Both cryopreserved (C-SAM) and dehydrated (D-SAM) sutureless amniotic membranes demonstrate similar efficacy for improving and resolving persistent epithelial defects without surgical intervention, according to a study published in American Journal of Ophthalmology.
Researchers enrolled 197 patients (mean age, 61.16 years; eyes, 204; defects, 220) with persistent epithelial defects who were treated with either C-SAM (n=127) or D-SAM (n=93) in the multicenter, retrospective, comparative clinical study. The team included patients with defects that failed to resolve after 7 days of treatment with artificial tear therapy, punctal occlusion, bandage contact lenses, or tarsorrhaphy.
The most common underlying etiologies for persistent epithelial defects were neurotrophic keratitis (46.8%), postinfectious keratitis (18.6%), postoperative keratitis (8.2%) and chemical injury (7.3%). The primary outcome was persistent epithelial defect resolution or improvement, while secondary outcomes were treatment failures and adverse events.
Overall, 100 persistent epithelial defects (45.5%) resolved with the use of a single amniotic membrane. This included 46.5% (n=59) of defects treated with C-SAM and 44.1% (n=41) of defects treated with D-SAM (P =.727). Among defects without resolution, 71 demonstrated improvement after treatment with 1 of the sutureless amniotic membranes. After considering improvements, 78.7% of patients receiving C-SAM experienced resolution or improvement following treatment compared with 76.3% of patients receiving D-SAM.
A total of 49 persistent epithelial defects neither experienced improvement nor resolution following treatment (C-SAM: 21.3%; D-SAM: 23.7%; P =.673) and no statistical significance between treatment and persistent epithelial defect improvement or resolution was noted.
The most common adverse events following C-SAM treatment were pain or ring dysesthesia (n=10; 7.9%), perforation (n=3; 2.4%), lost ring (n=2; 1.6%), and worsened persistent epithelial defects from ring trauma (n=2; 1.6%). Infectious or sterile infiltrate (n=9; 9.7%) scrolled or displaced amnion (n=6; 6.5%), and pain (n=4; 4.3%) were the most commonly reported adverse events among individuals treated with D-SAM.
“[B]oth C-SAMs and D-SAMs were equally as effective in the treatment of [persistent epithelial defects] failing conservative medical treatment, which widens the clinician’s flexibility for these two main types of commercially available [sutureless amniotic membranes],” according to the study authors. “Specific differences in adverse events may help dictate clinical use between these two options.”
Study limitations include a retrospective nature, failure to consider differences in pretreatments, and inconsistencies in available data.
Sell S, de la Presa M, Thakur S. Comparison of persistent epithelial defect treatment with sutureless cryopreserved and dehydrated amniotic membrane. Am J Ophthalmol. Published online December 10, 2022. doi:10.1016/j.ajo.2022.12.007