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Amniotic Membrane Transplantation for Ocular Surface Reconstruction

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Abstract

The use of amniotic membrane (or amnion) for transplantation as graft in ocular surface reconstruction is reviewed. This technique has become widespread because of the availability of the amnion, convenience and ease of use, and high and reproducible success rates. The mechanisms of action of the transplantation are varied and include the prolongation and clonogenic maintenance of epithelial progenitor cells, promotion of goblet and non-goblet cell differentiation, exclusion of inflammatory cells with anti-protease activities, suppression of Transforming Growth Factor β signaling and myoblast differentiation of normal fibroblasts. The observed clinical effects include facilitation of epithelialization, maintenance of normal phenotypes, and reduction of inflammation, vascularization and scarring. Amniotic membrane transplantation is being increasingly used as graft for various conjunctival and corneal diseases and as a patch in cases of chemical and thermal burns, refractory and recalcitrant keratitis, and most recently as an excellent substrate for expanding epithelial stem cells ex vivo.

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REFERENCES

  1. Trelford, J. D. and Trelford-Sauder, M. (1979) The amnion in surgery, past and present. Am. J. Obstet. Gynecol. 134: 833–845.

    PubMed  Google Scholar 

  2. de Rotth, A. (1940) Plastic repair of conjunctival defects with fetal membrane. Arch. Ophthalmol. 23: 522–525.

    Google Scholar 

  3. Brown, A. L. (1941) Lime burns of the eye: Use of rabbit peritoneum to prevent severe delayed effects. Arch. Ophthalmol. 26: 754–769.

    Google Scholar 

  4. Sorsby, A. and Symons, H. M. (1946) Amniotic membrane grafts in caustic burns of the eye. Br. J. Ophthalmol. 30: 337–345.

    Google Scholar 

  5. Sorsby, A., Haythorne, J., and Reed, H. (1947) Further experience with amniotic membrane grafts in caustic burns of the eye. Br. J. Ophthalmol. 31: 409–418.

    Google Scholar 

  6. Roper-Hall, M. J. (1965) Thermal and chemical burns. Trans. Ophthalmol. Soc. UK. 85: 631–640.

    PubMed  Google Scholar 

  7. Kim, J. C. and Tseng, S. C. G. (1995) Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea 14: 473–484.

    PubMed  Google Scholar 

  8. Dua, H. S. and Azuara-Blanco, A. (1999) Amniotic membrane transplantation. Br. J. Ophthalmol. 83: 748–752.

    PubMed  Google Scholar 

  9. Fukuda, K., Chikama, T., Nakamura, M., and Nishida, T. (1999) Differential distribution of subchains of the basement membrane components type IV collagen and laminin among the amniotic membrane, cornea, and conjunctiva. Cornea 18: 73–79.

    PubMed  Google Scholar 

  10. Tseng, S. C. G., Prabhasawat, P., Barton, K., Gray, T., and Meller, D. (1998) Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency. Arch. Ophthalmol. 116: 431–441.

    PubMed  Google Scholar 

  11. Lee, S.-H. and Tseng, S. C. G. (1997) Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am. J. Ophthalmol. 123: 303–312.

    PubMed  Google Scholar 

  12. Kruse, F. E., Rohrschneider, K., and VÖ lcker, H. E. (1999) Multilayer amniotic membrane transplantation for reconstruction of deep corneal ulcers. Ophthalmology 106: 1504–1511.

    PubMed  Google Scholar 

  13. Chen, H.-J., Pires, R. T. F., and Tseng, S. C. G. (2000) Amniotic membrane transplantation for severe neurotrophic corneal ulcers. Br. J. Ophthalmol. 84: 826–833.

    PubMed  Google Scholar 

  14. Cho, B.-J., Djalilian, A. R., Obritsch, W. F., Matteson, D. M., Chan, C. C., and Holland, E. J. (1999) Conjunctival epithelial cells cultured on human amniotic membrane fail to transdifferentiate into corneal epithelial-type cells. Cornea 18: 216–224.

    PubMed  Google Scholar 

  15. Meller, D. and Tseng, S. C. G. (1999) Conjunctival epithelial cell differentiation on amniotic membrane. Invest. Ophthalmol. Vis. Sci. 40: 879–886.

    Google Scholar 

  16. Koizumi, N., Inatomi, T., Quantock, A. J., Fullwood, N. J., Dota, A., and Kinoshita, S. (2000) Amniotic membrane as a substrate for cultivating limbal corneal epithelial cells for autologous transplantation in rabbits. Cornea 19: 65–71.

    PubMed  Google Scholar 

  17. Schwab, I. R. (1999) Cultured corneal epithelia for ocular surface disease. Trans. Am. Ophthalmol Soc. 97: 891–986.

    PubMed  Google Scholar 

  18. Koizumi, N., Fullwood, N. J., Bairaktaris, G., Inatomi, T., Kinoshita, S., and Quantock, A. J. (2000) Cultivation of corneal epithelial cells on intact and denuded human amniotic membrane. Invest. Ophthalmol. Vis. Sci. 41: 2506–2513.

    PubMed  Google Scholar 

  19. Tsai, R. J. F., Li, L.-M., and Chen, J.-K. (2000) Reconstruction of damaged corneas by transplantation of autologous limbal epithelial cells. New Eng. J. Med. 343: 86–93.

    PubMed  Google Scholar 

  20. Prabhasawat, P. and Tseng, S. C. G. (1997) Impression cytology study of epithelial phenotype of ocular surface reconstructed by preserved human amniotic membrane. Arch. Ophthalmol. 115: 1360–1367.

    PubMed  Google Scholar 

  21. Tseng, S. C. G., Li, D.-Q., and Ma, X. (1999) Suppression of Transforming Growth Factor isoforms, TGF-βreceptor II, and myofibroblast differentiation in cultured human corneal and limbal fibroblasts by amniotic membrane matrix. J. Cell Physiol. 179: 325–335.

    PubMed  Google Scholar 

  22. Lee, S.-B., Li, D.-Q., Tan, D. T. H., Meller, D., and Tseng, S. C. G. (2000) Suppression of TGF-β?signaling in both normal conjunctival fibroblasts and pterygial body fibroblasts by amniotic membrane. Curr. Eye Res. 20: 325–334.

    PubMed  Google Scholar 

  23. Tseng, S. C. G., Prabhasawat, P., and Lee, S.-H. (1997) Amniotic membrane transplantation for conjunctival surface reconstruction. Am. J. Ophthalmol. 124: 765–774.

    PubMed  Google Scholar 

  24. Azuara-Blanco, A., Pillai, C. T., and Dua, H. S. (1999) Amniotic membrane transplantation for ocular surface reconstruction. Br. J. Ophthalmol. 8339: 399–402.

    Google Scholar 

  25. Prabhasawat, P., Barton, K., Burkett, G., and Tseng, S. C. G. (1997) Comparison of conjunctival autografts, amniotic membrane grafts and primary closure for pterygium excision. Ophthalmology 104: 974–985.

    PubMed  Google Scholar 

  26. Shimazaki, J., Shinozaki, N., and Tsubota, K. (1998) Transplantation of amniotic membrane and limbal autograft for patients with recurrent pyterygium associated with symblepharon. Br. J. Ophthalmol. 82: 235–240.

    PubMed  Google Scholar 

  27. Kim, J. C., Lee, D., and Shyn, K. H. (1997) Clinical uses of human amniotic membrane for ocular surface diseases. In: Advances in Corneal Research (J. H. Lass, ed.). Plenum Press, New York, p. 117–134.

    Google Scholar 

  28. Solomon, A., Pires, R. T. F., and Tseng, S. C. G. (2001) Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia. Ophthalmology 108: 449–460.

    PubMed  Google Scholar 

  29. Ma, D. H.-K., See, L.-C., Liau, S.-B., and Tsai, R. J. F. (2000) Amniotic membrane graft for primary pterygium: comparison with conjunctival autograft and topical mitomycin C treatment. Br. J. Ophthalmol. 84: 973–978.

    PubMed  Google Scholar 

  30. Choi, Y. S., Kim, J. Y., Wee, W. R., and Lee, J. H. (1998) Effect of the application of human amniotic membrane on rabbit corneal wound healing after excimer laser photorefractive keratectomy. Cornea 17: 389–395.

    PubMed  Google Scholar 

  31. Wang, M. X. et al. (2001) Corneal haze and apoptosis is reduced by amniotic membrane matrix in excimer laser protoablation in rabbits. J. Cat. Refract. Surg. 27: 310–319.

    Google Scholar 

  32. Park, W. C. and Tseng, S. C. G. (2000) Modulation of acute inflammation and keratocyte death by suturing, blood and amniotic membrane in PRK. Invest. Ophthalmol. Vis. Sci. 41: 2906–2914.

    PubMed  Google Scholar 

  33. Koizumi, N., Inatomi, T., Sotozono, C., Fullwood, N. J., Quantock, A. J., and Kinoshita, S. (2000) Growth factor mRNA and protein in preserved human amniotic membrane. Curr. Eye Res. 20: 173–177.

    PubMed  Google Scholar 

  34. Na, B. K. et al. (1999) Analysis of human amniotic membrane components as proteinase inhibitors for development of therapeutic agent of recalcitrant keratitis. Trophoblast Res. 13: 459–466.

    Google Scholar 

  35. Kim, J. C. and Tseng, S. C. G. The effects of inhibition of corneal neovascularization after human amniotic membrane transplantation in severely damaged rabbit corneas. Korean J. Ophthalmol. 9:32–46.

  36. Tsubota, K. et al. (1996) Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens-Johnson syndrome. Am. J. Ophthalmol. 122: 38–52.

    PubMed  Google Scholar 

  37. Shimazaki, J., Yang, H.-Y., and Tsubota, K. (1997) Amniotic membrane transplantation of ocular surface reconstruction in patients with chemical and thermal burns. Ophthalmology 104: 2068–2076.

    PubMed  Google Scholar 

  38. Tsubota, K. et al. (1999) Treatment of severe ocular surface disorders with corneal epithelial stemcell transplantation. New Eng. J. Med. 340: 1697–1703.

    PubMed  Google Scholar 

  39. Tsubota, K. and Shimazaki, J. (1999) Surgical treatment of children blinded by Stevens-Johnson syndrome. Am. J. Ophthalmol. 128: 573–581.

    PubMed  Google Scholar 

  40. Meller, D., Maskin, S. L., Pires, R. T. F., and Tseng, S. C. G. (2000) Amniotic membrane transplantation for symptomatic conjunctivochalasis refractory to medical treatments. Cornea 19: 796–803.

    PubMed  Google Scholar 

  41. Rodriguez-Ares, M. T., Tourino, R., Capeans, C., and Sanchez-Salorio, M. (1999) Repair of scleral perforation with preserved scleral amniotic membrane in Marfan's syndrome. Ophthalmic Surg. Lasers 30: 485–487.

    PubMed  Google Scholar 

  42. Budenz, D. L., Barton, K., Tseng, S. C. G. (2000) Amniotic membrane transplantation for repair of leaking glaucoma filtering blebs. Am. J. Ophthalmol. 130: 580–588.

    PubMed  Google Scholar 

  43. Pires, R. T. F. et al. (1999) Amniotic membrane transplantation for symptomatic bullous keratopathy. Arch. Ophthalmol. 117: 1291–1297.

    PubMed  Google Scholar 

  44. Kim, J. S., Kim, J. C., Na, B. K., Jeong, J. M., and Song, C. Y. (1948) Amniotic membrane patching promotes healing and inhibits protease activity on wound healing following acute corneal alkali burns. Exp. Eye Res. 70: 329–337.

    Google Scholar 

  45. Meller, D. et al. (2000) Amniotic membrane transplantation for acute chemical or thermal burns. Ophthalmology 107: 980–990.

    PubMed  Google Scholar 

  46. John, T. (1999) Transplant successful in Stevens-Johnson syndrome: Human amniotic membrane technique treats acute damage, preserves child's eyesight. Ophthalmology Times 15: 10–13.

    Google Scholar 

  47. Kim, J. C. (1998) Use of temporary amniotic membrane graft for corneal diseases. Inaugural Scientific Meeting of Asia Pacific Society of Cornea and Refractive Surgery, 49.

  48. Schwab, I. R., Reyes, M., and Isseroff, R. R. (2000) Successful transplantation of bioengineered tissue replacements in patients with ocular surface disease. Cornea 19: 421–426.

    PubMed  Google Scholar 

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Tseng, S. Amniotic Membrane Transplantation for Ocular Surface Reconstruction. Biosci Rep 21, 481–489 (2001). https://doi.org/10.1023/A:1017995810755

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