engleski

Amniotic membrane transplantation - which side up?

Purpose: Amniotic membrane shows efficiency in treatment of corneal epithelial defects, bullous keratopathy and other ocular surface diseases. Most of the cytokines (BFF, TGF-β ) that are secreted from the amniotic membrane are located in the epithelium. Till now, common way for the amniotic membrane transplantation was with the epithelial side "UP". In this study we compared first results of the amniotic membrane transplantation with the epithelial side "DOWN" with results from the classical approach. Methods: Patients with the persistent epithelial defect PED (n=34), corneal ulcer CU (n=19), bullous keratopathy BK (n=40), acute corneal combustion ACC (n=3), post-keratitic HS (n=2) were randomly divided in two groups. In first group of patients amniotic membrane was transplanted with the epithelial side "UP" (PED=17, CU=10, BK=20, ACC=1). In second group amniotic membrane was transplanted with the epithelial side "DOWN" (PED=17, CU=9, BK=20, ACC=2, HS =2). Transplantation was repeated in the "UP" group in 9/48 eyes and in the "DOWN" group in 8/50 eyes. Amniotic membranes were prepared in Lions Croatian Eye Bank and stored at -20 oC. Results: Outcome success criteria included re-epitelisation, reduction of pain, healing of punctiform lesions and reduction of inflammation. Re-epitelisation was achieved in 82% (14/17) of patients from the "UP" group and 94% (16/17) from the "DOWN" group. 70% (7/10) of corneal ulcers healed in the "UP" group while 55% (5/9) healed in the "DOWN" group. In patients with bullous keratopathy reduction of pain was achieved in 90% (18/20) "UP" and 90% (18/20) "DOWN" " so pain reduction didn't depend on the transplant orientation. In patients with ACC complete healing without symblepharon formation was achieved. Decrease of vascularisation and stromal haze was achieved in HS. Conclusion: We achieved better results with epithelium "DOWN" in case of PED while better results with the epithelium "UP" were achieved in CU. The difference was not statistically significant thou. The orientation of the amniotic membrane didn't effect pain reduction in patients with BK.

amniotic membrane; transplantation; upper side

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