From the Guidelines
Amniotic membrane transplantation is a beneficial treatment option for ocular pemphigus, particularly for managing corneal complications and promoting ocular surface healing, as supported by the most recent study in 2024 1.
Key Points
- The procedure involves placing processed human amniotic membrane over the affected ocular surface, where it serves as a biological bandage that reduces inflammation, prevents scarring, and supports epithelial regeneration.
- For ocular pemphigus patients, amniotic membranes can be applied either as an overlay (covering the cornea and secured to the conjunctiva) or as an inlay (integrated into the ocular surface) 1.
- The membrane typically remains in place for 1-2 weeks before dissolving or being removed, and this treatment is particularly valuable for persistent epithelial defects, corneal ulceration, and symblepharon formation that often occur in pemphigus.
- Amniotic membrane transplantation should be used as part of a comprehensive treatment approach that includes systemic immunosuppression (such as prednisone, azathioprine, or rituximab) to control the underlying autoimmune disease, as recommended in the 2024 study 2.
Benefits and Considerations
- The procedure works by providing anti-inflammatory cytokines, growth factors, and a scaffold for cell migration, effectively creating a protective environment that promotes healing while the systemic medications address the autoimmune pathology.
- Multiple applications may be necessary for severe or recurrent cases, and close monitoring for infection or membrane displacement is essential post-procedure.
- The use of amniotic membrane transplantation in ocular pemphigus is supported by studies, including a 2016 study that demonstrated better outcomes in patients treated with amniotic membrane transplantation compared to those who received medical eye management only 3.
From the Research
Role of Amniotic Membranes in Ocular Pemphigus Treatment
- Amniotic membrane transplantation (AMT) has been used as a treatment for ocular surface reconstruction in patients with ocular cicatricial pemphigoid (OCP) and other autoimmune diseases 4, 5.
- The amniotic membrane has anti-angiogenetic, anti-scarring, and anti-inflammatory properties, making it a useful substrate for cell migration and regeneration 6, 7.
- AMT can be used as a first-step procedure for ocular surface reconstruction in OCP, with benefits including improved fornix depth, reduced symblepharon, and restoration of normal conjunctival epithelium 5.
- The use of amniotic membrane has also been reported in the treatment of paraneoplastic pemphigus (PNP) with corneal perforations, with multilayered amniotic membrane transplantation showing promise in promoting healing 8.
- While the effectiveness of AMT can deteriorate over time, it remains a valuable option for ocular surface reconstruction in patients with autoimmune diseases such as OCP and PNP 4, 5.
Benefits and Properties of Amniotic Membranes
- Amniotic membranes promote epithelization, have antimicrobial effects, decrease inflammation, fibrosis, and neovascularization 6, 7.
- The combination of these beneficial effects and reasonable mechanical properties make amniotic membranes a useful substrate for ex vivo expansion of epithelial progenitor cells 7.
- Amnion-derived cells, which have stem cell characteristics, have been proposed as potential contributors to cell-based treatment of ocular surface disease 7.
Clinical Use and Standardization
- The use of amniotic membranes in ophthalmic surgery remains one of the least standardized methods, with varying properties and clinical uses reported in different studies 6, 7.
- Further investigation is needed to provide evidence for the incorporation of AMT into treatment protocols for ocular pemphigus and other autoimmune diseases 4, 5.