[A clinical study of amniotic membrane transplantation for severe eye burns at the acute stage].

Objective: To investigate the possibility of ocular surface reconstruction with amniotic membrane in the acute stage of burn injury, to compare the results using fresh and preserved amniotic membranes and to evaluate the surgical methods and their effects.

Methods: Consecutive patients of whole corneal burn above degree III with complete destruction of the limbus were divided into two groups to receive amniotic membrane transplantation (8 eyes of 8 patients with fresh amnion, 12 eyes of 11 patients with preserved one) or lamellar keratoplasty (24 eyes of 22 patients). The follow-up period was 12 to 26 months with an average of (15 +/- 2) months.

Results: The ocular surface became stabilized after the transplantation of amniotic membrane. In eyes treated with fresh amniotic membrane, the corneal surface was epithelized immediately. In eyes treated with preserved amniotic membrane, the corneal surface was epithelized only after 2 - 3 weeks. Lamellar keratoplasty was performed in 3 of 12 eyes with preserved amnion transplantation because the amnion was dissolved due to persistent epithelial defects. Amnions were absorbed with time and superficial neovascularization followed in the corneal surfaces. Seven of eight transplanted fresh amnions were absorbed within 2 to 8 months [mean time (4.3 +/- 0.8) months], and 10 of 12 preserved amnions were absorbed within 1 to 3 months [mean time (2.0 +/- 0.3) months]. The difference was statistically significant (t = 4.22, P < 0.01). The conjunctival surface was successfully reconstructed with amniotic membrane at the acute stage of burn injury. Moderate symblepharon occurred in one case only. Corneal dissolution never occurred in all patients who received lamellar keratoplasty, but recurrent erosion of corneal epithelium occurred in the grafts and corneal neovasularization developed eventually. Corneal graft had to be performed again on four eyes and symblapharonplasty had to be performed on seven eyes. Mild to medium symblepharon was observed in 5 of 24 eyes received lamellar keratoplasty. Visual acuity could be maintained at hand movement in eyes treated with amniotic membrane transplantation without secondary glaucoma and cataract. Visual acuity was figure counting in most cases with lamellar keratoplasty.

Conclusions: Amniotic membrane transplantation (especially using a fresh membrane) can effectively reduce the inflammation of the cornea at the acute stage of burn injury, can prevent corneal ulcer and perforation and can make the stabilization process faster. It can also decrease corneal neovascularization as well as establish better conditions for successful keratoplasty.