Sutureless Amniotic Membranes Improve, Resolve Persistent Epithelial Defects

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.