Role of amniotic membrane transplantation for conjunctival reconstruction in ocular-cicatricial pemphigoid

• Published in: Ophthalmology (Rochester, Minn.) Vol. 110; no. 3; pp. 474 - 480
• Main Authors: Barabino, Stefano, Rolando, Maurizio, Bentivoglio, Giorgio, Mingari, Cristina, Zanardi, Sabrina, Bellomo, Rosa, Calabria, Giovanni
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2003; Elsevier
• Subjects: Aged; Aged, 80 and over; Amnion - transplantation; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Biological Dressings; Bullous diseases of the skin; Conjunctiva - pathology; Conjunctiva - surgery; Conjunctivitis - pathology; Conjunctivitis - surgery; Dermatology; Dexamethasone - therapeutic use; Epithelium; Female; Humans; Male; Medical sciences; Middle Aged; Ophthalmologic Surgical Procedures; Pemphigoid, Benign Mucous Membrane - pathology; Pemphigoid, Benign Mucous Membrane - surgery; Prospective Studies; Reconstructive Surgical Procedures; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Suture Techniques; Tissue Preservation; Visual Acuity; Human; Reconstruction; Scarring pemphigoid; Transplantation; Conjunctiva disease; Conjunctiva; Homotransplantation; Eye; Eye disease; Treatment; Surgery; Amnion; Technique
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/S0161-6420(02)01892-4

To evaluate the role and the effectiveness over time of amniotic membrane transplantation (AMT) as a first-step procedure to treat conjunctival reconstruction in late-stage ocular-cicatricial pemphigoid (OCP). Prospective interventional noncomparative case series. Nine eyes (9 patients) with advanced OCP. Preoperatively, the ocular surface conditions were evaluated by immunohistochemistry of conjunctival biopsy and impression cytology specimens. The amniotic membrane was obtained during cesarean section from women who were 39 weeks pregnant and seronegative for human immunodeficiency virus, hepatitis B and C, and syphilis; it was processed, histologically tested, and stored at −80° C. After scar tissue was removed, the preserved amniotic membrane was placed over the cornea, the bulbar, and tarsal conjunctiva, and was secured with 8-0 Vicryl sutures to the conjunctival edges and the deep fornices with double-armed 6-0 silk sutures. In 2 cases a double layer of amniotic membrane was transplanted. All patients received immunosuppressive systemic therapy and preservative-free tear substitutes and steroids topically for at least 6 months. During follow-up (average, 48 weeks; range, 28–96 weeks), a new standardized method was used to evaluate the fornix depth, and impression cytology testing was performed and conjunctival inflammation recorded and used as parameters for monitoring disease activity. Symblepharon, increased inferior fornix depth, presence of conjunctival goblet cells, and the degree of conjunctival inflammation. The conjunctival surface was free from symblepharon in all subjects for the first 16 weeks. At the week 28 examination, a small area of symblepharon was present in four eyes (44.4%). The depth of the fornix was significantly ( P < 0.0001, analysis of variance) improved at weeks 4, 16, and 28. The normal conjunctival epithelium with goblet cells was restored in 6 of 9 eyes (66.7%) at the week 4 examination and in 4 eyes (44.4%) at the week 28 examination. Conjunctival inflammation was clinically but not statistically reduced. The visual acuity improved in 5 subjects. AMT can be a first-step procedure for ocular surface reconstruction in OCP, but its effectiveness deteriorates slightly over time.