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Bulgarian Review of Ophthalmology

Amniotic membrane transplantation algorithms - outcomes within a period of 7 years

Y. Manolova, H. Grupcheva


The amniotic membrane transplantation (AMT) has become one of the most commonly performed operative procedures in severe, refractory diseases of the anterior ocular segment in recent years. Knowledge of surgical techniques is extremely essential in order to achieve good postoperative results.

Aim: The aim of the present study is to present an overview of amniotic membrane transplantations in the period from 2001 to 2016 and to develop algorithms for surgical treatment in order to permanently restore damaged anterior ocular surface.

Materials and Methods: The study enrolls 420 patients, hospitalized and operated in the Specialized Eye Hospital for a period of 7 years. All patients were transplanted a cryopreserved AM. The patients were divided in seven cohorts according to their diagnosis. Depending on the severity of the objective symptomatology (size and depth of the defect) and the type of the disease, an onlay and/or inlay technique of transplantation in single, dual or multi layers was used. Assessment of the size and depth of the defect was made using a three-stage scale (size - 1 to 4mm, 2- 4-7mm, 3-> 7mm diameter of the cornea, depth (1 - <20%; 2 - 20-50%; 3 -> 50% of the thickness of the cornea).

Results: 74% of patients received an onlay technique transplantation, and 26% - an inlay one. The result analyses show that there is a significant difference in the type of transplantation in the different groups of diagnoses. With all types of transplantations the size of the ulcer was influenced; a significant reduction in its size was observed in onlay type of transplantations, inlay ones (single layer) and inlay type (dual layer) (p <0.001). On the 25th postoperative day in 98% of the patients who have received an onlay type of transplantation a recovery of corneal defects below 2mm was observed. The same effect (92%) was observed in patients with single-layer combined transplantation. With multi-type inlay transplantation positive influence was observed in 71%. The outcomes that show how much the depth of the ulcer was influenced are similar to the ones associated with size.

Conclusion: The amniotic membrane proved to be the tool of choice for refractory, recurrent and severe pathological conditions affecting the anterior segment. The use of appropriate surgical technique according to the type and severity of the objective symptomatology leads to a significant improvement in the post-operative result.

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About The Authors

Y. Manolova
Department of Ophthalmology and Visual Science, Medical University of Varna

H. Grupcheva
Department of Ophthalmology and Visual Science, Medical University of Varna