The amniotic membrane (AM) is a resilient tissue with antiadhesive, bacteriostatic, and epithelialization properties, used in various ophthalmic procedures such as conjunctival reconstruction and treatment of corneal defects. Its application techniques include graft, patch, and layered methods, though its limitations are noted in specific surgeries like pterygium and acute alkali burns. Case studies highlighted the necessity for case selection due to variable effectiveness and potential complications associated with AM treatment.

2. Nature 0f amniotic membrane
The amniotic membrane (AM) is the inner
avascular layer of the three-layered foetal
membrane

5. Layers of amniotic membrane:
1- Epithelium.
2- Basement membrane
3- Stroma.

7. Nature of amniotic membrane
The structure of the membrane, which
presents a single layer of metabolically
very active cuboidal to columnar epithelium
firmly attached to a basement membrane
and an avascular and relatively sparsely
populated stroma, makes it an easy-to-
handle and resilient tissue. The epithelium
and stroma are endowed with a number of
cytokines and growth factors, key among
which are transforming growth factor β and
epidermal growth factor

8. Properties of amniotic
:membrane
1) Antiadhesive effects
effects2) Bacteriostatic
3) Epithelialisation effects.
•4) The lack of
immunogenicity

9. Principles that govern the manner in
which the membrane is applied to
the eye.
1 ) Graft or inlay technique. The AM is
intended to act as a substrate or
scaffold for epithelial cells to grow and
is therefore incorporated into the host
tissue (cornea or conjunctiva). The
AM is usually placed basement
membrane side up.

10. Principles that govern the manner in which
the membrane is applied to the eye.
2 ) Patch or overlay technique. Here the
AM functions essentially as a cover or a
biological bandage ‘contact lens,’
protecting the underlying healing
epithelial surface. The intention is for the
membrane to fall off or be removed over
a period of time.

11. Principles that govern the manner in
which the membrane is applied to the
eye.
3 ) Layered or fill in technique. In this
maneuver , the AM is used in multiple
small pieces to fill the entire depth of a
corneal ulcer or crater. A relatively larger
‘graft’ of membrane is applied to the
surface over which the epithelium is
expected to grow.

12. Uses in ophthalmology :
1) Conjunctival reconstruction
A ) Pterygium
B ) Conjunctival and corneal tumours

13. Uses in ophthalmology :
2 ) Persistent corneal epithelial
defects and perforations
3 ) Limbal stem cell deficiency
E,g : Cicatrising diseases such as
Stevens–Johnson syndrome, chemical
or thermal burns, and ocular cicatricial
pemphigoid (OCP).

14. Uses in ophthalmology :
4) Pseudophakic bullous
keratopathy
5 ) Symblepharon

15. Uses in ophthalmology :
6 ) Glaucoma
7 ) Oculoplastics and orbits

16. :New uncommon uses
1- Amniotic membrane transplantation is
successful anti-inflammatory treatment
in proven ulcerative herpetic keratitis.
2 - Amniotic membrane grafts for
nontraumatic corneal perforations,
descemetoceles, and deep ulcers.

17. :New uncommon uses
3- Amniotic membrane transplantation for
persistent corneal ulcers and
perforations in acute fungal keratitis.
4- Amniotic membrane transplantation
for severe neurotrophic corneal ulcers
5- Amniotic membrane transplantation in
infectious corneal ulcer

18. :New uncommon uses
6- Amniotic membrane transplantation in
severe bacterial keratitis.
7- Amniotic membrane transplantation in
the management of conjunctival
malignant melanoma and primary
acquired melanosis with atypia

19. :New uncommon uses
8- Use of Amniotic Membrane Graft
Combined With Intraoperative Mitomycin
C to Prevent Recurrence After Excision
of Recurrent Pterygia.

20. How to be prepared ?
The donor is screened to exclude risk of transmissible
infections such as human immunodeficiency virus
(HIV), hepatitis B virus, hepatitis C virus, and
Treponema pallidum infections. Ideally, the media
and washing solutions needed for the preparation of
amniotic membrane are prepared only a week to 10
days prior to use and not stored in the freezer weeks
ahead. The AM obtained under sterile conditions
after elective caesarian section is washed free of
blood clots and chorion. With the epithelial surface
up, amniotic membrane is spread uniformly without
folds or tears on individually sterilized 0.22 μm
nitrocellulose membranes of the required sizes.

21. How to be preserved ?
Less popular “”First method :
Freezing of cleaned fresh
membrane at −80 °C in either
phosphate-buffered saline in
dimethylsulphoxide (PBS DMSO)
or in Eagle's Minimum Essential
Medium (MEM) with glycerol.

22. How to be preserved ?
Second method : “ more popular “
Freeze drying of the membrane and
rehydration before use. Fresh
unpreserved membrane is also used
quite commonly in the developing world
but not in the Western countries

24. Limitations of AM
The AM in its early use was portrayed as
a
potential ‘miracle’ cure but it is found that
it
has limitations

25. Limitations of AM
* In pterygium surgery :
Amniotic membrane graft had a higher
recurrence rate than conjunctival
autograft

26. Limitations of AM
* In acute alkali burns :
AMT did not convey any benefit in visual
improvement. However, there was a
reduction in acute pain and more rapid
epithelisation in moderate burns. No
benefit was conferred in severe burns.

27. Limitations of AM
* In the treatment of leaking
trabeculectomy blebs:
AMT did not offer an effective
alternative to conjunctival
advancement

28. :Case presentation 1
A 43 ys old male referred to
ophthalmology department in Sohag
:university hospital presented with
Lt. central corneal melting
Bil. Posterior blephritis with severe dry eye

29. Treatment was in the form of :
1- Topical tear substitutes .
2- Topical antibioticies .
3 – Mydriatics cycloplegics .
4 – Systemic doxycycline .

30. Is amniotic membrane effective
in this case ?
Amniotic membrane was used in this
patient
Freeze dried membrane was sutured to
The conjuctiva by vicryil (8-0) covering the
corneal defect as one layer .

31. Follow up :
First day Postoperative :
Anterior chamber became formed and still
formed for about 3 days
Fourth day postoperative :
Amniotic membrane had dissolved with
loss of AC again .

32. Another trial !!!!!!

33. Another trial !!!!!!
At another trial , amniotic membrane was
used as multi layer cover to the corneal
Perforation.

35. Follow up :
AC still lost for about a week and the
membrane had dissolved ,
The patient was discharged after bandage
contact lens instillation and the same
medical treatment with follow up at out
patient clinic

36. Case presentation 2 :
History:
· Male – 22 y
· Xeroderma pigmentosa with
conjunctival CIN
· Excised with application of MMC 3
years ago.
· After surgery, he complaint from
chronic ocular irritation and diminution of
vision.

37. Examination:
· Scleral thinning at the site of
previously excised mass.
· Signs of old Anterior uveitis
· Complicated cataract
Treatment:
· Autologous scleral graft with amniotic
membrane inlay graft

39. Conclusion :
Amniotic membrane is not a magic-1
therapy.
2- Amniotic has many limitations.
3-Case selection is mandatory.