Management of Ocular Surface Inflammation with Persistent Epithelial Defects Using a Sutureless Human Amniotic Membrane Dehydrated Matrix: A Prospective Study Utilizing a Digital Ocular Surface Assessment Tool

Figures & data

Figure 1 A patient’s epithelial defect highlighted by fluorescein stain under blue filter uploaded to AOS software.

Figure 2 The white to white (WTW) is marked using the AOS software ruler tool. The highlighted epithelial defect is then measured (mm²) using the area tool in comparison to WTW measurement.

Figure 3 An example of temporal bulbar conjunctival inflammation score measurement followed by marking the desired area using the area tool.

Table 1 Demographics of the patient cohort

	n	Applications
Overall	46	47
Sex
Male	25	26
Female	21	21
Laterality
Left	22	22
Right	24	25
Infection status
Infection	2	2
No active infection	44	45
Excluded records^a	1	1

Note: ^aDeceased.

Table 2 Patient etiology and duration of sutureless amniotic membrane treatment

	Patients	Average HAMDM treatment duration (days)	SD (days)	Percentage of all defects
1. Limbal stem-cell deficiency	17 (37%)	24.6	19.7	37
Ocular burns	7 (41.2%)	24.3	22.1	15.2
Stevens–Johnson syndrome	6 (35.3%)	24.5	24.4	13
Aniridia	1 (5.9%)	41	–	2.2
Pemphigoid	1 (5.9%)	18	–	2.2
Perforation	1 (5.9%)	23	–	2.2
Penetrating keratoplasty	1 (5.9%)	20	–	2.2
2. Persistent epithelial defect	16 (34.8%)	23.8	9.8	34.8
Infectious keratitis	6 (37.5%)	24.8	9.9	13
Penetrating keratoplasty	4 (25%)	31.5	1	8.7
Fuchs endothelial dystrophy	2 (12.5%)	19.5	17.7	4.3
Entropion	1 (6.3%)	14	–	2.2
Neurotrophic cornea	1 (6.3%)	10	–	2.2
Ocular burns	1 (6.3%)	26	–	2.2
Peters anomaly	1 (6.3%)	17	–	2.2
3. Neurotrophic cornea	7 (15.2%)	26.3	5.6	15.2
Lagophthalmos	4 (57.1%)	29	5.6	8.7
Penetrating keratoplasty	2 (28.6%)	20.5	0.7	4.3
Herpetic eye disease	1 (14.3%)	27	–	2.2
4. Filamentary keratitis	2 (4.4%)	36.5	7.8	4.4
5. Corneal erosion	1 (2.2%)	7	–	2.2
6. Corneal thinning	1 (2.2%)	17	–	2.2
7. Ocular surface inflammation	1 (2.2%)	7	–	2.2
8. Laceration	1 (2.2%)	17	–	2.2

Note: ^aP^aPercentage of cases within each indication.

Table 3 Breakdown of persistent epithelial defect patient cohort

	Patients, n	Persistent epithelial defect	All defects
Infectious keratitis	6	37.5%	13%
Penetrating keratoplasty	4	25%	8.7%
Fuchs endothelial dystrophy	2	12.5%	4.3%
Entropion	1	6.3%	2.2%
Neurotrophic cornea	1	6.3%	2.2%
Ocular burns	1	6.3%	2.2%
Peters anomaly	1	6.3%	2.2%
Combined	16	–	39.1%

Table 4 Concomitant medications

	Defect, n (%)	Duration of OmniLenz treatment (days)	SD (days)
Topical antibiotics	46 (100)	24	14.1
Topical lubricants	46 (100)	24	14.1
Topical steroids	36 (78.3)	22.9	15.1
Analgesia	20 (43.5)	19.9	12.4
Antiproteases	17 (37)	20.5	12.8
Systemic immunosuppressants	10 (21.7)	28.2	21
Topical immunosuppressants	8 (17.4)	23.9	20.6
Systemic steroids	6 (13)	9	4.6
Oral antibiotics	6 (13)	23.8	16.4
Plasma eye drops	6 (13)	13.3	13.6
Tarsorrhaphy	6 (13)	26.1	9.1
Botulinum toxin	3 (6.5%)	23.3	28.3

Table 5 Overall patient outcomes

	Complete resolution, n (%)	Partial resolution, n (%)	No resolution, n (%)	Deteriorated state, n (%)
1. Corneal erosion (n=1)	1 (100)	0	0	0
2. Corneal thinning (n=1)	0	1 (100)	0	0
3. Filamentary keratitis (n=2)	1 (50)	1 (50)	0	0
4. Ocular surface inflammation (n=1)	0	0	0	1 (100)
5. Laceration (n=1)	1 (100)	0	0	0
6. Limbal stem-cell deficiency (n=17)	6 (35.3)	11 (64.7)	0	0
Aniridia (n=1)	1 (100)	0	0	0
Ocular burns (n=7)	1 (14.3)	6 (85.7)	0	0
Pemphigoid (n=1)	1 (100)	0	0	0
Perforation (n=1)	0	1 (100)	0	0
Penetrating keratoplasty (n=1)	1 (100)	0	0	0
Stevens–Johnson syndrome (n=6)	2 (33.3)	4 (66.6)	0	0
7. Neurotrophic cornea (n=7)	6 (85.7)	1 (14.3)	0	0
Herpetic eye disease (n=1)	1 (100)	0	0	0
Lagophthalmos (n=4)	4 (100)	0	0	0
Penetrating keratoplasty (n=2)	1 (50)	1 (50)	0	0
8. Persistent epithelial defect (n=16)	14 (87.6)	1 (6.2)	1 (6.2)	0
Entropion (n=1)	1 (100)	0	0	0
Fuchs endothelial dystrophy (n=2)	2 (100)	0	0	0
Infectious keratitis (n=6)	6 (100)	0	0	0
Neurotrophic cornea (n=1)	0	0	1 (100)	0
Ocular burns (n=1)	1 (100)	0	0	0
Peters anomaly (n=1)	1 (100)	0	0	0
Penetrating keratoplasty (n=4)	3 (75)	1 (25)	0	0
Overall (n=46)	29 (63)	15 (32.6)	1 (2.2)	1 (2.2)

Table 6 Degree of ocular surface inflammation: bulbar conjunctival blood vessel congestion scores through AOS digital assessment tool

	Start, % (SD)	End, % (SD)	Change, % (SD)
Upper quadrant	16.5 (6.8)	18 (6.1)	1.5 (2.4), P>0.05
Lower quadrant	23.4 (8.7)	19.7 (6)	3.8 (6.4), P>0.05
Nasal quadrant	21.8 (8.2)	14.8 (8.2)	7 (6.4,) P>0.05
Outer quadrant	16.5 (7.9)	16.5 (9.7%)	0 (10.6), P>0.05

Table 7 Follow-up treatments for patients following treatment with HAMDM

Follow-Up Treatment	No. of patients (%)
Bandage contact lens	7 (15.2%)
Fine-needle diathermy	2 (4.3%)
General follow-up	20 (43.5%)
Insulin drops	2 (4.3%)
Orbital floor triamcinolone	1 (2.2%)
Plasma eye drops	2 (4.3%)
Surgery	17 (37%)
Amniotic membrane transplantation	4 (23.5%)
Corneal transplant	1 (5.9%)
Fine-needle diathermy	1 (5.9%)
Fornix reconstruction	2 (11.8%)
Lid reconstruction	3 (17.6%)
Limbal stem-cell transplant	1 (5.9%)
Penetrating keratoplasty	4 (23.5%)
Tectonic graft	1 (5.9%)
Tarsorrhaphy	3 (6.5%)

Note: ^aPercentage of cases within each indication.

Table 8 Results of persistent epithelial defect treatment with amniotic membrane and plasma eye drops: comparison between studies

Sutureless HAMDM and plasma eye drops	Suture less HAMDM cohort	Suture less AMT^Citation15	Plasma eye drops^Citation25
Patients	16	90	36
Overall healing (% of defects)	87.6	63.3	63.9
Treatment time (days)	24.1	25.3	28

Maqsood S, Elsawah K, Dhillon N, et al. Management of persistent corneal epithelial defects with human amniotic membrane-derived dry matrix. Clin Ophthalmol. 2021;15:2231–2238. doi:10.2147/OPTH.S299141

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