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Editors Selection IGR 12-4

Laser and surgical treatment: Amniotic membrane for leaking blebs

Comment by Keith Barton on:

20889 Long-term results of amniotic membrane transplantation-assisted bleb revision for leaking blebs, Nagai-Kusuhara A; Nakamura M; Fujioka M et al., Graefe's Archive for Clinical and Experimental Ophthalmology, 2008; 246: 567-571

Find related abstracts

Nagai-Kusuhara (855) reported a series of six cases of leaking blebs successfully repaired using amniotic membrane. Unlike previous reports,^1-3 where the amniotic membrane was used as an alternative to conjunctiva, in five out of six reported cases, they inserted the amniotic membrane epithelial side down, the opposite method to that used in the earlier reports, and closed the conjunctiva over the amniotic membrane, using it presumably as an extra supporting layer that was not intended to epithelialise. This seems to have been successful. Surprisingly, they used mitomycin C with these cases without resulting in additional avascularity and leakage. A problem that the authors found in the earlier studies was that recurrence of the ring of steel around the amniotic membrane bleb resulted in a recurrent focal bleb. In combination with persistent avascularity of the amniotic membrane that remained thin, there was a risk of later recurrence of leakage or failure. Overall this article confirms previous reports that amniotic membrane is sometimes useful, especially when conjunctiva is in short supply.

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