Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery

AIM: To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation(CAT with AMT), conjunctival autograft transplantation(CAT) alone and amniotic membrane transplantation(AMT) alone.METHODS: In this retrospective study, 142 eyes of 142 pterygium patients(104 primary, 38 recurrent) who underwent CAT(group A), AMT(group B) or CAT with AMT(group C) respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications.RESULTS: The number of recurrence post-surgery were 17(9 from primary, 8 from recurrent; the same description below), 18(10, 8) and 2(1, 1) in groups A, B, and C respectively; dry eyes were 22(16, 6), 27(18, 9) and 7(3, 4); conjunctival inflammations were 30(17, 13), 27(16, 11) and 11(6, 5). Patients in group C(either primary or recurrent or both) mainly showed significantly better results than those in group A or B(P<0.05) regarding above-mentioned clinical effects.CONCLUSION: Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone.

Amniotic membrane transplantation with topical interferon alfa-2b after excision of ocular surface squamous neoplasia

To evaluate the outcome of amniotic membrane transplantation(AMT) after tumor excision followed by topical interferon alfa-2 b(IFNα2 b) drops for primary ocular surface squamous neoplasia(OSSN). Twelve eyes of 12 patients with a mean age of 66±10 y were included. The average followup was 23±10 mo. All 12 patients had limbal involvement. Smooth ocular surface and transparent cornea were achieved in all cases. No sign of inflammation, neovascularization, symblepharon or recurrence was noted at the last follow-up. We conclude that AMT with topical IFNα2 b drops restores a healthy ocular surface in OSSN without recurrence.

Toxic keratopathy associated with abuse of topical anesthetics and amniotic membrane transplantation for treatment

AIM: To evaluate the clinical findings of toxic keratopathy associated with abuse of topical anesthetics and the treatment efficacy of amniotic membrane transplantation(AMT).·METHODS: Fifteen eyes of 10 patients with abuse of topical anesthetics were included in this study. The data collected included patients' demographic information,initial best corrected visual acuity(BCVA), clinical findings, time to AMT, duration of epithelization,additional treatments, posttreatment BCVA, and the results of psychiatric examination.·RESULTS: All patients were male, with the mean age of37.9 ±5.4y. The patients had received 0.5% proparacaine hydrochloride due to pain resulting from foreign bodies,such as welding flash burns and car battery explosions,for a mean of 18.2 ±12.4d. The mean initial BCVA of the patients was 0.069 ±0.100. All patients had persistent epithelial defects, stromal infiltration, ring ulcer, and corneal edema. Initially, medical treatment was attempted in all cases. Because of severe pain, persistent epithelial defects and progressing stromal thinning did not improve with medical treatment, thus, the patients underwent AMT. The mean posttreatment BCVA of the patients was 0.33 ±0.27. All of them, except for two patients, showed improved visual acuity. One patient underwent evisceration for corneal melting and endophthalmitis in another center, and one patient underwent evisceration for severe pain of unknown origin. All 5 patients who consented to a psychiatric examination had depression, had personality disorder,and used tobacco.·CONCLUSION: AMT appears to be an effective method for pain relief, rapid epithelial and stromal healing;however, visual prognosis is still poor despite medical and surgical interventions.

Evaluation of the effects of acyclovir and/or human amniotic membrane on herpes virus culture and quantitative virus inactivity by real-time polymerase chain reaction

·AIM: To investigate the permeability of amniotic membrane in herpes virus cell culture to acyclovir with real time polymerase chain reaction(RT-PCR).·METHODS: Madin-Darby Bovine Kidney(MDBK) cell culture and Bovine Herpes Virus(BHV1) type 1 were used in the study. Cell cultures were grouped into two on the basis of herpes virus inoculation. Each group was sub-grouped into three. Amniotic membrane(V-HAM),acyclovir(V-A), and amniotic membrane and acyclovir(V-HAM-A) were applied to these subgroup cultures,respectively. After the application of the membrane and the drug, the cultures were evaluated at 24 and 48 h for cytopathic effect positive(CPE +) with a tissue culture microscope. In the CPE(+) samples, the DNA was extracted for viral DNA analysis by RT-PCR.·RESULTS: In control cultures without herpes virus CPE was not detected. Besides, amniotic membrane and acyclovir did not have cytotoxic effect on cell cultures.CPE were detected in Bovine Herpesvirus type-1inoculated cell cultures after amniotic membrane and/or acyclovir application. DNA analysis with RT-PCR indicated that Cycle threshold(Ct) values were lower in the BHV1 and membrane applied group(amniotic membrane group < acyclovir group < membrane and acyclovir group). This showed that membrane did not have antiviral effect. The membrane and acyclovir cell culture groups with high Ct values indicated thatmembrane was permeable and had a low barrier effect to drug.·CONCLUSION: In our in-vitro study, we found that amniotic membrane, which can be used in the treatment of corneal diseases, did not have antiviral effect. Besides,we detected that amniotic membrane was permeable to acyclovir in BHV-1 inoculated MDBK cell culture.However, more studies are necessary to investigate the quantitative effects of amniotic membrane and acyclovir.