Top Uses of Amniotic Membrane to Heal the Eyes
The Amniotic Membrane in General
Amniotic membrane treatments and transplants are allographic treatments, meaning they come from a donor. The amniotic membrane comes from the innermost layer of the placenta and is made up of three layers: the epithelium, a thick basement membrane, and an avascular stromal matrix. The stroma of an amniotic membrane can be subdivided further into a compact layer, a fibroblast layer, and an outer spongy layer. For use in treatment, the amniotic membrane is harvested in a sterile environment from placental tissue obtained during elective cesarean sections. Donors are screened for transmissible diseases, and the amniotic membrane is further treated with broad-spectrum antibiotics immediately after collection.
There are two types of amniotic membrane that can be used in-office. One is cryopreserved, where the amniotic membrane is frozen slowly. With this technique, many positive aspects of the amniotic membrane are preserved, such as the hyaluronic acids, growth factors, and collagen. The second type of amniotic membrane is dehydrated, kept at room temperature, and rehydrated for use.
The amniotic membrane is believed to be anti-inflammatory and anti-fibrotic because of the hyaluronic acid present. Hyaluronic acid is a clear substance that retains water to keep tissues lubricated. The amniotic membrane is also angiogenic, so it forms new blood vessels from pre-existing ones, and antimicrobial. The amniotic membrane can promote cell growth through cell migration, adhesion and differentiation and inhibits cell death. For eye problems, in short, it is used to reconstruct the ocular surface after a procedure, used as a graft, or used as a bandage, a physical barrier, to promote healing.
The conjunctiva of the eye is the thin membrane that covers the front surface of the eye and the inner surface of the eyelids. The basement of the amniotic membrane is similar to the conjunctiva.
One thing desirable in treating the eye is epithelialization which is the process by which epithelial cells damaged or lost in a wound are replaced. Amniotic membrane is excellent for epithelialization.
In 30 years, there has been no reported case of rejection by the host or an allergic reaction to amniotic membrane transplants.
Types of Eye Issues that May be Treatable by Amniotic Membrane
The top uses of the amniotic membrane to assist in eye healing are listed here.
– Ocular surface reconstruction. This is in instances where the surface of the eye is damaged, such as in keratitis (infectious and noninfectious), Stevens-Johnson syndrome and with chemical injuries. The amniotic membrane eye procedure can be done in one of three ways. First, there is the graft, or inlay, technique, where the amniotic membrane acts as a scaffold for epithelial cells to grow. In this case, the amniotic membrane is placed basement side up and it is incorporated into the cornea or conjunctiva. The other method is the patch, or overlay, technique. The amazing thing about amniotic membranes is how they can function as a “biological bandage,” protecting what is underneath even from the friction of blinking action. In this case, the amniotic membrane is not incorporated, but will eventually fall off or be removed. A third technique can also be utilized, which is referred to as the layered, or fill-in, technique. Small pieces of amniotic membrane are used to fill a corneal ulcer or crater. Then, a graft is applied to the surface.
– LSCD. With this condition, patients are missing cells that are vital for the corneal epithelium to repair itself. Corneal conjunctivalization and scarring and chronic inflammation lead to lack of clarity, chronic pain, photophobia, among other problems. genetic conditions, Stevens-Johnson Syndrome and burns can lead to this condition. With LSCD, amniotic membrane treatment will be used in conjunction with other treatments. Outcomes have been achieved in the 60-70% success range.
– Pseudophakic bullous keratopathy. This is a painful condition sometimes resulting from trauma during cataract surgery. This condition can lead to decreased vision, tearing, and pain. Treatment with amniotic membrane has been shown to greatly reduce pain even in the long term to manage this condition.
– Persistent corneal epithelial defects, ulcers, and perforations. These can result from many causes, including inflammatory disease like keratoconjunctivitis sicca (dryness of the conjunctiva and cornea); neurotrophic disease from diabetes, infection, or nerve damage from surgery; or mechanical factors such as abnormal lid pathology. Amniotic membrane treatment is used to increase the thickness of the stroma with sutures or fibrin glue.
– Conjunctival reconstruction. One example of amniotic treatment for conjunctival reconstruction is with glaucoma treatment. It reduces scarring at the time of surgery, can repair early or late leaks, among other positive outcomes.
– Acute ocular burns. In August of 2000 it was reported that amniotic membrane transplantation was found to be effective to deal with acute ocular burns. Effectiveness depends upon the extent of the burn. By reducing inflammation, cells grow back and can reduce visual loss from scarring. Treatment, for best results, should be within the first two weeks of injury.
There are an increasing number of eye problems for which amniotic membrane transplants or treatments might provide to be useful. The science is still developing but much promise has been shown. The good news about amniotic membrane treatment is that amniotic membrane price is often covered by insurance. The amniotic membrane price might also be covered by Medicare. If you have questions about how amniotic membranes might help you, or the amniotic membrane price, please use the contact form below to find a doctor.