Transcript Preliminary Experience with the use of Freeze dried

Freeze -Dried Amniotic Membrane Transplantation:
In expensive Tectonic Support in complicated
Infectious Keratitis Cases
Hatem Kobtan MD FRCS (Ed) (Glasg)
Cairo University
Dina Kobtan MD
The authors have no financial disclosure
Aim of Work
 To evaluate the efficacy and safety of Freeze dried amniotic membrane
transplantation (FD-AMT) as a tectonic support (Biologic contact lens) in
cases of keratitis with corneal perforation, descemetocele
and
melting.
A
B
Fig (A) FD AM held with forceps as a sheet. (B) H and E stain of the membrane
showing a single epithelial layer and underlying stroma.
Freeze dried AMT
Kobtan
World Cornea Congress 2010
Material and Methods

This study involved a prospective, noncomparative, interventional case series.
11 eyes of 11 patients with infectious
keratitis were enrolled.

The FD-AM application consisted of an
overlay technique. The AM was secured
by interrupted 8-0 Vicryl sutures placed
just outside the limbus.

After surgery all patients continued to
receive their appropriate antimicrobials
medications until inflammation had
subsided.

Current opinion ophthalmology. Volume 12(4). 2001
FD-AM invariably dissolved over the
course of approximately one week.
Multiple application of AM was not
necessary except in case 10 and 11.
Freeze dried AMT
Kobtan
World Cornea Congress 2010
Case 1
A
A
B
Case 1: (A) Color photo showing deep corneal ulcer measuring 5X 5 mm
A
reaching
down to the level of descemet’s membrane ( Blue arrow) with
surrounding superficial and deep corneal vascularization (Yellow arrow)
(B) Shows formation of a vascularized leukoma 8 weeks post FD AMT.
30-1-07
Freeze dried AMT
Kobtan
World Cornea Congress 2010
Case 2
A
27-5-06
B
4-7-06
Case 2 : (A) Color photo showing corneal perforation (Black arrow) with lost
anterior chamber and positive Seidel testing. (B) Four weeks following FDAMT with formation of a vascularized leukoma.
Freeze dried AMT
Kobtan
World Cornea Congress 2010
Case 3
A
Case 3 : ( A ) Color photo showing peripheral corneal melting (Blue arrow).
(B) A vascularized leukoma is seen 8 weeks post FD-AMT.
Freeze dried AMT
Kobtan
World Cornea Congress 2010
Case 4
A
B
Case 4: (A) Color photo shows central huge descemetocele (Green arrow)
that subsequently developed in the area of corneal thinning . (B) Nine
weeks post FD-AMT shows complete resolution of the descemetocele.
Freeze dried AMT
Kobtan
World Cornea Congress 2010
Results
 Complete epithelialization with stromal rebuild under the
transplanted membrane was achieved in all cases with two
exceptions case 10 and 11 which showed persistent localized
central thinning most likely due to LSCD.
 All patients demonstrated resolution of the ocular inflammation
with no recurrence of infection in any of the treated patients
during the mean follow-up of 1 month to 2 years.
Freeze dried AMT
Kobtan
World Cornea Congress 2010
Conclusion
 FD-AMT was effective for treating corneal descemetocele, corneal
perforation and melting of moderate severity associated with
infectious keratitis when used with the appropriate antimicrobial.
 AMT offers the following advantages over tectonic corneal grafts
and conjunctival flaps including avoidance of potential complications
of corneal transplantation including allograft rejection; Feasibility of
AMT in places where there is a shortage of cornea tissues and
preservation of patient’s cosmetic appearance without covering of
the cornea with vascularized conjunctival tissue..
 This novel and promising biomaterial may be a useful
alternative to cryopreseved –AMT. It may be even advantageous
with regards its ready availability, sterililization and production
costs.
Freeze dried AMT
Kobtan
World Cornea Congress 2010
Warning
 FDA has not approved the use of the freeze dried AM. FDA has
concluded that removal of cytokine containing cells from FD tissue
would interfere with human amniotic membrane's ability to
actively mediate wound repair and wound healing.
References
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Wakana Ito, Tsutomu Inatomi, Chie Sotozono, Tatsuo Nakamura, Yasuhiko Shimizu, and
Shigeru Kinoshita1. Sterilized, Freeze-Dried Amniotic Membrane: A Useful Substrate
for Ocular Surface Reconstruction. Investigative Ophthalmology and Visual Science
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2. Sippel, Kimberly C., Ma, Joseph J.K. ; Foster, C. Stephen: Amniotic membrane
surgery. Current openion ophthalmology 12(4) 2001 269-281.
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with ulceration. Am J Ophthalmol 1997;123: 303–12.
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transplantation for reconstruction of deep corneal ulcers. Ophthalmology 1999, 106:
1504–1511.
5. Letko E, Stechschulte SU, Kenyon KR, et al .: Amniotic membrane inlay and overlay
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659–663.