Amniotic membrane transplantation R4 김태경 / Pf. 김만수 Department of Ophthalmology and Visual Science Kangnam St. Mary's Hospital The Catholic University of Korea

Amniotic membrane transplantation -Indications-

Amniotic membrane transplantation As a graft for conjunctival disease : 노출된 bare sclera가 넓으나, non-ischemic : 병변 경계 부위의 결막은 정상 상피와 기질을 가진 경우 사용 가능함

4. Grade III: Loss of the upper, lower, medial, and lateral fornices. AMT for acquired socket contracture Classification of contracted socket 4. Grade III: Loss of the upper, lower, medial, and lateral fornices.   5. Grade IV: Loss of all the fornices and reduction of palpebral aperture in horizontal and vertical dimensions.   6. Grade V: Recurrence of contraction of the socket after repeated trials of reconstruction. . Grade 0: Socket is lined with healthy conjunctiva and has deep and well formed fornices.   2. Grade I: Shallow lower fornix or shelving of the lower fornix.   3. Grade II: Loss of the upper and lower fornices.   Amniotic membranes are a valuable tool in socket reconstruction, as they promote normal conjunctival epithelial migration and subsequent differentiation over the graft, reinforcement of basal epithelial adhesion, and inhibition of subconjunctival fibrosis due to downregulation of transforming growth factor-[beta], and they also possess a potent antimicrobial activity [6–10].   It should be noted, however, that an amniotic membrane is a ‘substrate graft’ in contrast to an oral mucous membrane graft, which is considered as a ‘substitute graft’ [7]. Substrate grafts require some healthy conjunctival epithelial cells to differentiate and multiply over the graft; therefore, sockets with severe contraction from lid margin to lid margin may not be amenable to amniotic membrane transplantation.

Cautery Fixation for Amniotic Membrane Transplant in Pterygium Surgery A, Surgical photograph with overlay demonstrating location of cautery spots (gray circles) and sutures (black plus signs). B, Surgical photograph demonstrating appearance of fixated graft after cautery fixation is complete.

Treatment of Necrotizing Scleritis after Conjunctival Autografting for Pterygium with Amniotic Membrane Transplantation FiGURE 1 Slit-lamp photography of the patient shows a focal area of extreme thinning with uveal show, surrounded by edematous conjunctiva. FiGURE 2 Two-month post-operative appearance of the patient after amniotic membrane transplantation.

Conjunctival Resection With and Without Amniotic Membrane Graft for the Treatment of Superior Limbic Keratoconjunctivitis AM allows epithelialization in a more physiological condition, by diminishing scarring and adhesion between conjunctiva and sclera, and may therefore lead to a higher probability of relapsing conjunctival redundancy

Conjunctival squamous cell carcinoma excision, cryotherapy, & AMT #POD 1yr AMT : in conjunctivochalasis

Amniotic membrane transplantation As a amniotic membrane patch : 일시적으로 이식 양막을 제거 : PRK, PTK후 각막 혼탁과 통증을 줄임, 화학화상에서 염증과 흉터를 줄임, 상피 재생을 촉진시킴

Amniotic membrane transplantation As a carrier for expanding epithelial stem cells : 양막 - Limbal Stem Cell수명을 연장, 세포 고유의 특성을 유지시킴 줄기 세포 체외 배양을 위한 바닥막 겸 운반체가 됨 : 작은 윤부 조직을 떼어 양막에서 3~4주간 배양 상피 세포가 배양된 양막을 윤부 결핍된 각막에 이식 가능

Amniotic membrane transplantation As a carrier for expanding epithelial stem cells Advantages : using small number of donor cells : reducing effect on donor surface : AM is absorbed and restructured into underlying stroma and not need removal