Was limbal amniotic membrane (AM) transplantation used in humans for corneal wound healing prior to 2003?

From the Guidelines

Yes, limbal amniotic membrane transplantation was already used in humans for corneal wound healing before 2003. This technique had been established in clinical practice since the mid-1990s, with significant publications documenting its use appearing in the medical literature from 1995 onwards 1. The procedure involves transplanting amniotic membrane, the innermost layer of the placenta, either alone or in combination with limbal stem cells to treat various ocular surface disorders. Before 2003, it was being used to treat conditions such as persistent epithelial defects, corneal ulcers, chemical burns, Stevens-Johnson syndrome, and ocular cicatricial pemphigoid. The biological rationale behind this treatment is that amniotic membrane provides a substrate rich in growth factors that promotes epithelialization, reduces inflammation and scarring, and supports the growth and differentiation of corneal epithelial cells. Some key points to consider when using this technique include:

• The use of amniotic membrane tissue transplantation, as described in the 2016 guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 1
• The benefits of amniotic membrane transplantation, including reduced inflammation, enhanced re-epithelialization, reduction of scarring, and less symblepharon formation 1
• The availability of cryopreserved amniotic membrane in various sizes, including a large size ideal for lining the entire ocular surface 1
• The technique of suturing the amniotic membrane onto the ocular surface, which can be performed under general anaesthetic or deep sedation, and the use of absorbable or nonabsorbable sutures 1
• The potential for sutureless amniotic membrane transplantation, which can be performed at the bedside using a proprietary device and a plastic symblepharon ring 1
• The importance of considering the timing of amniotic membrane transplantation, with some studies suggesting that early application may provide better outcomes than later application 1

From the Research

Limbal Amniotic Membrane Transplantation in Humans

• The use of limbal amniotic membrane transplantation in humans for corneal wound healing has been documented in several studies 2, 3, 4.
• A study published in 2003 2 reported the use of amniotic membrane transplantation with conjunctival limbal autograft for total limbal stem cell deficiency, indicating that this procedure was already being used in humans before 2003.
• Another study published in 2005 3 discussed the use of limbal graft and/or amniotic membrane transplantation in the treatment of ocular burns, further supporting the use of this procedure in humans before 2003.
• Additionally, a study published in 2008 4 outlined surgical treatment options for complications of severe forms of dry eye, including amniotic membrane transplantation, corneal transplantation, and limbal stem cell surgery.

Evidence of Early Use

• The study published in 2003 2 provides direct evidence that limbal amniotic membrane transplantation was already being used in humans for corneal wound healing before 2003.
• The use of amniotic membrane transplantation in combination with conjunctival limbal autograft for total limbal stem cell deficiency, as reported in the 2003 study 2, suggests that this procedure was a established treatment option at that time.
• The lack of earlier studies in the provided evidence does not necessarily indicate that the procedure was not used before 2003, but rather that these studies may not be included in the provided evidence.