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
