Study of the effect of amniotic membrane grafting on corneal ulcers.

The first reported use of fetal membranes in skin transplantation was by Davis in 1910. In 1913, Sabella used amniotic membrane on burned and ulcerated skin surfaces and observed lack of infection, marked decrease in pain, and increased rate of re-epithelialization of traumatized skin surface. Others have demonstrated the use of amniotic membrane as a biological dressing for open wounds including burns and chronic ulceration of the legs. The first use of amniotic membrane transplantation (AMT) in ophthalmology was by De Roth in 1940 who reported partial success in the treatment of conjunctival epithelial defects after symblepharon. Sorsby and Symons in 1946 found that patients with caustic burns of the conjunctiva with corneal involvement could be treated successfully using amniotic membrane. Little else regarding AMT appeared in the ophthalmic literature until 1995 when Kim and Tseng used AMT for ocular surface reconstruction of severely damaged corneas in a rabbit model. Since that experimental study, AMT has been used for persistent corneal epithelial defects, corneal ulcers,leaking filtering blebs after glaucoma surgery, pterygium surgery, conjunctival surface reconstruction, bullous keratopathy, chemical or thermal burns, ocular surface reconstruction with or without limbal stem cell grafting, and in patients with ocular cicatricial pemphigoid or Stevens-Johnson syndrome. Conclusion: Our study proves that amniotic membrane grafting is indeed an effective treatment modality in ulcers especially in providing symptomatic relief. It reduces the time required for healing and thereby prevents the various complications associated with non healing ulcers. The need for a therapeutic keratoplasty is significantly low and thereby the various complications associated with it may also be avoided.. Though some of our patients showed really thick opacities probably an effect of the amniotic membrane itself, this is of no consequence as an optical keratoplasty can be undertaken later with respect to improving vision. The response seems to be better with respect to bacterial corneal ulcers. As the amniotic membrane is easily available and there are no complications associated, it proves to be a useful measure for the treatment of corneal ulcers