Amniotic membrane transplantation.

In 1910 Davis was the first to report the use of fetal membranes as surgical material in skin transplantation. Since then the use of amniotic membrane in surgery has been expanded. It is now utilised as a biological dressing for burned skin, skin wounds, and chronic ulcers of the leg, as an adjunctive tissue in surgical reconstruction of artificial vagina, 17–19 and for repairing omphaloceles. 20 It has also been used to prevent tissue adhesion in surgical procedures of the abdomen, head, and pelvis. 21 22 In the 1940s several authors reported the beneficial role of amniotic membrane in treating a variety of ocular surface disorders. 23 However, its use was abandoned for decades until recently, when it was reintroduced to ophthalmologists. Several studies have addressed this subject and the scope of the application of amniotic membrane transplantation (AMT) in the management of ocular surface disorders is ever increasing. Certain characteristics make the amniotic membrane ideally suited to its application in ocular surface reconstruction. It can be easily obtained and its availability is nearly unlimited. The tissue can be preserved at −80°C for several months, allowing suYcient time to plan surgery or consider a trial of other options. Amniotic membrane does not express HLA-A, B, or DR antigens and hence immunological rejection after its transplantation does not occur. It is also believed to have antimicrobial properties, reducing the risks of postoperative infection. Antifibroblastic activity and cell migration/growth promoting activity have also been demonstrated with regard to the amniotic membrane. The purpose of this paper is to review the characteristics of amniotic membrane that make it potentially useful to treat ocular surface abnormalities and to discuss the current indications, the surgical technique, and the outcome of AMT.