Human amniotic membrane-derived dry matrix (AMDDM) is a promising new tool for treating persistent epithelial defects (PEDs) that can be applied easily, according to research published in Clinical Ophthalmology.
Managing PEDs requires physicians to also control the underlying etiologies, which extends the follow-up period. First-line treatments can include a range of options, such as frequent lubrication, plasma drops, discontinuation of other topical medications, bandage contact lens, punctal occlusion, pressure patching, epithelial debridement, lid botulinum toxin injection, and tarsorrhaphy. In refractory cases, amniotic membrane transplantation has been successful in promoting the re-epithelialization of PEDs, according to the researchers. Prior investigations suggest amniotic membranes promote epithelialization by preventing apoptosis and releasing growth factors that stimulate and support epithelial cells. In addition, amniotic membrane transplantation is reported to have anti-inflammatory, antimicrobial, antifibrotic, and anti-angiogenic properties.
To investigate the outcomes of using human AMDDM to manage PEDs of various etiologies, researchers conducted a cohort study of 84 patients ranging in age from 7 to 92 years. During the study, 93 PEDs were treated with AMDDM at 2 centers in the UK. To be included in the study, patients had PEDs that failed to epithelialize in 2 weeks with standard therapy. Patients with absent or shallow fornices to fit in a bandage contact lens and fewer than 24 hours of AMDDM application were excluded from the study.
A total of 106 applications of AMDDM were recorded for 81 patients (52 men, 29 women) with a spectrum of different etiologies. Of them, 58% of the eyes showed complete healing, and 28% showed a partial decrease of the size of PEDs, with an average treatment length recorded as 22.4±12.3 days. In patients with limbal stem cell deficiency (n=44; aniridia=12, chemical injury=9, Stevens-Johnson syndrome=10), 50% of PEDs showed complete healing, and 27% showed partial healing. In patients with microbial keratitis (n=21) (bacterial: 13, fungal: 4, herpetic: 3, acanthamoeba: 1) 57% of PEDs showed complete healing and 33% were partially healed. In patients with keratoplasty (n=16), 56% of PEDs showed complete healing and 31% were partially healed. Vision remained stable in 59% and improved in 27%, according to investigators.
“AMDDM proved to have easy application in the outpatient clinic setting with no storage restrictions,” the report explains. “It was very well tolerated by the patients and had moderate to excellent results based on the indication.”
The retrospective nature of the study and short- to moderate-term follow-up are limitations.
Maqsood S, Elsawah K, Dhillon N, et al. Management of persistent corneal epithelial defects with human amniotic membrane-derived dry matrix. Clin Ophthalmol. 2021;15(5):2231-2238. doi:10.2147/OPTH.S299141