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Sutureless cryopreserved amniotic membrane graft and wound healing after photorefractive keratectomy
Anton Vlasov1, Rose K Sia1, Denise S Ryan1
1From the Ophthalmology Service (Vlasov, Stutzman), Walter Reed National Military Medical Center, Bethesda, Maryland, the Warfighter Refractive Eye Surgery Program and Research Center (Sia, Ryan, Rivers), Fort Belvoir, Virginia, the Ophthalmology Service (Mines), Madigan Army Medical Center, Tacoma, Washington, the Ocular Surface Center and Ocular Surface Research & Education Foundation (Tseng), Miami, Florida, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
Purpose:
To evaluate the effect of sutureless cryopreserved amniotic membrane (Prokera) on corneal wound healing after photorefractive keratectomy (PRK).
Setting:
Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, DC, USA.
Design:
Prospective nonrandomized control trial.
Methods:
Patients had PRK for myopia with or without astigmatism. A 20% ethanol solution was used to create a standard 9.0 mm epithelial defect followed by photoablation with the Allegretto Wave Eye-Q 400 Hz laser. After surgery, a high-oxygen-transmissible bandage contact lens (Acuvue Oasys) was applied on the dominant eye and cryopreserved amniotic membrane on the nondominant eye. The postoperative regimen was otherwise identical for both eyes. Postoperatively, patients were evaluated daily until complete corneal reepithelialization occurred in both eyes and then at 2 weeks and 1, 3, 6, and 12 months. Reepithelialization was assessed daily with slitlamp examination, fluorescein staining, and photography. Secondary outcome measures included adverse effects, ocular comfort, visual outcomes, and corneal haze.
Results:
Forty patients were enrolled. The amniotic membrane graft sped corneal reepithelialization 1 day after PRK but was not better than the bandage contact lens in hastening complete reepithelialization of the cornea. Visual outcomes, corneal clarity, and optical quality of the cornea were comparable between the amniotic membrane graft eyes and bandage contact lens eyes.
Conclusion:
Although the amniotic membrane graft was reasonably well tolerated with few significant adverse effects, the role of amniotic membrane in modulating wound healing after PRK remains speculative.
