When was amniotic membrane transplantation first used in humans to treat ocular surface disease?

Historical Timeline of Amniotic Membrane Transplantation for Ocular Surface Disease

Amniotic membrane transplantation (AMT) was first used in humans to treat ocular surface disease in 1940 by De Rotth, who used fresh amniotic membrane for conjunctival surface reconstruction. 1

Historical Development

The use of amniotic membrane in ophthalmology has evolved significantly over the decades:

1. 1940: First documented use of fresh amniotic membrane for ocular surface reconstruction by De Rotth
2. 1990s: Revival of interest in AMT with the development of preservation techniques
3. 1998: Widespread availability in the UK through a national supply program 2
4. 1999-2000s: Development of multilayer techniques for deep corneal ulcers 3
5. 2000s onward: Refinement of techniques including "inlay" and "overlay" methods 1

Mechanisms of Action

Amniotic membrane functions through several mechanisms that make it valuable for ocular surface reconstruction:

• Acts as a basement membrane substitute or temporary graft 4
• Provides anti-inflammatory and anti-scarring effects 5, 4
• Contains growth factors that promote epithelial wound healing 4
• Facilitates migration of epithelial cells 6
• Reinforces basal cellular adhesion 6
• Encourages epithelial differentiation 6
• Demonstrates anti-bacterial properties 6

Application Techniques

Several techniques have been developed for AMT application:

• Inlay technique: Membrane acts as a scaffold for epithelial cell migration from surrounding areas 1
• Overlay technique: Membrane functions as a biological contact lens with epithelial healing occurring underneath 1
• Self-retaining applications: Using therapeutic lenses or scleral rings without suturing 1
• Multilayer technique: For deep corneal ulcers and descemetoceles 3

Current Clinical Applications

AMT is now used for numerous ocular surface conditions:

• Persistent epithelial defects and corneal ulcers 5, 4, 3
• Chemical and thermal injuries 2
• Bullous keratopathy 2
• Ocular surface reconstruction following pterygium, tumor removal, or scarring 5
• Limbal stem cell deficiency (often combined with stem cell transplantation) 5
• Stevens-Johnson syndrome/toxic epidermal necrolysis 1
• Corneal perforations and descemetoceles 5, 3
• Symblepharon and fornix reconstruction 6

Clinical Outcomes

Success rates vary by condition:

• Persistent epithelial defects: 31.4% success rate for healed and stable surface 2
• Chemical/thermal injuries: 27.8% success rate for healed uninflamed eye with clear cornea 2
• Bullous keratopathy: 22.2% success rate for pain-free, stable surface 2
• Ocular surface reconstruction: 52.2% success rate for epithelialized uninflamed conjunctiva 2
• Limbal stem cell deficiency: 57.1% success rate for corneal phenotype 2

Important Considerations

• Prognosis depends on the underlying disease and quality of the ocular surface 5
• Outcomes are inversely related to the degree of inflammation 5
• Previous treatment with topical steroids is significantly associated with failure (OR 5.70) 2
• Use of a bandage contact lens at the end of the procedure is associated with better outcomes (OR 0.19) 2
• Early application may provide better outcomes than later application 1

AMT has become an established technique in the treatment of various ocular surface diseases, bringing major advances in reconstructive surgery of the ocular surface over the past several decades since its first use in 1940.