Study Reveals Amniotic Membrane Grafting Effective for Moderate Ocular Burns, Limited in Severe Cases

"The most reliable level II evidence indicates that AMG is effective in accelerating re-epithelialization for moderate acute ocular surface burns. However, when used as an adjunct to medical therapy, it did not show significant improvements in re-epithelialization for severe burns, nor did it enhance visual acuity or corneal clarity in either moderate or severe cases," the researchers wrote in their study published in Ophthalmology Journal.

The amniotic membrane, known for its natural healing properties, provides a supportive environment for cell regeneration and tissue repair, making it a valuable option for ophthalmic interventions. Considering this, Peter B. Veldman, Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, Illinois, and colleagues assessed the existing literature regarding the effectiveness of amniotic membrane grafting in treating acute chemical and thermal ocular surface burns, focusing on the rates of corneal re-epithelialization and the enhancement of visual acuity or corneal clarity.

For this purpose, the researchers conducted literature searches in the PubMed database in May 2023, with an update in January 2024, restricting the results to English language publications without date limitations. The searches led to 474 citations, of which 58 were reviewed in full text, and 9 met the inclusion criteria. Among these, four studies were rated as level II and five as level III. The assessment emphasizes three level II articles that reported consistent primary and secondary outcomes but exhibited suboptimal study designs, particularly concerning power calculations and the absence of a priori sample-size calculations.

The study led to the following findings:

• Amniotic membrane grafting significantly enhanced corneal re-epithelialization compared to medical therapy alone in eyes with moderate-grade burns.
• In cases of severely burned eyes, AMG showed no additional benefit over medical therapy.
• AMG did not provide a significant advantage in improving visual acuity or corneal clarity for either moderate or severe ocular surface burns.

Level II studies provide evidence that amniotic membrane grafting (AMG) can effectively enhance the rate of corneal re-epithelialization in cases of moderate acute chemical and thermal ocular surface burns. As such, AMG may be considered a valuable adjunct to medical therapy for patients with moderate burns, potentially improving healing outcomes.

"However, these studies also reveal that AMG does not offer significant benefits over medical therapy in severe ocular surface burns, nor does it enhance visual acuity or corneal clarity in moderate or severe cases. It is important to interpret these negative findings within the context of study limitations, particularly regarding power, which may affect the reliability of the results," the researchers wrote.

Reference:

Veldman PB, Greiner MA, Cortina MS, Kuo AN, Li JY, Miller DD, Shtein RM, Weikert MP, Yin J, Kim SJ, Shen JF. Efficacy of Amniotic Membrane Grafting for the Treatment of Chemical and Thermal Ocular Surface Injuries: A Report by the American Academy of Ophthalmology. Ophthalmology. 2024 Oct 9:S0161-6420(24)00514-1. doi: 10.1016/j.ophtha.2024.08.021. Epub ahead of print. PMID: 39387749.