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Amniotic membrane transplantation for the management of corneal epithelial defects: An in vivo confocal microscopic study.
  1. Mario Nubile (m.nubile{at}unich.it),
  2. Harminder S Dua (hdua{at}onetel.com),
  3. Manuela Lanzini (manulanzini{at}virgilio.it),
  4. Paolo Carpineto (p.carpineto{at}unich.it),
  5. Marco Ciancaglini (m.ciancaglini{at}unich.it),
  6. Lisa Toto (totolisa{at}hotmail.com),
  7. Leonardo Mastropasqua (mastropa{at}unich.it)
  1. Ophthalmology Clinic, University "G. d'Annunzio" of Chieti-Pescara, Italy, Italy
  2. Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, United Kingdom, United Kingdom
  3. Ophthalmology Clinic, University "G. d'Annunzio" of Chieti-Pescara, Italy, Italy
  4. Ophthalmology Clinic, University "G. d'Annunzio" of Chieti-Pescara, Italy, Italy
  5. Ophthalmology Clinic, University "G. d'Annunzio" of Chieti-Pescara, Italy, Italy
  6. Ophthalmology Clinic, University "G. d'Annunzio" of Chieti-Pescara, Italy, Italy
  7. Ophthalmology Clinic, University "G. d'Annunzio" of Chieti-Pescara, Italy, Italy

    Abstract

    Purpose: To evaluate amniotic membrane (AM) tissue morphology and corneal epithelial healing in human eyes after amniotic membrane transplantation (AMT), using laser scanning in vivo confocal microscopy (IVCM).

    Patients and methods: Twenty eyes of twenty patients, treated with single layer epithelial side up AMT for chemical burns in the acute stage (n=8) and persistent corneal epithelial defect (n=12) were studied by serial IVCM post AMT until complete re-epithelization. Changes in morphology of transplanted amniotic tissue and healing corneal epithelium were noted. AM and corneal epithelial cell density was calculated using image analysis software.

    Results: IVCM enabled visualisation of transplanted AM and of regenerating epithelial cells under the AM. The mean AM epithelial cell density, one day after transplant, was 4613 ± 380 cell/mm2. Average AM epithelial thickness was 35 ± 4 μm, while AM stromal thickness was 116 ± 31 μm. The amniotic stroma appeared to be composed of a superficial dense fibrous layer and a deeper loose reticular network of fibers. Amniotic epithelium was lost within 15 days of transplant and complete re-epithelisation of the corneal surface was achieved between one and four weeks.

    Conclusions: Laser scanning IVCM is a useful method for evaluating AM tissue morphology, degradation and corneal epithelial healing after AMT for different clinical indications. When the amniotic membrane acts as a patch, i.e. epithelial cells migrate under rather than over the membrane, the membrane disintegrates and is lost.

    • amniotic membrane
    • confocal microscopy
    • corneal epithelium
    • ocular surface

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      Harminder S Dua Arun D Singh, Editors-in-Chief