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Impact of adjuvant amniotic membrane transplantation in infectious ulcerative keratitis

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Abstract

Purpose

To evaluate the effectiveness of cryopreserved human amniotic membrane transplantation (hAMT) in patients with infectious ulcerative keratitis.

Methods

A retrospective cohort study based on medical records of patients who underwent hAMT procedure over a 2-year period (2020–2021) was conducted at Ege University Hospital, Turkey. Cryopreserved hAM was used. Best corrected visual acuity (BCVA) was measured with the Snellen chart. Detailed ophthalmological examination was performed at all visits. Treatment success was defined as complete healing including disappearance of corneal infiltrates, epithelial defect closure, reduction in anterior segment reaction.

Results

A total of 13 eyes of 12 patients were diagnosed with ulcerative keratitis between 2020 and 2021. hAMT was performed in severe keratitis patients in which corneal infiltrates extending to middle to deep stromal and patients with neurotrophic component, in other words, having trouble for wound healing. The mean age was 60.9 ± 18.7 years, and 66.6% of the patients were male. Average ulcer horizontal diameter was 9.7 ± 2.8 mm. A single-layer human amniotic membrane (hAM) was transplanted 92.3% of eyes. Overlay technique was used in all patients for hAMT. The mean residence time of the amniotic membrane on the ocular surface was 14.1 ± 10.2 days. The mean time from the first presentation to the hAM transplantation was 9.7 ± 6.8 days. The average hospitalization time of all patients was 15 ± 12.1 days, pre-hAMT was 10.2 ± 7.3 days and post-hAMT was 4.8 ± 9.1 days. The mean follow-up time was 3 months. Recovery response was positive in 76.9%. Average healing time was 32.1 ± 14.04 days.

Conclusions

hAMT was effective in the treatment of infectious ulcerative keratitis by accelerating and supporting wound healing. Performing hAM transplantation at the early stages of the disease and prolonged residence of membrane on the ocular surface increase the success of the treatment and moreover shortens hospitalization time.

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References

  1. Solomon A, Rosenblatt M, Monroy D (2001) Suppression of Interleukin1 alpha and Interleukin1 beta in the human limbal epithelial cells cultured on the amnitic membrane stromal matrix. Br J Ophthalmol 85(4):444–449

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hori J, Wang M, Kamiya K, Takahashi H, Sakuragawa N (2006) Immunological characteristics of amniotic epithelium. Cornea 25(Supplement 1):S53–S58. https://doi.org/10.1097/01.ico.0000247214.31757.5c

    Article  PubMed  Google Scholar 

  3. Ohno-Matsui K et al (2005) The effects of amniotic membrane on retinal pigment epithelial cell differentiation. Mol Vis 11(January):1–10

    CAS  PubMed  Google Scholar 

  4. Iakimenko SA, Buznyk OI, Rymgayllo-Jankowska B (2013) Amniotic membrane transplantation in treatment of persistent corneal ulceration after severe chemical and thermal eye injuries. Eur J Ophthalmol 23(4):496–503. https://doi.org/10.5301/ejo.5000243

    Article  PubMed  Google Scholar 

  5. Casalita V, Nora RLD, Edwar L, Susiyanti M, Sitompul R (2020) Amniotic membrane transplantation for infectious corneal ulcer treatment: A cohort retrospective study. Med J Indones 29(4):379–385. https://doi.org/10.13181/mji.oa.203849

    Article  Google Scholar 

  6. Heiligenhaus A, Bauer D, Meller D, Steuhl KP, Tseng SCG (2001) Improvement of HSV-1 necrotizing keratitis with amniotic membrane transplantation. Investig Ophthalmol Vis Sci 42(9):1969–1974

    CAS  Google Scholar 

  7. Gicquel JJ, Bejjani RA, Ellies P, Mercié M, Dighiero P (2007) Amniotic membrane transplantation in severe bacterial keratitis. Cornea 26(1):27–33. https://doi.org/10.1097/ICO.0b013e31802b28df

    Article  PubMed  Google Scholar 

  8. Ting DSJ, Henein C, Said DG, Dua HS (2021) Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis. Sci Rep 11(1):1–15. https://doi.org/10.1038/s41598-021-92366-x

    Article  CAS  Google Scholar 

  9. Zarbin M, Chu D, Dua HS, Gomes JAP, King AJ, Maharajan VS (2004) Diagnostic and surgical technique the amniotic membrane in ophthalmology. Surv Ophthalmol 49(1):51–77. https://doi.org/10.1016/j.survophthal.2003.10.004

    Article  Google Scholar 

  10. Yelchuri ML, Madhavi B, Gohil N, Sajeev HS, Prajna NV, Srinivasan S (2017) In vitro evaluation of the drug reservoir function of human amniotic membrane using moxifloxacin as a model drug. Cornea 36(5):594–599. https://doi.org/10.1097/ICO.0000000000001168

    Article  PubMed  Google Scholar 

  11. Laranjeira P et al (2018) Amniotic membrane extract differentially regulates human peripheral blood T cell subsets, monocyte subpopulations and myeloid dendritic cells. Cell Tissue Res 373(2):459–476. https://doi.org/10.1007/s00441-018-2822-1

    Article  CAS  PubMed  Google Scholar 

  12. Sibley D, Larkin DFP (2020) Update on Herpes simplex keratitis management. Eye 34(12):2219–2226. https://doi.org/10.1038/s41433-020-01153-x

    Article  PubMed  PubMed Central  Google Scholar 

  13. Semeraro F et al (2014) Neurotrophic keratitis. Ophthalmologica 231(4):191–197. https://doi.org/10.1159/000354380

    Article  CAS  PubMed  Google Scholar 

  14. Thatte S, Choudhary U, Sharma B (2017) Efficacy of amniotic membrane transplantation in refractory infective keratitis leading to stromal thinning descematocele and perforations. JOJ Ophthalmol 3(3):1–6. https://doi.org/10.19080/JOJO.2017.03.555611

    Article  Google Scholar 

  15. Chen HC, Tan HY, Hsiao CH, Huang SCM, Lin KK, Ma DHK (2006) Amniotic membrane transplantation for persistent corneal ulcers and perforations in acute fungal keratitis. Cornea 25(5):564–572. https://doi.org/10.1097/01.ico.0000227885.19124.6f

    Article  PubMed  Google Scholar 

  16. Kim JS, Kim JC, Hahn TW, Park WC (2001) Amniotic membrane transplantation in infectious corneal ulcer. Cornea 20(7):720–726. https://doi.org/10.1097/00003226-200110000-00010

    Article  CAS  PubMed  Google Scholar 

  17. Bourcier T et al (2004) Importance of amniotic membrane transplantation in the treatment of severe Acanthamoeba keratitis. Can J Ophthalmol 39(6):621–631. https://doi.org/10.1016/s0008-4182(04)80027-9

    Article  PubMed  Google Scholar 

  18. Abdulhalim BEH, Wagih MM, Gad AAM, Boghdadi G, Nagy RRS (2015) Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study. Br J Ophthalmol 99(1):59–63. https://doi.org/10.1136/bjophthalmol-2014-305224

    Article  PubMed  Google Scholar 

  19. Kheirkhah A, Tabatabaei A, Zavareh MK, Khodabandeh A, Mohammadpour M, Raju VK (2012) A controlled study of amniotic membrane transplantation for acute Pseudomonas keratitis. Can J Ophthalmol 47(3):305–311. https://doi.org/10.1016/j.jcjo.2012.03.014

    Article  PubMed  Google Scholar 

  20. Tabatabaei SA, Soleimani M, Behrouz MJ, Torkashvand A, Anvari P, Yaseri M (2017) A randomized clinical trial to evaluate the usefulness of amniotic membrane transplantation in bacterial keratitis healing. Ocul Surf 15(2):218–226. https://doi.org/10.1016/j.jtos.2017.01.004

    Article  PubMed  Google Scholar 

  21. Chen JHC, Ma DHK, Tsai RJF (2002) Amniotic membrane transplantation for pseudomonal keratitis with impending perforation. Chang Gung Med J 25(3):144–152

    CAS  PubMed  Google Scholar 

  22. Riley SC, Leask R, Denison FC, Wisely K, Calder AA, Howe DC (1999) Secretion of tissue inhibitors of matrix metalloproteinases by human fetal membranes, decidua and placenta at parturition. J Endocrinol 162(3):351–359. https://doi.org/10.1677/joe.0.1620351

    Article  CAS  PubMed  Google Scholar 

  23. Bo Z, Ping W, Ling Juan X, Xin Yu L, Zhang H, Gui Gang L (2014) Amniotic membrane covering promotes healing of debridement for fungal keratitis cornea epithelium and improves visual acuity after debridement for fungal keratitis. Int. J. Ophthalmol. 7(3):785. https://doi.org/10.3980/j.issn.2222-3959.2015.03.38

    Article  Google Scholar 

  24. Espana EM et al (2003) Amniotic membrane transplantation for bullous keratopathy in eyes with poor visual potential. J Cataract Refract Surg 29(2):279–284. https://doi.org/10.1016/S0886-3350(02)01525-0

    Article  PubMed  Google Scholar 

  25. Yarımada YAS, Barut Selver Ö, Palamar M, Eğrilmez S, Aydemir SŞ, Hilmioğlu Polat S (2022) Comparison of culture-positive and -negative microbial keratitis. Turk J Ophthalmol 52:1

    Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Ege University Medical Faculty Hospital, Bornova, 35100, Izmir, Turkey

    Okyanus Bulut, Gunel Musayeva & Ozlem Barut Selver

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  1. Okyanus Bulut
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  2. Gunel Musayeva
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  3. Ozlem Barut Selver
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Contributions

Okyanus Bulut was responsible for conducting research, screening potentially eligible studies, extracting and analyzing data, drafting manuscript. Gunel Musayeva was responsible for helping to draft the manuscript. Ozlem Barut Selver was responsible for designing the study protocol, coordinating the study, interpreting results and providing feedback on the final report. All authors read and approved the final manuscript.

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Correspondence to Ozlem Barut Selver.

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Conflicts of interest

The authors have no relevant financial or nonfinancial interests to disclose. Author Okyanus Bulut declares that she has no conflict of interest. Author Gunel Musayeva declares that she has no conflict of interest; author Ozlem Barut Selver declares that she has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Bulut, O., Musayeva, G. & Selver, O.B. Impact of adjuvant amniotic membrane transplantation in infectious ulcerative keratitis. Int Ophthalmol 43, 915–923 (2023). https://doi.org/10.1007/s10792-022-02493-1

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