“Pleats Fold” Technique of Amniotic Membrane Transplantation for Management of Corneal Perforations

Namba, Hiroyuki; Narumi, Mari; Nishi, Katsuhiro; Goto, Sakiko; Hayashi, Shinya; Yamashita, Hidetoshi

doi:10.1097/ico.0000000000000128

Cited by 5 publications

(12 citation statements)

References 19 publications

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“…Namba et al [17] suggested that AMT is sufficient in maintaining corneal shape, although it is not able to provide tectonic integrity. ey also recommended against multilayered AMTs for permanent wound closure in corneal perforations involving the optical axis because the central cornea can become cloudy, with the final visual result requiring optical keratoplasty.…”

Section: Journal Of Ophthalmologymentioning

confidence: 99%

“…ey also recommended against multilayered AMTs for permanent wound closure in corneal perforations involving the optical axis because the central cornea can become cloudy, with the final visual result requiring optical keratoplasty. Multilayered AMTs are a useful tool in the management of corneal ulceration or perforation to restore corneal integrity and to minimise the risk of corneal grafts [13,17,19]. In our series, we also preferred AMTs because of the lower risk of complications and their ability to promote epithelial healing at the core of the corneal melting.…”

Section: Journal Of Ophthalmologymentioning

confidence: 99%

“…e surgical treatment of corneal perforation usually begins with a tectonic treatment to stabilise the eye. Optical surgery is then performed to restore visual function [2,17]. e amniotic membrane (AM), the innermost layer of a foetal membrane, synthesises a variety of biological factors, including growth factors, cytokines and neurotrophins; it has many important biological properties in the context of corneal surgery.…”

Section: Introductionmentioning

confidence: 99%

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Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations

Krysik¹,

Dobrowolski

Wylęgała

et al. 2020

Journal of Ophthalmology

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Purpose. To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. Anatomical and functional results, including advantages and disadvantages of the interventions, will also be explored. Methods. A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. A larger monolayer amniotic patch was then sutured, with the epithelial side facing the top of the first membrane, to the perilimbal conjunctiva. For corneal patch grafts, the size-fitting technique of graft trephination was applied, and the donor-recipient junctions were sewn with interrupted sutures. All the procedures were evaluated, noting outcomes and complications of surgery, preoperative and postoperative visual acuities, postoperative intraocular pressures, graft rejection, and other late comorbidities and complications. Results. We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. In 63 eyes (33%), more than one amnion or graft treatment was necessary to close the corneal perforation. Conclusions. The success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; nevertheless, patch grafts deliver better tectonic reconstruction than amniotic membrane alone.

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Section: Journal Of Ophthalmologymentioning

confidence: 99%

Section: Journal Of Ophthalmologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations

Krysik¹,

Dobrowolski

Wylęgała

et al. 2020

Journal of Ophthalmology

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“…It consists of three layers: the epithelial layer, the basement membrane layer, and the stromal layer [15,16]. AMs which promote epithelial growth and inhibit fibrosis, inflammation, and neovascularization have been widely used in ocular surface reconstruction [5,6,14,[17][18][19][20]. AMs can repair corneal defects as an effective material for corneal reconstruction [5,6,14].…”

Section: Discussionmentioning

confidence: 99%

“…With the rapid development of ophthalmology, a variety of original surgery using AMs for the treatment of corneal perforation has gradually performed, including the use of ultra-dry-cross-linked AM for surgery [17], "Pleats Fold" technology [18], and "Swiss Roll" technology [19]. Although these techniques all show good results in the literature, there are only good for peripheral corneal perforation, and the use of central corneal perforation requires further surgery, such as penetrating keratoplasty [17][18][19]. Besides, several clinical studies have reported that the final outcome of patients with corneal ulcers treated with multilayer amniotic membrane transplantation is the formation of a stable avascular leucoma [18,[21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Lamellar Keratoplasty Combined with Amniotic Membrane Transplantation for the Treatment of Corneal Perforations: A Clinical and In Vivo Confocal Microscopy Study

Lan

Shen

Wang

et al. 2020

BioMed Research International

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Purpose. To evaluate the clinical and in vivo confocal microscopy outcome of lamellar keratoplasty combined with amniotic membrane transplantation for the treatment of corneal perforations. Methods. In this retrospective, noncomparative, and interventional case series, 13 eyes of 13 patients with corneal perforation were included. All eyes were treated with lamellar keratoplasty combined with amniotic membrane transplantation for corneal reconstruction. Age, underlying etiology, location, size of corneal ulcer, size of corneal perforation, hospitalization days and follow-up time, and corneal confocal microscopy were investigated. Aqueous leakage, anterior chamber formation, epithelial healing time, and visual acuity (VA) were monitored after operation. Results. The cause of corneal perforation (n = 13) was classified as infectious (n = 1) and noninfectious (n = 12). Most of the locations of corneal perforation were paracentral, and 2 of them were center. The anterior chambers were formed without aqueous leakage and other complications at postoperative day. The mean time of regained a smooth corneal surface was 7.5 ± 2.9 (ranging from 4 to 14) days. The mean hospitalization day was 13.1 ± 4.5 (ranging from 7 to 22) days. The mean follow-up time is 22.5 ± 14.5 (ranging from 4 to 43) months. The AM appeared as a high-reflective reflection in the corneal stroma after surgery about half a year and is almost transparent at about one year. Corneal stroma-derived cells were populated in the AM at about 1 month, increased at 2 months, and almost not obviously at 20 months postoperatively. The size and density of endothelial cells were stable after 1 year near the perforation site. The VA improved to varying degrees in 9 eyes, remained unchanged in 2 eyes, and decreased in 2 eyes. One eye recurrence and no side effects occurred during the follow-up time. Conclusion. Lamellar keratoplasty combined with amniotic membrane transplantation may be an alternative, safe, and effective surgical therapy in the treatment of corneal perforations in the absence of a fresh donor cornea. We recommend this surgery to treat with the size of corneal perforation of <4 mm in diameter no matter peripheral or central corneal perforation, especially who had immune-related diseases.

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Concentrations of tissue inhibitor of matrix metalloproteinase‐1 and hyaluronic acid in canine amniotic membranes cryopreserved for different time points and its effects in dogs with complicated corneal ulcers

Dower¹,

Ribeiro

Gomes

et al. 2021

Veterinary Ophthalmology

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Objectives To determine the concentrations of total protein (TP), tissue inhibitor of matrix metalloproteinase‐1 (TIMP‐1) and hyaluronic acid (HA) in amniotic membranes (AMs) harvested from placentas of bitches of different ages and cryopreserved for different time points. The outcomes of complicated corneal defects of dogs repaired with AMs stored for the same time points were also evaluated. Procedures Ten cryopreserved canine AMs were stored for short term (2–50 days), middle term (92–210 days), or long term (256–357 days). TP was quantified by Bradford’s test, whereas TIMP‐1 and HA were quantified by ELISA. Twenty‐one dogs that had an AM transplantation to restore deep or perforating corneal wounds were selected. Results TIMP‐1 levels were lower in AMs cryopreserved for middle term (p = .02) and long term (p = .0009), when compared to AMs stored for short term. TP (p = .39) and HA (p = .18) concentrations in AMs did not differ among the storage time. TIMP‐1 concentration in AMs correlated with storage time (R = −.65, p < .0001), while TP (R = −.33, p = .07) and HA concentrations did not (R = −.15, p = .41). The age of donors did not correlate with the components evaluated in the AMs. Corneal defects repaired with AMs stored for short term healed sooner than the ones repaired with AMs stored for middle (p < .01) and long term (p = .02). Additionally, TIMP‐1 levels in AMs correlated negatively with the epithelization time (R = −.62, p = .002). Graft opacity was severe in 55% of cases. However, the HA levels in AMs correlated negatively with the opacification score (R = −.47, p = .03). Vision was observed in more patients who presented deep ulcers and descemetoceles, than in the ones with perforations (p = .004). Conclusions TIMP‐1 concentration in canine AMs significantly decreased over a year storage time, while TP and HA concentrations did not change during the same period. The age of donors did not correlate with the components evaluated in the AMs. Complicated corneal defects repaired with AMs cryopreserved for short term healed sooner and tended to be less opaque; however, satisfactory to optimal outcomes were achieved even in the eyes repaired with AMs stored for up to a year.

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“Pleats Fold” Technique of Amniotic Membrane Transplantation for Management of Corneal Perforations

Cited by 5 publications

References 19 publications

Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations

Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations

Lamellar Keratoplasty Combined with Amniotic Membrane Transplantation for the Treatment of Corneal Perforations: A Clinical and In Vivo Confocal Microscopy Study

Concentrations of tissue inhibitor of matrix metalloproteinase‐1 and hyaluronic acid in canine amniotic membranes cryopreserved for different time points and its effects in dogs with complicated corneal ulcers

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