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The amniotic membrane (AM) has found several clinical applications for ophthalmic indications, in particular, those related to ocular surface (OS) diseases. Successful results have been reported after use in treatment of persistent corneal epithelial defects, bullous keratopathy, acute and late stages of chemical burns and OS inflammatory diseases such as Stevens Johnson syndrome and after excision of conjunctival lesions, besides others.1–3
The AM has a complex structure, and several layers have been described. Essentially, it is composed of a metabolically active epithelium, which rests on a basement membrane and an avascular stroma. The epithelium and the stroma contain several growth factors, cytokines and other metabolically active substances. The transforming growth factor (TGFb) and the epidermal growth factor (EGF) are major and important growth factors. Proinflammatory and anti-inflammatory cytokines, such as interleukin 6 (IL-6), IL-8, IL-10 and IL-1ra, metalloproteases and tissue inhibitors of metalloproteases, and others have also been described.3 4
The mechanism of action of the membrane is not precisely known. Much of its beneficial effect can be attributed to its role as a substrate or scaffold supporting cell growth, migration and adhesion.5 The actions …