of various growth factors, anti?inflammatory and anti?angiogenic factors, and its low immunogenicity, contribute to its ability to promote epithelial growth and differentiation with the reduction in fibrosis during healing. To harvest amniotic membrane, informed consent is obtained from a patient undergoing an elective caesarian section, and the donor is screened to exclude the risk of infections. Under sterile precautions, the amniotic membrane is separated from the chorion and washed free of blood clots. With the epithelial surface up, the amniotic membrane is spread uniformly without folds or tears on individually sterilized 0.22 ?m nitrocellulose filter papers of the required sizes. The prepared filter paper with the adherent amniotic membrane is placed in freshly prepared Dulbecco’s Modified Eagle’s Medium and stored at ?80°C. The amniotic membrane can be used for surgical procedures like symblepharon release, pterygium or dermoid excision, perforated ulcers, nonhealing epithelial defects, etc. Highlights: Instructional videos demonstrating the preparation and preservation of amniotic membrane are very sparse. This video clearly explains how any ophthalmologist can learn to prepare and preserve the human amniotic membrane and gives a glimpse of its properties, advantages, and scope of use

Demographic profile and clinical characteristics of patients presenting with acute ocular burns

Purpose: To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. Methods: This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Results: Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work?place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV?VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV?VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). Conclusion: The findings clearly delineate the at?risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data?driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB

Outcome Of LSCT With And Without AMT In Partial LSCD

Purpose – To compare the outcomes of LSCT with and with out AMT in patients of partial LSCD following chemical burns. Method – 32 eyes with unilateral LSCD were randomized into two groups. Group A included 16 eyes who underwent LSCT with AMT while group B included 16 eyes who underwent LSCT alone at a tertiary hospital. Outcome were measured in terms of improvement of visual acuity , corneal clarity, vascularization and symblepharon reduction. Patients were followed up at end of 1st week,1 month and 3rd month,6th month and 1 year. There wasResults – improvement of visual acuity in both groups. Also both group shows reduction in symblepharon score and corneal vascularization. Both group shows improvement in corneal clarity. Both surgical technique are usefulConclusions- treatment modalities in patients with partial LSCD following ocular chemical injury.

Management of recurrent optic disc pit–associated maculopathy with human amniotic membrane graft in a pediatric case

Background: Optic disc pit–associated maculopathy (ODP-M) is a rare presentation in children. Therefore, only a few pediatric cases successfully managed have been reported in the literature. This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT). Purpose: To demonstrate a successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence. Synopsis: A 13-year-old patient who had been previously operated with 25-G pars plana vitrectomy with double internal limiting membrane peel and juxtapapillary endolaser with SF 6 gas tamponade for optic disc pit–associated maculopathy (ODP-M) presented with recurrence 9 months after primary surgery. Three 25-G sclerotomies were made and human amniotic membrane graft was tucked into the ODP; the position of the graft was confirmed with intraoperative ocular coherence tomography. Subretinal fluid rapidly resolved within 48 h and best-corrected visual acuity improved to 0.5 logMAR after one week. Later follow-ups showed no complications or recurrence. Highlights: This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT), without any additional tamponade.

Role of tenon advancement in treating limbal ischemia in acute chemical injury

Background: In acute chemical injury, damage can range from ocular surface epithelial defects to limbal and scleral ischemia. This may subsequently progress to corneal or scleral melting and perforation and finally result in phthisis bulbi. Thus, acute chemical injury is a potentially blinding condition and warrants attention. The accurate technique to assess the damage incurred should be practiced to avoid undertreatment and subsequent complications. Surgical intervention wherever needed should be appropriately timed and should be performed. The primary aim of medical or surgical intervention in acute chemical injury is to attain a stable and epithelized ocular surface. Even a conjunctival phenotype over the cornea is a desirable outcome. Purpose: This video discusses the nuances involved in the assessment and planning of Tenon advancement with amniotic membrane grafting for treating limbal ischemia in acute chemical injury. Synopsis: The video demonstrates the technique of restoration of limbal vascularization by performing Tenon advancement with amniotic membrane grafting and its outcome. Highlights: Ocular surface painting with fluorescein dye is essential to assess the areas of surface involvement. Merely instilling the fluorescein dye in the cul?de?sac will underestimate the extent of the damage. Tenon advancement should ideally be planned between 7 and 10 days following an injury when actual limbal blanching is obvious. A stable and epithelized ocular surface is the desirable outcome irrespective of the epithelial phenotype.

Factores asociados con el éxito de una prueba de trabajo de parto después de cesárea (TOLAC) sin antecedente de parto / Factors associated with the success of a trial of labor after cesarean section (TOLAC) without a history of vaginal delivery

Resumen OBJETIVO: Determinar los factores asociados con una prueba de trabajo de parto después de una cesárea exitosa en mujeres sin antecedente de parto previo. MATERIALES Y MÉTODOS: Estudio observacional de casos y controles, longitudinal, retrospectivo y analítico efectuado en pacientes atendidas entre el 2017 y 2020 en el Hospital Ángeles Lomas, con embarazo único de más de 37 semanas, con una prueba de trabajo de parto, con una cesárea previa y sin parto previo. Se compararon las variables independientes entre el grupo que logró una prueba exitosa de trabajo de parto después de cesárea con las del grupo con prueba fallida. Para el análisis estadístico se utilizó el programa SPSS de IBM, versión 21. Todas las variables categóricas se expresan en frecuencias y porcentajes. RESULTADOS: Se incluyeron 135 pacientes con prueba de trabajo de parto después de cesárea de las que 65 (48.1%) tuvieron parto (prueba exitosa) y 70 (51.8%) cesárea (prueba fallida). Hubo una mayor proporción de trabajo de parto espontáneo en el grupo con prueba exitosa en comparación con el grupo con prueba fallida (66.2% en comparación con 37.1%). No hubo diferencias significativas en cuanto a la conducción del trabajo de parto, integridad de membranas amnióticas al ingreso, horas de trabajo de parto y peso al nacer. CONCLUSIONES: Un índice de masa corporal menor, un trabajo de parto espontáneo y una mayor dilatación al ingreso se asociaron, significativamente, con una prueba exitosa de trabajo de parto después de cesárea. La integridad de las membranas, la duración de la prueba y el peso al nacer no tuvieron diferencias significativas entre los grupos.

Abstract OBJECTIVE: To determine the factors associated with a trial of labor after a successful cesarean section in women with no history of previous delivery. MATERIALS AND METHODS: Observational case-control, longitudinal, retrospective, analytical, retrospective study performed in patient attended between 2017 and 2020 at Hospital Ángeles Lomas, with a singleton pregnancy of more than 37 weeks, with a trial of labor, with a previous cesarean section and no history of previous delivery. The independent variables were compared between the group that achieved a successful trial of labor after cesarean section with those of the group with failed trial. For statistical analysis, the IBM SPSS program, version 21, was used. All categorical variables are expressed in frequencies and percentages. RESULTS: We included 135 patients with trial of labor after cesarean section of whom 65 (48.1%) had labor (successful trial) and 70 (51.8%) had cesarean section (failed trial). There was a higher proportion of spontaneous labor in the successful trial group compared to the failed trial group (66.2% compared to 37.1%). There were no significant differences in labor conduction, amniotic membrane integrity on admission, hours of labor, and birth weight. CONCLUSIONS: Lower body mass index, spontaneous labor, and greater dilation on admission were significantly associated with a successful trial of labor after cesarean section. Membrane integrity, length of trial, and birth weight had no significant differences between groups.

Research progress of amniotic membrane transplantation in the treatment of ophthalmic diseases / 国际眼科杂志(Guoji Yanke Zazhi)

Amniotic membrane is the innermost membrane in human placenta. It supports epithelialization and has the characteristics of anti-fibrosis, anti-inflammation and anti-angiogenesis. It is gradually widely used in ophthalmic surgery and other surgical operations. In recently years, the amniotic membrane has been used more frequently in ophthalmic clinic and has achieved better curative effect. This article reviews the application of amniotic membrane transplantation in ocular diseases such as ocular burn, conjunctival disease, corneal disease, pterygium, glaucoma and macular hole. It is expected that amniotic membrane transplantation will bring new ideas for the treatment of ocular diseases.

Role of amniotic membrane transplantation in treating acute ocular manifestations in Steven–Johnson syndrome and its long-term impact

Background: Steven–Johnson syndrome (SJS) is a serious disorder affecting the skin and mucous membrane, causing multiple flaccid bullae and purpuric rashes with sheet?likeepithelial detachment including the ocular surface. The long?term outcomes following SJS are dismal and manifest as corneal vascularization, lid?wiper keratopathy, and severe dry eyes. The disease course can be modified if amniotic membrane graft is performed at the first week of disease, and the above?said complications can be avoided. This procedure thus not only decreases the morbidity but also improves the quality of life. Purpose: This video discusses the long?term sequelae of SJS which can be modified with timely intervention during the acute stage and thus significantly decreases morbidity. Synopsis: The video demonstrates the simple technique of amniotic membrane transplantation in the acute stage in SJS and its impact in long run. Highlights: There should be a low threshold for doing early amniotic membrane transplantation in patients with SJS with ocular surface involvement. Early intervention can change the disease course and decrease disease morbidity significantly.

Management of descemetocele: Our experience and a simplified treatment algorithm

Purpose: To formulate a treatment algorithm for the management of descemetocele. Methods: This was a prospective interventional study that was conducted at a tertiary eye?care center. All consecutive cases of descemetocele during the study period (April 1, 2017–March 31, 2018) were evaluated for the following parameters: age, sex, previous medical or surgical therapy, risk factors, preexisting ocular diseases, location, site and size of descemetocele, interventions undertaken, visual acuity, and the fellow eye status. The surgical modalities and fellow eye status were correlated individually with therapeutic and functional outcomes, based on which a treatment algorithm was formulated. Results: The study included 24 eyes of 24 patients (19M, 5F) with a median age of presentation of 45 years. The mean follow?up duration was 6.79 ± 3.97 months (3–12 months). The most common cause of descemetocele was microbial keratitis (66.66%), and most cases were central (50%), small (58.33%), and non?perforated (79.16%). The surgical interventions undertaken were cyanoacrylate glue (CG, 37.5%), penetrating keratoplasty (PKP, 33.33%), patch graft (16.66%), and deep anterior lamellar keratoplasty (DALK, 12.5%). Therapeutic success was noted in 13/24 eyes (54.16%). Final visual acuity > 3/60 was seen in 25% cases. Suboptimal therapeutic (P = 0.07) and visual (P = 0.34) outcomes were noted in subjects with non?functional fellow eye. Conclusion: PKP was preferred for descemetoceles with active microbial keratitis and extensive infiltrates, while CG and DALK were undertaken for healed microbial keratitis, neurotrophic keratitis, and ocular surface disorders with partial limbal stem cell deficiency (LSCD). For total LSCD, amniotic membrane graft was preferred.

Fibrin glue assisted amniotic membrane graft reconstruction of conjunctival fornix and canthus following excision of conjunctival tumours

Conjunctival tumors involving non?limbal locations, such as the fornix and canthus, are typically excised using a “non?touch” technique, often with a wide surgical margin. Reconstruction of these large defects can be difficult due to the contour of the ocular surface and are often complicated by shortening of the fornix, symblepharon formation, and restriction of eye movements. In our experience, the use of amniotic membrane grafts combined with the sealant properties of fibrin glue such as Tisseel® has improved our surgical outcomes during the reconstruction phase. We would like to highlight and describe our surgical technique using fibrin glue and squint hooks to aid amniotic membrane graft reconstruction for surgically challenging locations in the fornix and canthus following excision of conjunctival lesions, with excellent surgical outcomes.

Management of recurrent optic disc pit–associated maculopathy with human amniotic membrane graft in a pediatric case

Background: Optic disc pit–associated maculopathy (ODP-M) is a rare presentation in children. Therefore, only a few pediatric cases successfully managed have been reported in the literature. This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT). Purpose: To demonstrate a successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence. Synopsis: A 13-year-old patient who had been previously operated with 25-G pars plana vitrectomy with double internal limiting membrane peel and juxtapapillary endolaser with SF 6 gas tamponade for optic disc pit–associated maculopathy (ODP-M) presented with recurrence 9 months after primary surgery. Three 25-G sclerotomies were made and human amniotic membrane graft was tucked into the ODP; the position of the graft was confirmed with intraoperative ocular coherence tomography. Subretinal fluid rapidly resolved within 48 h and best-corrected visual acuity improved to 0.5 logMAR after one week. Later follow-ups showed no complications or recurrence. Highlights: This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT), without any additional tamponade.

Observation on efficacy of pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation in the treatment of patients with pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy of pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation in the treatment of patients with pterygium. METHODS:Prospective controlled study. A total of 102 patients(102 eyes)with pterygium treated in the hospital between October 2015 and October 2019 were selected as study subjects, and they were divided into observation group and control group according to the random number table method, with 51 cases in each group. The control group was treated with pterygium excision combined with amniotic membrane transplantation, and the observation group was given pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation. The perioperative indicators(intraoperative blood loss, surgical time, corneal epithelial repair time)and clinical efficacy at 3mo after surgery were compared between the two groups, and the disease recovery-related indicators \〖tear film break-up time(BUT), uncorrected visual acuity(UCVA), Schirmer Ⅰ test(SⅠt), corneal astigmatism degree(CAD)\〗 before and 3mo after surgery, postoperative aesthetic degree and recurrence during follow-up were recorded.RESULTS:The corneal epithelial repair time in observation group was shorter than that in control group(4.14±1.35 <i>vs</i> 4.72±1.37d,<i>P</i><0.05), while the surgical time was longer than that in control group(32.24±6.69 <i>vs</i> 29.67±5.21min,<i>P</i><0.05), and there was no statistical significance in the intraoperative blood loss between the two groups(<i>P</i>>0.05). At 3mo after surgery, there was no statistical difference in the effective rate of treatment between the two groups(86.3% <i>vs</i> 78.4%, <i>P</i>>0.05). At 3mo after surgery, the BUT, UCVA and SⅠt in the two groups were significantly enhanced compared with those before surgery(all <i>P</i><0.05), and the UCVA and SⅠt in observation group were higher than those in control group(all <i>P</i><0.05), but there was no statistical difference in the BUT between the two groups(<i>P</i>>0.05). The CAD in the two groups was significantly lower than that before surgery(<i>P</i><0.05), but the difference was not significant between the groups(<i>P</i>>0.05). At 3mo after surgery, the scores of dimensions of aesthetic scale for pterygium treatment(ocular recovery, subjective symptoms)were significantly higher in observation group than those in control group(all <i>P</i><0.05), but there were no statistical differences in the scores of cleanliness of surgical area and congestion between the two groups(all <i>P</i>>0.05). There was no statistically significant difference in recurrence rate between the two groups during follow-up(<i>P</i>>0.05).CONCLUSION: Pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation can effectively treat pterygium and prevent recurrence, and it has faster postoperative recovery and better aesthetic degree compared to pterygium excision combined with amniotic membrane transplantation.

The clinical effect of amniotic membrane patching in the treatment of recurrent macular hole associated with retinal detachment of high myopia / 中华眼底病杂志

Objective:To evaluate the safety and efficacy of amniotic membrane patching in the treatment of recurrent macular hole associated with retinal detachment of high myopia (MHRD).Methods:A prospective study. From March 2018 to January 2020, 11 patients (11 eyes) of recurrent macular hole associated with MHRD at the First Affiliated Hospital of Zhengzhou University were enrolled. Among them, there were 3 males (3 eyes), and 8 females (8 eyes). The average age was 63.64±5.82. The axis length (AL) was 29.10± 0.59 mm, and the logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA) was 2.23±0.57. Patients previously received pars plana vitrectomy (PPV) combined with internal limiting membrane stripping surgery, which was more than 1 time. All eyes underwent standard pars plana three-channel 23G PPV combined with amniotic membrane covering and silicone oil filling. The silicone oil was removed 6 months after surgery. Follow-up time was up to 3 months after silicone oil removal surgery. 1, 3, and 6 months after the operation, the same equipment and methods were used to conduct relevant examinations before the operation to observe the closure of the macular hole, retinal reattachment and changes in logMAR BCVA. The logMAR BCVA before and after surgery was compared by paired t test. Results:At 1, 3, and 6 months after the operation, the retinas of all eyes were anatomically repositioned, the macular holes were well closed, and the amniotic membrane was attached to the retina. At 3 months after the silicone oil removal operation, there was no recurrence of macular hole in all eyes; logMAR BCVA was 1.35±0.32. No serious complications occurred during and after surgery in all eyes.Conclusion:Amniotic membrane patching is a safe and effective method for recurrent macular hole associated with MHRD.

Clinical study of modified free conjunctival flap transplantation with limbal stem cells in the treatment of pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the clinical effect of modified free conjunctival flap transplantation with limbal stem cells in the treatment of pterygium and its impact on tear film function.<p>METHODS: A total of 60 pterygium patients admitted to our hospital from March 2017 to March 2021 were randomly divided into the control group and the observation group, with 30 cases in each group. The control group was treated with amniotic membrane transplantation, and the observation group was treated with modified free conjunctival flap transplantation with limbal stem cells. The treatment period of both groups was 21d. And then the clinical efficacy, operation duration, corneal wound repair time, xerophthalmia score, tear film rupture time value and basic tear secretion test value before and 1, 3mo after treatment, and the occurrence of adverse reactions were compared between the two groups.<p>RESULTS: The total effective rate of clinical treatment in the observation group was higher than that of the control group(χ2=5.963, P=0.015), the operation duration in the observation group was longer than that for the control group(t=-2.643, P<0.05), and the repair time of corneal wound was shorter than that of the control group(t=2.182, P<0.05). At 1 and 3mo after surgery, dry eye score in two groups decreased compared with that before surgery(all P<0.05), and there was a difference between observation group and control group(t=2.082, 3.956; all P<0.05). The time of tear film rupture at 1 and 3mo after surgery was increased compared with that before surgery(all P<0.05), and there was a difference between the observation group and the control group(t=4.245, 2.070; all P<0.05).The experimental value of basal tear secretion at 1 and 3mo after surgery increased compared with that before surgery(all P<0.05), and there was a difference between the observation group and the control group(t=2.076, 2.223; all P<0.05).There was no significant difference in the incidence of complications between the two groups(P=0.572).<p>CONCLUSION: The improved free conjunctival flap transplantation with limbal stem cells can effectively improve the clinical symptoms and tear film function of patients with pterygium, which is beneficial to the recovery of postoperative corneal wound, and can reduce the incidence of adverse reactions.

Treatment Of Bilateral Gingival Recession Using Coronally Advanced Flap And Amniotic Membrane On One Side And Coronally Advanced Flap And PRF Membrane On Other Side: A Case Report

Gingival Recession is a common, complex, and unpleasant clinical condition. It is more commonly associated with root hypersensitivity, impaired esthetics and root caries. Successful treatment outcome becomes challenging in such cases. Coronally advanced flap for rootcoverage is most commonly used technique. Combination of biological membranes derived from human body itself along with coronally advanced flap yields better results. This case report describe s a case of bilateral Class I gingival recession treated with amniotic membrane on one sideand PRF membrane along with Coronally advanced flap on other side.

Uso de membrana amniótica e injerto meek en un niño con quemaduras severas / Use of amniotic membrane and meek graft in a child with severe burns

El desbridamiento temprano seguido de cobertura con piel autóloga ha demostrado reducir la mortalidad en los pacientes quemados. En pacientes con quemaduras extensas, la carencia de zonas de piel donante es un factor limitante a la hora del tratamiento. El hecho de que no se pueda lograr un desbridamiento y cobertura completos en un primer tiempo favorece la infección de la quemadura y la septicemia, pudiendo tener consecuencias nefastas. Por tanto, es necesario disponer de otras opciones distintas a los injertos mallados de piel parcial, el tratamiento estándar hoy día. Presentamos el caso clínico de un niño con quemaduras severas y describimos los resultados obtenidos con el uso de la membrana amniótica como cobertura temporal y al injerto mallado tipo MEEK.

Early debridement followed by coverage with autologous skin has been shown to reduce mortality in burn patients. In patients with extensive burns, the lack of areas of donor skin is a limiting factor at the time of treatment. The fact that a complete debridement and coverage cannot be achieved in the first stage favors the infection of the burn and septicemia, which can have dire consequences. Therefore, it is necessary to have other options than partial skin mesh grafts, the standard treatment today. We present the clinical case of a child with severe burns and describe the results obtained with the use of the amniotic membrane as temporary covering and the MEEK-type mesh graft.

Curative effect of pterygium excision combined with free conjunctival flap transplantation on primary pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the curative effect of pterygium excision combined with free conjunctival flap transplantation on primary pterygium and the influence on tear film function.<p>METHODS:Totally 120 patients(126 eyes)with primary pterygium who were admitted to the hospital between January 2018 and October 2019 were selected as the research subjects. They were divided into two groups according to the random number table method. 62 cases(64 eyes)in the conjunctival transplantation group were treated with pterygium excision combined with free conjunctival flap transplantation. 58 cases(62 eyes)in the amniotic membrane transplantation group were treated with pterygium excision combined with amniotic membrane transplantation. The length of Schirmer's-Ⅰ test(SⅠt), tear film break-up time(BUT), corneal fluorescein staining(FL)scores, noninvasive Keratograph tear breakup time(NIBUT), determine tear river height(TMH)and conjunctival goblet cell count were determined before surgerry, at 3mo and 6mo after surgery. Patients' quality of life was evaluated with ocular surface disease index(OSDI), and the therapeutic effect and recurrence were evaluated at 6mo after surgery.<p>RESULTS: There was no significant difference in the average repair time of corneal epithelium or the duration of symptoms between the conjunctival transplantation group and the amniotic membrane transplantation group(<i>P</i>>0.05). At 6mo after surgery, the BUT \〖(11.11±2.77)s <i>vs</i>(10.01±2.41)s\〗, NIBUT \〖(10.01±1.52)s <i>vs </i>(9.52±0.98)s\〗 in conjunctival transplantation group was longer than that in the amniotic membrane transplantation group(<i>P</i><0.05), and the FL score was lower than the amniotic membrane transplantation group \〖(0.44±0.10)points <i>vs</i>(0.50±0.11)points\〗(<i>P</i><0.05). The conjunctival goblet cell counts in both groups were increased significantly after surgery(<i>P</i><0.05). At 3mo and 6mo after surgery, the counts in conjunctival transplantation group were larger than those in the amniotic membrane transplantation group \〖(311.41±58.45)/mm² <i>vs</i>(285.46±68.96)/mm²,(342.41±66.89)/mm² <i>vs</i>(314.41±70.12)/mm²\〗(<i>P</i><0.05). The OSDI scores of both groups were significantly decreased after surgery(<i>P</i><0.05), but there was no significant difference between groups(<i>P</i>>0.05). There was no statistically significant difference in the overall curative effect between the two groups(<i>P</i>>0.05). The recurrence rates in the conjunctival transplantation group and the amniotic membrane transplantation group were 6.3% and 6.5%, respectively(<i>P</i>>0.05).<p>CONCLUSION: Pterygium resection combined with autologous conjunctival flap transplantation is equivalent to amniotic membrane transplantation in terms of postoperative recovery and prevention of pterygium recurrence. Both can improve the stability of patients' tear film function.