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Clinical Sciences
May 2001

Amniotic Membrane Inlay and Overlay Grafting for Corneal Epithelial Defects and Stromal Ulcers

Author Affiliations

From the Immunology and Uveitis Service (Drs Letko, Romero, Samson, Nguyen, Harper, and Foster) and Cornea Service (Drs Stechschulte, Primack, Azar, and Dohlman), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston; Cornea Consultants, Boston (Drs Stechschulte and Kenyon); Ludwigs Maximilian Universitat Augenklinik, München, Germany (Drs Kenyon and Gruterich); Al-Bahar Ophthalmology Center, IBN Sina Hospital, Safat, Kuwait(Dr Sadeq); and General Hospital of Athens, University Eye Clinic, Athens Medical School, Athens, Greece (Dr Baltatzis).

Arch Ophthalmol. 2001;119(5):659-663. doi:10.1001/archopht.119.5.659

Objectives  To determine the effect of amniotic membrane transplantation (AMT) on persistent corneal epithelial defects (PEDs) and to compare the efficacy between inlay and overlay techniques.

Methods  Thirty patients (30 eyes) underwent AMT for PED. The use of AMT was restricted to patients in whom all previous measures, including bandage contact lens and tarsorrhaphy, had failed. The amniotic membrane was placed on the surface of the cornea in overlay (group A) or inlay (group B) fashion.

Results  The PED healed after the first AMT in 21 eyes (70%) within an average of 25.5 days after surgery and recurred in 6 eyes (29%). Among the 22 eyes treated with an overlay AMT (group A), the PED healed after the first AMT in 14 eyes (64%) within an average of 24.5 days and recurred in 4 eyes (29%). Among the 8 eyes treated with an inlay AMT (group B), the PED healed within an average of 27.4 days after AMT, which did not statistically significantly differ from group A (P = .72). The PED healed after the first AMT in 7 eyes (88%) and recurred in 2 (29%) of 7 eyes.

Conclusions  The AMT can be helpful in the treatment of PED in which all other conventional management has failed. However, the success rate in our study was not as high as that previously reported, and our results showed a high incidence of recurrences of epithelial defects. We did not find any difference between overlay and inlay techniques in terms of healing time and recurrence rate.