Membrana amniótica como alternativa de tratamiento en superficie ocular

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Abstract

Se realizó una revisión bibliográfica con el objetivo de conocer la utilidad de la membrana amniótica como alternativa de tratamiento en la superficie ocular. Son abordados tópicos como las diferentes formas de obtención, preparación y conservación de la misma, sus mecanismos de acción y aplicaciones. Se consultó una bibliografía que abarca un periodo de varios años para conocer los resultados publicados sobre el trasplante de membrana amniótica humana en la superficie ocular.

Translated abstract

A literature review was made to learn about the usefulness of the amniotic membrane as a therapeutic option for the ocular surface. The different ways for obtaining, preparing, and conserving this membrane, its mechanism of action and its applications were also addressed. Literature covering several years was reviewed in order to be acquainted with the published results of the human amniotic membrane transplantation on the ocular surface.

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Most cited references 43

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Amniotic membrane transplantation for conjunctival surface reconstruction.

John Lee, P Prabhasawat, J. Tseng (1997)

To determine whether preserved human amniotic membrane can be used to reconstruct the conjunctival defect created during surgical removal of a large lesion or during symblepharon lysis. Amniotic membrane transplantation was performed in six consecutive patients (seven eyes) during removal of large conjunctival lesions and in nine patients (nine eyes) during removal of conjunctival scars or symblepharon. During a mean follow-up period +/- SD of 10.9 +/- 9.1 months (range, 2.2 to 34.0 months), 10 patients (11 eyes) showed successful surface reconstruction without recurrence, five patients (five eyes) showed improved visual acuity, and one patient (one eye) showed epithelialization within 3 weeks and resolution of motility restriction. Two patients (two eyes) showed partial success, with surrounding conjunctival inflammation. Three cases (three eyes) failed and exhibited recurrent scarring: one patient had received mitomycin treatment and beta radiation, whereas the transplanted amniotic membrane of the second patient was partially, and of the third patient was completely, dissolved or replaced by the inflamed pseudopterygial tissue. Two patients (two eyes) had epithelial cyst formation. Amniotic membrane transplantation can be considered an alternative substrate for conjunctival surface reconstruction during removal for large tumors, disfiguring scars, or symblepharon, especially for those whose surrounding conjunctival tissue remains relatively normal.

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Cultivation of corneal epithelial cells on intact and denuded human amniotic membrane.

N Koizumi, G Bairaktaris, S Kinoshita … (2000)

Surgery to reconstruct the ocular surface is greatly facilitated by the use of amniotic membrane, either as a biologic drape or, more recently, as a substrate for the transplantation of cultivated corneal epithelial cells. This study was designed to compare the usefulness of intact and denuded human amniotic membranes as a substrate for corneal epithelial cell culture. Small (3-mm-diameter) biopsy specimens of superficial cornea including epithelium were excised from the central and limbal regions in rabbits. They were cultured on human amniotic membrane with or without amniotic epithelial cells and examined by light, scanning electron, and transmission electron microscopy. Cellular outgrowth from the central explants (n = 10) after 14 days in culture measured 1.82 +/- 2.62 mm2 on intact amniotic membrane and 131.83 +/- 28.31 mm2 on denuded amniotic membrane. In contrast, outgrowths from the limbal explants (n = 10) at the same time measured 4.58 +/- 4.56 and 505.39 +/- 134.20 mm2 on intact and denuded amniotic membranes, respectively. The leading edges of the outgrowths on intact amniotic membrane were much less uniform than those on denuded amniotic membrane, and, in the former, corneal epithelial cells appeared to migrate over the top of amniotic epithelial cells. Limbal cells cultivated on denuded amniotic membrane formed a nicely stratified layer that adhered well to the underlying amniotic membrane. Denuded amniotic membrane appears to be an excellent substrate for the cultivation of corneal epithelial cells, with a view to transplantation.

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Correlation of corneal complications with eyelid cicatricial pathologies in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis syndrome.

Edgar M Espana, Alireza Baradaran-Rafii, Tetsuya Kawakita … (2005)

To look at the correlation between many factors (time of hospitalization, floppy eyelid syndrome, trichiasis, open lacrimal puncta, symblepharon, and aqueous tear deficiency) and corneal complications in Stevens-Johnson syndrome (SJS). Observational cases series. Clinical data were retrospectively reviewed from 38 patients (32.7+/-20.1 years old) with SJS (n = 11) and with toxic epidermal necrolysis (TENS) (n = 27) from January 2002 to August 2004. One case report with SJS was included to verify the presence of tarsal/lid margin ulceration at the acute stage. The medical history was retrieved regarding presumed causative medications used within 15 days and the duration of hospitalization. Data of the latest photographic documentation and eye examination were compared and correlated in a masked fashion. Floppy eyelid, trichiasis, lid margin keratinization, meibomian gland orifice metaplasia, symblepharon, tarsal scar, and corneal complications. Acute SJS/TENS was characterized by tarsal conjunctival ulceration. Keratinization of the eyelid margin with variable degrees of meibomian gland dysfunction was observed in all cases. Floppy eyelid, trichiasis, partially or totally opened lacrimal punctum, symblepharon, and aqueous tear deficiency were not significantly correlated with corneal complications. In contrast, there was a strong correlation between the severity of eyelid margin and tarsal pathology and the extent of corneal complications (Spearman r, 0.54; P = 0.0005). A multivariable regression analysis also showed that the extent of eyelid and tarsal pathology had a significant effect on corneal complications (coefficient, 0.84; P = 0.006). Patients with acute SJS/TENS are characterized by severe inflammation and ulceration of the tarsal conjunctiva and lid margins. If left unattended, lid margin keratinization and tarsal scar, together with lipid tear deficiency, contribute to corneal complications because of blink-related microtrauma. Attempts to suppress inflammation and scarring by amniotic membrane transplantation at the acute stage and to prevent microtrauma at the chronic stage are vital to avoid sight-threatening complications.

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Author and article information

Contributors

Keyly Fernández García: Role: ND

Leané Yeny Bonet Hernández: Role: ND

Urbano Rodriguez de Paz: Role: ND

Zulema Gómez Castillo: Role: ND

Madelyn Jareño Ochoa: Role: ND

Patricia Andújar Coba: Role: ND

Journal

Journal ID (publisher): oft

Title: Revista Cubana de Oftalmología

Abbreviated Title: Rev Cubana Oftalmol

Publisher: Editorial Ciencias Médicas (Ciudad de la Habana )

ISSN: 1561-3070

Publication date (Print): December 2012

Volume: 25

Issue: 2

Pages: 312-323

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[1 ] Instituto Cubano de Oftalmología Ramón Pando Ferrer Cuba

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Publisher ID: S0864-21762012000200015

SO-VID: 6c32e589-ddcc-4a39-b7c5-13be31d7ea64

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http://creativecommons.org/licenses/by/4.0/

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Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=0864-2176&lng=en

Membrana amniótica como alternativa de tratamiento en superficie ocular Translated title: Amniotic membrane as a therapeutic option for the ocular surface

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Most cited references 43

Amniotic membrane transplantation for conjunctival surface reconstruction.

Cultivation of corneal epithelial cells on intact and denuded human amniotic membrane.

Correlation of corneal complications with eyelid cicatricial pathologies in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis syndrome.

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