[Reconstruction of the conjunctival and corneal surface. Transplantation of amnionic membrane]

The ocular surface epithelia with the tear film as a unit provide clear vision and comfort and serve as the first line the defense. It is important to understand how ocular surface health is maintained and how ocular surface failure occurs. Furthermore, it is timely to summarize new information concerning action mechanisms and clinical uses of amniotic membrane transplantation for ocular surface reconstruction. When appropriately processed and preserved, amniotic membrane as a native matrix can be used as a graft to restore conjunctival surfaces following removal of lesions such as pterygium, tumor, scar, symblepharon, and conjunctivochalasis. It can also be used as a graft to restore corneal surfaces suffering from limbal stem-cell deficiency. For partial limbal deficiency, amniotic membrane alone is frequently sufficient, while for total limbal deficiency it needs to be combined with limbal stem-cell transplantation with or without corneal transplantation. When used as a graft or patch, amniotic membrane can facilitate healing of persistent corneal ulcers and recurrent corneal erosion and reduce corneal haze following keratectomy. Reported data indicate that amniotic membrane transplantation facilitates rapid healing with recovery of a normal epithelial phenotype in the epithelium and reduces inflammation, vascularization, and scarring in the stroma.