Amniotic membrane transplantation over tectonic epikeratoplasty in the management of corneal ulcers: advantages and limitations

Department of Ophthalmology and Optometry, Laboratory of Tissue Engineering and Cells Cultures Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. The human amniotic membrane (AM), which has a wide range of useful effects (activation of epithelization, suppression of inflammation and scarring, inhibition of angiogenesis), is successfully used to treat eye burns, corneal ulcers, bullous keratopathy, persistent corneal erosion, Stevens-Jones syndrome, pemphigoid, recurrent pterygium, symblepharon, etc. Low immunogenicity and the possibility of preserving the membrane further expanded its clinical use. AM can be used as a surgical transplant, in which the membrane is integrated into the host tissue, as well as a biological dressing, in which the membrane temporarily lays on the surface of the eyeball. In this paper we aim to evaluate AM’s efficiency in the management of corneal ulcers when compared to a well established treatment method, such as the tectonic keratoplasty. Aim of the study. To compare the results of tectonic epikeratoplasty (TEK) and amniotic membrane transplantation (AMT) in patients with corneal ulcers and to assess the advantages and limitations of AMT in the management of ocular surface impairments. Materials and methods. 210 patients with progression of corneal ulcers or perforated ulcers were treated during the period of 2015-2019: 96 patients were operated with TEK and 114 patients - with AMT. In TEK, a complete cornea with adjacent scleral rim was fixed upon the recipient eye by scleral sutures. In AMT, a multilayered amniotic membrane fragment was attached to the corneal surface by conjunctival sutures - patch technique - which means that the AM was used as a temporary dressing. The AM was prepared from fresh placentas of seronegative donors and stored at -80 ° C. Results. The integrity of the corneal surface was restored in 75% (n = 72) cases in the TEK group and in 59,6% (n = 68) cases in the AMT group. Corneal vascularization after graft removal was increased in 69,8% (n = 67) of patients with TEK and 40,35% (n = 46) of patients with AMT. In the TEK group, the procedures were repeated in 19,8% (n = 19) of patients, and 6,25% (n = 6) of them had penetrating keratoplasty eventually, as opposed to 33,3% (n = 38) and 5,26% (n = 6) respectively in the AMT group. Conclusions. Although the AM could be used as a first step measure to maintain ocular integrity, in many cases further surgery is needed for ocular surface reconstruction, as the AMT isn’t effective enough if severe stromal thinning and impending corneal perforation are involved. Nevertheless, while TEK is more effective in restoring corneal integrity, AMT has a number of advantages: less complexity and duration of surgery, low antigenicity of the graft and availability of transplanted material. Both methods can be used as intermediate measures before further ocular surface reconstructive procedures can be performed

Impact of differently processed amniotic membrane grafts on the outcome of corneal ulcers in rabbit models

Introduction. Thanks to its regenerative properties, the human amniotic membrane (AM) is extensively used in ophthalmology to treat a wide range of eye surface conditions. Despite the vast amount of studies justifying its ophthalmic use, there is lacking scientific data on the effectiveness of differently processed AM in the treatment of corneal ulcers. In this paper, we aim to compare the effectiveness of cryopreserved, lyophilized and decellularized amniotic membrane transplantation (AMT) in the management of corneal ulcers in a rabbit model. Material and methods. Corneal ulcers were surgically induced in the left eyes of 28 rabbits. Four groups, each containing 7 specimens, were formed: group A (control) – rabbits treated conservatively, with no AMT; group B – rabbits operated with cryopreserved AM; group C – rabbits operated with decellularized AM; and group D – rabbits operated with lyophilized AM. The rabbits were clinically observed for a 3-month period, with the assessment of objective signs, the evolution of the corneal lesion and/or complications. After the follow-up period, the rabbits were euthanized; the left corneas were excised, fixed in 10% formaldehyde and then embedded in paraffin, cut into thin sections, stained with hematoxylin-eosin, and studied by light microscopy. Results. The cornea regenerated the slowest in the control group (28 days), the fastest in group B (15 days), followed by group D (18 days) and then group C (21 days). The highest rate of infectious complications was found in rabbits from group A (57%, n=4), and the lowest – in the group operated with cryopreserved AM (14%, n=1). Corneal neovascularization and opacification were most intense in the control group. In the groups operated with AM, corneal transparency was relatively uniformly recovered, with a slightly poorer outcome in the group C. In conservatively treated corneas (A), histological examination revealed a thickened and deformed epithelium, patchy connective tissue and epithelial cell depletion; in corneas treated with cryopreserved AM (B), fibroblast proliferation and solitary lymphocytic infiltrate below Bowman's membrane were revealed; in corneas treated with decellularized (C) and lyophilized (D) AM, polymorphic and atrophied epitheliocytes were found. Conclusion. While there were significant differences between the control group and the eyes treated with AMT, the clinical signs did not differ significantly between groups operated with cryopreserved, decellularized and lyophilized AM. Still, the cryopreserved AM showed the best results in terms of post-operative complications, regenerative capacities and restoration of corneal transparency

Amniotic membrane transplantation in the management of cornal ulcers refractory to conventional treatment

Catedra de Oftalmologie și Optometrie, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Laboratorul de Inginerie Tisulară și Culturi CelulareSummary. Assess the efficacy of amniotic membrane transplantation (AMT) to patients with refractory corneal ulcer and evaluate the benefits and limitations of AMT in the management of ocular surface pathology. A retrospective study was performed, which included 37 patients (37 eyes) diagnosed with corneal ulcer of various etiologies, refractory to conventional drug treatment. Satisfactory results were found in the vast majority of operated eyes. The amniotic membrane can be considered a successful alternative for the reconstruction of the ocular surface. Success rates of TMA differ depending on the etiology of the ulcer, with major efficacy in bacterial and herpetic ulcers on the one hand, and limited benefits in severe chemical burns and autoimmune pathologies on the other.Introducere. Corneea este o structură extrem de sensibilă și dinamică, a cărei integritate este crucială pentru funcționarea optimă a ochiului. Orice leziune mecanică sau chimică asupra acesteia, atât prin mecanisme exogene (substanțe chimice, acțiune mecanică, agenți patogeni infecțioși etc.), cât și endogene – cum ar fi modificarea compoziției filmului lacrimal în cazurile severe de sindrom de ochi uscat – poate duce la dereglarea integrității anatomice, fiziologice și funcționale a ochiului ca organ. Managementul patologiei suprafeței oculare a evoluat mult pe parcursul anilor, cu modificări radicale ale tehnicilor și rezultatelor. La momentul actual, datorită dezvoltării tehnicilor de aplicare a membranei amniotice (MA) umane pe suprafața oculară, precum și a metodelor de păstrare și procesare ale acesteia, membrana amniotică se dovedește a fi un instrument versatil în mâinile oftalmologilor, iar indicațiile de utilizare ale ei se extind pe măsură ce proprietățile acesteia sunt studiate și elucidate. În acest studiu prezentăm un sumar al experienței noastre în ceea ce privește utilizarea membranei amniotice ca metodă de tratament al ulcerelor corneene refractare la tratamentul convențional. Scopul studiului a constat în aprecierea eficienței transplantului de membrană amniotică (TMA) la pacienții cu ulcer corneean refractar și evaluarea avantajelor și limitărilor TMA în managementul patologiei de suprafață oculară. Materiale și metode. S-a efectuat un studiu retrospectiv, în care au fost incluși 37 de pacienți (37 de ochi) cu diagnosticul de ulcer cornean de diversă etiologie, refractar la tratamentul medicamentos convențional. Pacienții au fost supuși TMA în perioada ianuarie 2019 – octombrie 2020, în incinta Spitalului Clinic Municipal „Sfânta Treime”, or. Chișinău. MA a fost obținută în condiții aseptice din placentele proaspete ale parturientelor seronegative și păstrată prin crioconservare la temperatura de -80°C. După ce materialul necrotic și cicatricial a fost excizat de pe țesutul lezat, MA a fost aplicată pe suprafața corneană cu fața epitelială orientată în jos, fiind ulterior suturată la conjunctiva pericheratică cu fir continuu de Nylon. După intervenție, pacienții au fost examinați zilnic în primele 7 zile, apoi la 14 zile după externare și ulterior lunar. Durata de urmărire postoperatorie a pacienților a variat de la 1 la 12 luni. Rezultate. Din cei 37 de pacienți, 21 (56,7%) au fost bărbați și 16 (43,3%) femei. Vârsta medie a fost de 51,7±12,4 ani (interval: 23 - 72 ani). Durata medie de descompunere a MA pe suprafața oculară a fost de aproximativ 14 zile (interval: 8 - 22 zile). Rezultate satisfăcătoare au fost constatate la marea majoritate din ochii operați. Integritatea structurală a corneei și a conjunctivei a fost îmbunătățită la 30 (81%) de ochi, cu beneficii limitate doar în cazurile de arsuri oculare vechi și la pacienții cu patologie autoimună. Din 37 de ochi, 30 (72,9%) au avut și o îmbunătățire a acuității vizuale. Îmbunătățirea a fost importantă la pacienții cu defecte epiteliale persistente și ulcere traumatice superficiale, dar și pacienții cu arsuri alcaline recente și ulcere micotice au avut o ameliorare postoperatorie de 1-2 linii pe scala Snellen. Cu toate că marea majoritate a pacienților a prezentat date obiective oftalmolscopice îmbunătățite ale suprafeței corneene, doar 29 (78%) au raportat ameliorare subiectivă. Din totalul de ochi operați, în 5 cazuri a fost nevoie de transplant de membrană amniotică repetat pentru a restabili integritatea suprafeței oculare, iar la 2 pacienți cu defecte stromale profunde s-a efectuat epikeratoplastie tectonică (EKT) de urgență pentru a preveni perforarea corneană. Discuții. Membrana amniotică poate fi considerată o alternativă de succes pentru reconstrucția suprafeței oculare. Totuși, TMA nu este întotdeauna suficient pentru a preveni sau înlocui transplantul tectonic de cornee, mai ales dacă sunt prezente subțierea stromală severă și riscul de perforare a corneei. În timp ce EKT este mai eficientă în restabilirea integrității corneene în unele scenarii clinice, TMA prezintă o serie de avantaje, precum: complexitatea și durata mai scurtă a operației, antigenitatea scăzută a grefei și disponibilitatea materialului transplantat. În cele din urmă, ambele metode pot fi utilizate ca măsuri intermediare înaintea efectuării altor proceduri de reconstrucție oculară. Concluzii. TMA este o opțiune de tratament valoroasă pentru reconstrucția suprafeței oculare, în mod special, în tratamentul ulcerelor corneene refractare la tratamentul convențional. Ratele de succes ale TMA diferă în funcție de etiologia ulcerului, cu eficiență majoră în ulcerele bacteriene și herpetice pe de o parte, și beneficii limitate în arsurile chimice severe și patologii autoimune pe de alta

The use of amniotic membrane in the treatment of corneal ulcers and ocular surface defects

Department of Ophthalmology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: The human amniotic membrane (HAM) has been proved to possess a vast variety of beneficial effects (stimulation of epithelialization, antiangiogenic, antibacterial and antiinflamatory effects), which can be very useful in many ophthalmological indications, such as corneal trophic ulcers resistant to medication and some cases of ocular surface destruction.This paper is an attempt to introduce the HAM transplantation indications in ophtalmology, to present the methods an techniques of HAM aplication on the human eye, to describe our experience with the amniotic membrane and to analyse the transplantation outcomes in patients with corneal ulcers of diverse etiology. Materials and methods: A total of 19 patients were included in the study. All of them underwent HAM transplantation at the MCH „St. Trinity”. The patients presented corneal ulcers of various complexity and etiology and were distributed in 3 main categories: group A (n=14), which included patients with corneal erosions in dry eye syndrome (n=5), viral keratitis (n=6), persistent epithelial defects after corneal abscess (n=2) and chemical burns (n=1); group B (n=4), which included patients with severe stromal thinning and iminent corneal perforation; group C (n=1), with one case of symblepharon and extensive corneo-conjunctival adhesions. The HAM was prepared from a fresh placenta of a seronegative pregnant woman and stored at -80°C. The amniotic membrane was applied on the ocular surface using the „patch” technique. Results: The cornea regeneratedsatisfactory in 11 patientsout of 14 in group A, but the epithelial defect recurred in 3 of them. In the second group the transplantation was less effective - 2 patientsout of 4 needed further tectonic corneal graft and1 penetrant keratoplasty was performed. The HAM transplantation showed good results in symblepharon surgery, facilitating epithelialization and preventing corneo-conjunctival adhesions in the group C. Conclusions: The HAM transplantation showed good results in facilitating corneal healing and regeneration in patients with persistent epithelial defects, as well as preventing corneo-conjunctival adhesions followingsymblepharon surgery. Nevertheless, in some cases,further surgerywas needed for ocular surface reconstruction, as the HAM transplantation wasn’t effective enough to prevent the tectonic corneal graft if severe stromal thinning and impending corneal perforation were involved

Efficiency of amniotic membrane transplantation in the management of limbal stem cell deficiency

State University of Medicine and Pharmacy “Nicolae Testemiţanu”, Department of Ophthalmology-Optometry, Chișinău, Republic of Moldova, State University of Medicine and Pharmacy “Nicolae Testemiţanu”, Department of Surgery no. 2, Chișinău, Republic of Moldova, State University of Medicine and Pharmacy “Nicolae Testemiţanu”, Department of Medical Rehabilitation, Physical Medicine and Manual Therapy, Chișinău, Republic of Moldova, Laboratory of Tissue Engineering and Cell Cultures, Chișinău, Republic of Moldova, Congresul consacrat aniversării a 75-a de la fondarea USMF ”Nicolae Testemițanu” 21-23 octombrie 2020Abstract. Objectives. This paper aims to examine the efficacy, safety, and long term outcomes of amniotic membrane transplantation for corneal surface reconstruction, in cases of limbal stem cell deficiency. Material and methods. A systematic literature search was performed on PubMed, for papers published up to February 2020, using the following combined search terms: "limbal stem cell deficiency", "amniotic membrane", "limbal transplant". Only clinical trials with human subjects were selected for analysis. We collected the data on amniotic membrane properties and mechanisms of action, processing, preservation and transplantation techniques, and clinical outcomes of different treatment methods. Results. The surgical approach for treating limbal stem cell deficiency depends on the extent of the disease. Isolated amniotic membrane transplantation appears to have a limited beneficial effect on limbal stem cells, whereas amniotic membrane transplantation, combined with certain types of limbal stem cell transplantation, provides long-term biological and mechanical support for the donor tissue explants. Combined with simple limbal epithelial transplantation, the amniotic membrane has shown excellent results in the surgical management of limbal stem cell deficiency. Conclusions. Preliminary results of amniotic membrane use in limbal transplantation show quite satisfactory data, but the lack of high-level randomized controlled studies makes it difficult to assess the comparative efficacy of amniotic membrane transplantation in limbal stem cell deficiency surgical management

Amniotic membrane transplantation: new indications in the treatment of ophthalmic diseases

Catedra de Oftalmologie și Optometrie, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”Summary. Amniotic membrane transplantation is currently being used for a continuously widening spectrum of ophthalmic indications thanks to the amniotic membrane’s unique combination of properties, including the facilitation of epithelial cells migration, the reinforcement of basal cellular adhesion, and the stimulation of epithelial differentiation. This review explores the everexpanding ophthalmological indications for the use of human amniotic membranes.Actualitatea temei. Transplantul de membrană amniotică (TMA) are o tradiție îndelungată în chirurgia oftalmologică și a devenit foarte popular recent, datorită metodelor nou dezvoltate de conservare a țesuturilor. S-a demonstrat că membrana amniotică (MA) are proprietăți antiinflamatorii, antifibrotice, anti-angiogenice și regenerative. TMA este utilizat cu succes nu doar în restabilirea integrității corneene, dar și în reconstrucția defectelor conjunctivale după îndepărtarea pterigionului, leziunilor conjunctivale și simblefaronului. Scopul studiului. Revizuirea celor mai recente indicații oftalmologice pentru TMA și prezentarea noilor abordări de tratament al patologiei de suprafață oculară, utilizând MA. Materiale și metode. În acest studiu am trecut în revistă literatura de specialitate în vederea analizării datelor actuale despre aplicațiile MA în managementul chirurgical al patologiei de suprafață oculară și am rezumat rezultatele diferitor abordări chirurgicale. A fost efectuată o căutare sistematică a literaturii pe PubMed pentru lucrări publicate între anii 2009 și 2021, folosind următorii termeni de căutare: „membrană amniotică”, „transplant”, „cornee” și/sau „conjunctivă”. Au fost colectate înformațiile referitoare la mecanismele de acțiune și proprietățile MA, noile indicații clinice ale TMA, precum și considerații relevante pentru terapiile de viitor. Rezultate și discuții. MA este un material valoros, care poate fi utilizat atât proaspăt, cât și crioconservat, în reconstructia suprafeței oculare, având o structură histologică similară cu cea a conjunctivei și o compozitie chimică asemănătoare cu cea a filmului lacrimal și a umorii apoase. Repetabilitatea, lipsa intervenției intraoculare și procedura relativ ușoară fac din TMA o opțiune chirurgicală atractivă. Acesta s-a dovedit a fi o alternativă bună în multe situații clinice pentru reconstrucția corneei și conjunctivei, inclusiv arsuri acute, defecte epiteliale persistente ale corneei și afecțiuni care provoacă cicatrici conjunctivale. Noile strategii de tratament, precum extinderea de celule epiteliale limbale in vitro, utilizând MA ca purtător sau substrat, creează noi abordări promițătoare de tratament al afecțiunilor oculare. Aplicațiile fără sutură, cu utilizarea adezivelor de fibrină, au demonstrat atât eficiența procedurii, cât și confortul pacientului. Concluzii. TMA se dovedește a fi un instrument foarte versatil în mâinile oftalmologului, iar indicațiile pentru utilizarea acestui material se extind rapid pe măsură ce există o mai bună înțelegere a proprietăților sale. Cu toate acestea, este importantă o utilizare judicioasă și o selecție adecvată a pacientului pentru obținerea rezultatelor optime

The impact of culture media on the endothelial viability of corneas

Background: The complexity of cryopreservation and its potential to damage the endothelium make it so that it is rarely used in routine eye banking, except for occasional, clinically urgent transplants, where the main objective is to save the eye. The culture medium was the method of choice in the Eye Bank. Material and methods: The study group was divided into 3 subgroups. For penetrating keratoplasty and anterior lamellar keratoplasty, corneas taken up to 24 hours, with a number greater than 2000 endothelial cells per mm2, are preferably used. Results: In the first group we found: weakly edematous epithelium; thin, transparent stroma; thin Descemet’s membrane; transparent endothelial layer, endothelial cell density greater than 2800 cells/mm2. The corneas of the second group presented: edematous, but with uncompromised integrity epithelium; slightly edematous, transparent stroma; slightly folded Descemet’s membrane; intact endothelial layer and an average of 2600 cells/mm2. Corneas of the third group: evidently edematous epithelium, with exfoliations in some areas and Bowman’s membrane detachment; considerable edema of stroma in all layers; pronounced folds of Descemet’s membrane; interrupted endothelial layer along the outline of the folds. Conclusions: The age of the donor and the preservation time are important factors that influence corneas in culture media and determine the state of endothelial cells. Although the number of endothelial cells usually decreases with age, there are still many corneas from donors over 80 years of age who meet the minimum criteria for transplantation

Amniotic membrane transplantation in ophthalmology: indications and techniques

Introduction: The human amniotic membrane (HAM) has been proved to possess a multitude of beneficial effects - stimulation of epithelialization, antiangiogenic, antibacterial and antiinflamatory effects, which can be very useful in many ophthalmological indications, such as corneal trophic ulcers resistant to medication and some cases of ocular surface destruction. Besides evaluating the efficiency of the HAM transplantation in this paper, we tried to describe our experience with amniotic membrane in the treatment of ocular surface abnormalities. Purpose and objectives: To introduce the HAM transplantation indications in ophtalmology, to present the methods an techniques of HAM aplication on the human eye, to describe our experience with the amniotic membrane and to analyse the transplantation outcomes in patients with corneal ulcers of diverse etiology. Materials and methods:19 patients were included in the study. All of them underwent HAM transplantation from December 2014 to March 2015, at the MCH „St. Trinity”. The patients presented corneal ulcers of diverse complexity and etiology and were distributed in 3 main categories: group A (n=14), which included patients with corneal erosions in dry eye syndrome (n=5), viral keratitis (n=6), persistent epithelial defects after corneal abscess (n=2) and chemical burns (n=1); group B (n=4), which included patients with severe stromal thinning and iminent corneal perforation; group C (n=1), with one case of symblepharon and extensive corneoconjunctival adhesions. The HAM was prepared from a fresh placenta of a seronegative pregnant woman and stored at -80°C. In all cases the amniotic membrane was applied on the ocular surface using the „patch” technique only. Results: The cornea regenerated satisfactory in 11 patients out of 14 in group A, but the epithelial defect recurred in 3 of these cases. In the second group the transplantation was less effective - 2 patients out of 4 needed further tectonic corneal graft and 1 penetrant keratoplasty was performed. The HAM transplantation showed good results in symblepharon surgery, facilitating epithelialization and preventing corneo-conjunctival adhesions in the group C. Conclusions: The HAM transplantation proved efficient in facilitating corneal healing and regeneration in patients with persistent epithelial defects, as well as preventing corneo-conjunctival adhesions following symblepharon surgery. Nevertheless, in some cases, further surgery was needed for ocular surface reconstruction. The HAM transplantation wasn’t effective enough to prevent the tectonic corneal graft if severe stromal thinning and impending corneal perforation were involved

Could human amniotic membrane be a source for acupoint thread embedding therapy?

Background: Peripheral neuropathy usually leads to a major cause of motor disability, but the functional restoration after treatment continues to show modest results. Acupoint thread-embedding therapy is a subtype of acupuncture treatment in which biodegradable threads are inserted into skin, subcutaneous tissue or muscles at specific points for long stimulation. Different biodegradable materials have been developed and widely used. Human amniotic membrane is rich in collagen, extracellular matrix proteins and growth factors. The avascular, low immunogenic, anti-inflammatory, antibacterial, anti-fibrotic and non-tumorigenic properties of amniotic membrane make it valuable in medical applications and its use has no ethical problems. Elasticity, stiffness and other biomechanical properties also make it possible to use the amniotic membrane for various medical purposes. AM is almost always considered as discarded substance, it satisfies most of the criteria of an ideal biological tissue and shows almost zero rejection phenomenon. Conclusions: The human amniotic membrane, the cellular compounds and extracellular matrix have a lot of benefic proprieties that are or could be used in treatment of many human diseases. Its biological and biomechanical properties are promising in the manufacture and use of filaments in acupoint thread embedding therapy

Membrana amniotică: sursă de tratament al defectelor cutanate la pacienții diabetic

Background. The amniotic membrane has a number of unique properties: anti-inflammatory, bacteriostatic, a capacity for maximum reepithelialization of the affected tissue; so being an attractive method of grafting tissue defects, especially at diabetic patients. Objective of the study. To evaluate the efficacy of scar healing in diabetic patients by amniotic membrane treatment. Material and Methods. It was initiated a study on 10 diabetic patients with chronic ulcers, lasting more than 1 month. Patients were divided into two groups: the first group (control group) included 5 patients whose tissue defects were treated with a split free skin graft. The other group of 5 patients with tissue defects was treated with amniotic membrane, which was obtained and prepared initially and then applied. Results. In the control group at 2 patients, the tissue defect was completely healed, and at 3 patients the free skin graft was rejected. In the other group where was used the amniotic membrane, was obtained a complete healing with a duration of 14-60 days. Conclusion. Amniotic membrane can be a perfect source of treatment for defects at patients with diabetes, replacing conventional treatment. Introducere. Membrana amniotică, având o serie de proprietăți unice: antiinflamatorie, bacteriostatică, o capacitate de reepitelizare maximă a țesutului afectat, este o metodă atractivă de grefare a defectelor de țesut, îndeosebi la pacienții diabetici. Scopul lucrării. Evaluarea eficacității de cicatrizare a defectului la pacienții diabetici prin tratamentul cu membrană amniotică. Material și Metode. A fost inițiat un studiu pe 10 pacienți diabetici cu ulcere cronice, cu o durată mai mare de 1 lună. Pacienții au fost împărțiți în două grupuri: primul grup (grup control) a inclus 5 pacienți ale căror defecte de țesut au fost tratate cu grefă de piele liberă despicată. Celălalt grup de 5 pacienți cu defecte de țesut, a fost tratat cu membrana amniotică, obținută și preparată inițial. Rezultate. În grupul control, la 2 pacienți defectul de țesut a fost cicatrizat totalmente, iar la 3 pacienți grefa de piele liberă a fost respinsă. În celălalt grup unde am utilizat membrana amniotică, s-a obținut o cicatrizare completă cu o durată de 14-60 de zile. Concluzii. Membrana amniotică poate fi o sursă perfectă de tratament al defectelor la pacienții diabetici, înlocuind tratamentul convențional