Role Of Amniotic Membrane Transplantation (Amt) In Management Of Recurrent Pterygium

To study the outcome of Amniotic Membrane Transplantation ( AMT ) in the management of recurrent pterygia.

Benha University hospital

Retrospective clinical study included 40 cases with recurrent pterygia with at least 6-months of follow up.

- Excision of pterygium with bare sclera technique and patients were subdivided into 2 groups: group-1 subsequently managed with topical MM-C, while group-2 was managed with AMT at the time of surgery.

- Human AM: AM was collected from human placenta. HIV , hepatitis type-B, C, and Syphilis had been excluded by serological tests. The placenta is cleaned, the AM is prepared, sterilized and  preserved for recent use The amniotic membrane was defrosted at room temperature for 15 minutes, before surgery, and washed with saline solution.

- All patients were subjected to :

1. A detailed history taking.

2. Complete ophthalmic examination.

All surgeries went uneventful.

1. Visual acuity: Improvement occurred in 60% of group-1 and 70% of group-2, however there was no significant difference between the 2 groups.

2. Postoperative astigmatism: There was a significant difference between preoperative and postoperative corneal astigmatism after 6 months in both groups ( p<0.01).However, the difference between the two groups was statistically insignificant.

3. Corneal bed complications: In the 1^st postoperative 2 weeks, there was statistically insignificant higher incidence of delayed wound healing and superficial punctate keratitis in MMC group.

4. Scleral bed complications: There was 2 cases of conjunctival defect and two cases of scleral thinning in MMC group.

Amniotic membrane has proved to promote apoptosis of activated inflammatory cells, phagocytosis and enhance the action of anti-inflammatory cytokines preventing proliferation and fibroblast differentiation. The adjunctive use of Amniotic membrane and intraoperative mitomycin-C in pterygium surgery resulted in a low recurrence rate. The recurrence rate has significantly decreased from as high as 30-82 % during the past few decades to less than 10 % now. This combined procedure of Amniotic membrane transplantation with intra-operative MM-C is effective in the treatment of recurrent pterygium with an improvement in visual acuity and postoperative corneal astigmatism.