[Amniotic membrane transplantation in various systemic diseases : Success and recurrence rates in relation to...

Amniotic membrane transplantation (AMT) has been an important procedure for treatment of persistent corneal epithelial defects for many years. The aim of this study was to evaluate the influence of underlying systemic diseases, concomitant systemic medication, corneal status, depth of the epithelial defect, and surgical technique on AMT success and recurrence rates.

A total of 780 AMT procedures (496 patients, 519 eyes) performed from 2013 to 2019 were retrospectively analyzed. The presence of systemic disease (divided into different categories) and concomitant medication, the depth of the corneal defect (erosion/ulcer), the corneal status (own cornea/graft), and the surgical technique (patch/sandwich/graft) were recorded. Main outcome measures included epithelial closure at 4 weeks ("success") and the recurrence rate. The follow-up period was 1 year. Significance was set at p ≤ 0.05.

There was an epithelial closure rate of 58.8% and a recurrence rate of 18.7%. Cases with thyroid gland disease had a significantly lower success rate than the rest of the study population (p = 0.003). Cases with a viral infection showed a significantly higher success rate (65.7%, n = 204) compared to cases without a viral etiology (56.5%, n = 326; p = 0.039). Regarding concomitant medication, the success rate was significantly higher when systemic steroids were used (p < 0.001). Comparing the success of AMT on the own cornea and on a graft, the success rate on the own cornea was significantly higher (p = 0.019) than on a donor cornea. There was no significant difference in surgical technique regarding success and recurrence rate.

Amniotic membrane transplantation is a reasonable option for persistent epithelial defects even under everyday clinical conditions. Especially in case of primary success (epithelial closure after 4 weeks) can a better long-term outcome be assumed. Thyroid gland disease is related to significantly worse success rates. Significantly worse results of AMT can be expected on a transplant than on the patient's own cornea.