BACKGROUND: Amniotic membrane transplantation (AMT), as a new tool in the armamentarium of therapies available for ocular surface problems, became widely available in the UK in 1998. This study evaluates the indications for treatment, the surgical procedures used, and the results of a subset of the first AMT cases carried out by the group using this nationally available supply. This user group model provides data which is different from that obtained from uncontrolled case series, or clinical trials, and may be more representative of the outcomes that can be expected when a procedure becomes widely available. METHODS: The first 233 AMTs, performed by the UK user group, were evaluated by audit and outcomes were assessed at 3 months. RESULTS: Of the 233 transplants, there were 126 (54.1%) valid outcome returns: the outcome for persistent epithelial defects was a healed and stable surface in 11/35 (31.4%, 95% CI 16.9 to 49.3); for chemical/thermal injuries, a healed uninflamed eye with clear cornea in 5/18 (27.8%, 95% CI 9.7 to 53.4); for bullous keratopathy a pain-free, stable surface without bullae in 4/18 (22.2%, 95% CI 6.4 to 47.6); for ocular surface reconstruction, an epithelialised uninflamed conjunctiva without scarring in 12/23 (52.2%, 95% CI 30.6 to 73.2); and for limbal stem cell deficiency, a corneal phenotype in 4/7 (57.1%). The operative technique least associated with failure was use of a bandage contact lens at the end of the procedure (OR 0.19, 95% CI 0.06 to 0.59, p = 0.004). Previous treatment with topical steroids was significantly associated with failure (OR 5.70, 95% CI 1.77 to 18.43, p = 0.004). CONCLUSION: Although the outcome criteria used in this study were stringent, and the follow-up duration was short, the results of AMT by this user group were generally less favourable than those of previously reported case series. Controlled clinical trials would improve the quality of evidence for use of amniotic membrane in ocular disease.
BACKGROUND: Amniotic membrane transplantation (AMT), as a new tool in the armamentarium of therapies available for ocular surface problems, became widely available in the UK in 1998. This study evaluates the indications for treatment, the surgical procedures used, and the results of a subset of the first AMT cases carried out by the group using this nationally available supply. This user group model provides data which is different from that obtained from uncontrolled case series, or clinical trials, and may be more representative of the outcomes that can be expected when a procedure becomes widely available. METHODS: The first 233 AMTs, performed by the UK user group, were evaluated by audit and outcomes were assessed at 3 months. RESULTS: Of the 233 transplants, there were 126 (54.1%) valid outcome returns: the outcome for persistent epithelial defects was a healed and stable surface in 11/35 (31.4%, 95% CI 16.9 to 49.3); for chemical/thermal injuries, a healed uninflamed eye with clear cornea in 5/18 (27.8%, 95% CI 9.7 to 53.4); for bullous keratopathy a pain-free, stable surface without bullae in 4/18 (22.2%, 95% CI 6.4 to 47.6); for ocular surface reconstruction, an epithelialised uninflamed conjunctiva without scarring in 12/23 (52.2%, 95% CI 30.6 to 73.2); and for limbal stem cell deficiency, a corneal phenotype in 4/7 (57.1%). The operative technique least associated with failure was use of a bandage contact lens at the end of the procedure (OR 0.19, 95% CI 0.06 to 0.59, p = 0.004). Previous treatment with topical steroids was significantly associated with failure (OR 5.70, 95% CI 1.77 to 18.43, p = 0.004). CONCLUSION: Although the outcome criteria used in this study were stringent, and the follow-up duration was short, the results of AMT by this user group were generally less favourable than those of previously reported case series. Controlled clinical trials would improve the quality of evidence for use of amniotic membrane in ocular disease.
Authors: E Letko; S U Stechschulte; K R Kenyon; N Sadeq; T R Romero; C M Samson; Q D Nguyen; S L Harper; J D Primack; D T Azar; M Gruterich; C H Dohlman; S Baltatzis; C S Foster Journal: Arch Ophthalmol Date: 2001-05
Authors: D Meller; R T Pires; R J Mack; F Figueiredo; A Heiligenhaus; W C Park; P Prabhasawat; T John; S D McLeod; K P Steuhl; S C Tseng Journal: Ophthalmology Date: 2000-05 Impact factor: 12.079
Authors: Edgar M Espana; Martin Grueterich; Helga Sandoval; Abraham Solomon; Eduardo Alfonso; Carol L Karp; Francisco Fantes; Scheffer C G Tseng Journal: J Cataract Refract Surg Date: 2003-02 Impact factor: 3.351
Authors: Yu Mi Han; Roberto Romero; Jung-Sun Kim; Adi L Tarca; Sun Kwon Kim; Sorin Draghici; Juan Pedro Kusanovic; Francesca Gotsch; Pooja Mittal; Sonia S Hassan; Chong Jai Kim Journal: Biol Reprod Date: 2008-08-06 Impact factor: 4.285
Authors: Claire L Allen; Gerry Clare; Elizabeth A Stewart; Matthew J Branch; Owen D McIntosh; Megha Dadhwal; Harminder S Dua; Andrew Hopkinson Journal: PLoS One Date: 2013-10-30 Impact factor: 3.240