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In vivo analysis of stromal integration of multilayer amniotic membrane transplantation in corneal ulcers.
Am J Ophthalmol 2011; 151(5):809-822.e1AJ

Abstract

PURPOSE

To evaluate integration of amniotic membrane into the corneal stroma using laser scanning in vivo confocal microscopy and anterior segment optical coherence tomography (AS-OCT).

DESIGN

Prospective noncomparative interventional case series.

METHODS

Twenty-two eyes of 22 consecutive patients (mean age 53.9 ± 9.2 years) presenting with noninfectious corneal ulcers and stromal thinning unresponsive to medical treatment were enrolled. Multiple layers of amniotic membrane were applied over the ulcer bed to fill the ulcer crater and held in place with an overlying amniotic membrane patch, which was anchored to the surrounding cornea with 10-0 nylon interrupted sutures. Outcome measures were healing of the corneal ulcers, corneal morphology and stromal thickness changes at the ulcer site as measured by AS-OCT and surface epithelialization, stromal repopulation, and structural modifications of the amniotic membrane grafts as evaluated by confocal microscopy.

RESULTS

Follow-up extended to 12 months. Successful result was observed in 20 of 22 eyes (90.9%). AS-OCT showed that the mean residual stromal thickness at the ulcer bed was 222 ± 70 μm before surgery. The mean thickness of amniotic membrane layers at the same site was 394 ± 80 μm while the mean total corneal thickness was 623 ± 51 μm at day 1 post surgery. Thereafter a progressive reduction in thickness to 420 ± 61 μm at 6 months occurred, after which the thickness stabilized. Confocal microscopy showed that integration of the amniotic membrane tissues with corneal stroma was preceded by epithelialization over the amniotic membrane covering the ulcer. This occurred 15 ± 5 days post surgery in the successful cases. Confocal microscopy also showed that the amniotic membrane patch was degraded during the first few weeks after surgery, while the integrated amniotic tissues underwent progressive modifications characterized by early loss of amniotic epithelial cells, changes in fibrillar structure, and migration into the amniotic stroma by corneal stroma-derived cells.

CONCLUSIONS

Multiple layers of amniotic membrane can integrate into the corneal stroma with resulting increase in corneal thickness. This appears to be related to re-epithelialization of the transplanted membrane. Integrated amnion within the stromal defect undergoes progressive changes including contraction of tissue and repopulation by corneal stroma-derived cells.

Authors+Show Affiliations

Department of Medicine and Ageing Science, Ophthalmic Clinic, University G. d'Annunzio of Chieti-Pescara, Italy. m.nubile@unich.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21310388

Citation

Nubile, Mario, et al. "In Vivo Analysis of Stromal Integration of Multilayer Amniotic Membrane Transplantation in Corneal Ulcers." American Journal of Ophthalmology, vol. 151, no. 5, 2011, pp. 809-822.e1.
Nubile M, Dua HS, Lanzini M, et al. In vivo analysis of stromal integration of multilayer amniotic membrane transplantation in corneal ulcers. Am J Ophthalmol. 2011;151(5):809-822.e1.
Nubile, M., Dua, H. S., Lanzini, M., Ciancaglini, M., Calienno, R., Said, D. G., ... Carpineto, P. (2011). In vivo analysis of stromal integration of multilayer amniotic membrane transplantation in corneal ulcers. American Journal of Ophthalmology, 151(5), pp. 809-822.e1. doi:10.1016/j.ajo.2010.11.002.
Nubile M, et al. In Vivo Analysis of Stromal Integration of Multilayer Amniotic Membrane Transplantation in Corneal Ulcers. Am J Ophthalmol. 2011;151(5):809-822.e1. PubMed PMID: 21310388.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In vivo analysis of stromal integration of multilayer amniotic membrane transplantation in corneal ulcers. AU - Nubile,Mario, AU - Dua,Harminder S, AU - Lanzini,Manuela, AU - Ciancaglini,Marco, AU - Calienno,Roberta, AU - Said,Dalia G, AU - Pocobelli,Augusto, AU - Mastropasqua,Rodolfo, AU - Carpineto,Paolo, Y1 - 2011/02/18/ PY - 2010/10/01/received PY - 2010/11/05/revised PY - 2010/11/05/accepted PY - 2011/2/12/entrez PY - 2011/2/12/pubmed PY - 2011/6/16/medline SP - 809 EP - 822.e1 JF - American journal of ophthalmology JO - Am. J. Ophthalmol. VL - 151 IS - 5 N2 - PURPOSE: To evaluate integration of amniotic membrane into the corneal stroma using laser scanning in vivo confocal microscopy and anterior segment optical coherence tomography (AS-OCT). DESIGN: Prospective noncomparative interventional case series. METHODS: Twenty-two eyes of 22 consecutive patients (mean age 53.9 ± 9.2 years) presenting with noninfectious corneal ulcers and stromal thinning unresponsive to medical treatment were enrolled. Multiple layers of amniotic membrane were applied over the ulcer bed to fill the ulcer crater and held in place with an overlying amniotic membrane patch, which was anchored to the surrounding cornea with 10-0 nylon interrupted sutures. Outcome measures were healing of the corneal ulcers, corneal morphology and stromal thickness changes at the ulcer site as measured by AS-OCT and surface epithelialization, stromal repopulation, and structural modifications of the amniotic membrane grafts as evaluated by confocal microscopy. RESULTS: Follow-up extended to 12 months. Successful result was observed in 20 of 22 eyes (90.9%). AS-OCT showed that the mean residual stromal thickness at the ulcer bed was 222 ± 70 μm before surgery. The mean thickness of amniotic membrane layers at the same site was 394 ± 80 μm while the mean total corneal thickness was 623 ± 51 μm at day 1 post surgery. Thereafter a progressive reduction in thickness to 420 ± 61 μm at 6 months occurred, after which the thickness stabilized. Confocal microscopy showed that integration of the amniotic membrane tissues with corneal stroma was preceded by epithelialization over the amniotic membrane covering the ulcer. This occurred 15 ± 5 days post surgery in the successful cases. Confocal microscopy also showed that the amniotic membrane patch was degraded during the first few weeks after surgery, while the integrated amniotic tissues underwent progressive modifications characterized by early loss of amniotic epithelial cells, changes in fibrillar structure, and migration into the amniotic stroma by corneal stroma-derived cells. CONCLUSIONS: Multiple layers of amniotic membrane can integrate into the corneal stroma with resulting increase in corneal thickness. This appears to be related to re-epithelialization of the transplanted membrane. Integrated amnion within the stromal defect undergoes progressive changes including contraction of tissue and repopulation by corneal stroma-derived cells. SN - 1879-1891 UR - https://www.unboundmedicine.com/medline/citation/21310388/In_vivo_analysis_of_stromal_integration_of_multilayer_amniotic_membrane_transplantation_in_corneal_ulcers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9394(10)00876-7 DB - PRIME DP - Unbound Medicine ER -