0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letters |

Amniotic Membrane Transplantation in Human Immunodeficiency Virus–Positive Children FREE

Paolo Capozzi, MD; Chiara Morini, MD; Pasquale Vadalà, MD
Arch Ophthalmol. 2008;126(6):866-876. doi:10.1001/archopht.126.6.866.
Text Size: A A A
Published online

Amniotic membrane transplantation (AMT) is a beneficial and safe procedure in several ocular surface impairments.1 Reported adverse effects of AMT are pseudopterygium, postoperative bacterial ulcer, ocular discomfort, and fibrotic reaction.2,3 Goyal et al4 recently observed an organized amniotic membrane in a human immunodeficiency virus (HIV)–positive child after an AMT for symblepharon. We report a similar case of an HIV-positive patient treated with an AMT at our institution.

An HIV-positive 10-year-old girl with a history of herpetic keratitis and penetrating keratoplasty (January 2006) of the right eye was referred to our pediatric ophthalmology service in June 2006. At our examination, visual acuity was +1.7 logMAR (logarithm of minimum angle resolution) OD and 0.0 logMAR OS. The cornea had a central opacification that was deeply vascularized. A severe active corneal inflammation was present. Fundus examination in the right eye was not valuable. We treated the patient with an AMT to reduce the neovascularization before a second penetrating keratoplasty. The amniotic membrane was provided by the S. Giovanni Eye Bank, Rome, Italy. Preservation methods and transplantation followed the surgical technique described by Lee and Tseng,5 with the basement membrane facing down and assured by 8 interrupted nylon 10.0 sutures. Postoperative treatment included topical antibiotic and fluorometholone, 0.1%, eyedrops for 2 weeks. The patient underwent ocular examinations on a daily basis for the first 4 days and then once a week for 3 months. Suture removal was performed in August 2006.

The clinical course in this patient was successful, as it has been for other pediatric AMTs performed at our institution.

We observed a progressive reduction of the neovascularization and inflammation and a remarkable increase of the corneal transparency (Figure).

Place holder to copy figure label and caption
Figure.

Eye of a human immunodeficiency virus–positive 10-year-old girl who had received amniotic membrane transplantation for a central corneal opacification with neovascularization (60th postoperative day). A, The amniotic membrane was fully reabsorbed without any adverse effect. B, After suture removal, the good corneal transparency achieved with mild ocular inflammation is apparent. Only a few residual vessels are observable on the inferior corneal sectors.

Graphic Jump Location

On the 40th postoperative day, the amniotic membrane was fully reabsorbed and visual acuity improved to 0.5 logMAR OD. Clinical conditions were stable in the follow-up period, and the patient is currently on a waiting list for a second penetrating keratoplasty.

In the reported case, AMT was effective in reducing the corneal neovascularization and surface inflammation and allowed for an improved corneal transparency, likely through a partial restoration of the limbal stem cell pool. These effects were important while planning a second corneal graft. In fact, chronic surface inflammation and corneal neovascularization are well-known risk factors for a keratoplasty rejection.6 Through the AMT, the reduction of these risk factors was achieved, avoiding long-term local and systemic steroidal therapies. Moreover, we did not see any adverse effect or unusual reaction, as observed by Goyal et al.4

In the article by Goyal and colleagues, a severe fibrotic reaction was observed after AMT in an HIV-positive child. The thickened membrane was removed. The investigators presumed that “the abnormal CD4+ T lymphocytes . . . were unable to recognize the amniotic membrane as foreign . . . , resulting in an abnormal immune reaction,” and they concluded that “its vision potential in patients with altered immune systems should be guarded, given our experience in 1 patient with HIV.”4 We assume that the difference in the pathogenesis of the diseases in these 2 children may explain the different reaction to the amniotic membrane. Indeed, given the satisfactory results observed in our case, we do not support their suggestion.

ARTICLE INFORMATION

Correspondence: Dr Morini, Pediatric Ophthalmology Service, Ospedale Pediatrico Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy (chiaramorini@gmail.com).

Financial Disclosure: None reported.

Gomes  JARomano  ASantos  MSDua  HS Amniotic membrane use in ophthalmology. Curr Opin Ophthalmol 2005;16 (4) 233- 240
PubMed Link to Article
Pires  RTTseng  SCPrabhasawat  P  et al.  Amniotic membrane transplantation for symptomatic bullous keratopathy. Arch Ophthalmol 1999;117 (10) 1291- 1297
PubMed Link to Article
Paridaens  DBeekhuis  Hvan Den Bosh  WRemeyer  LMelles  G Amniotic membrane transplantation in the management of conjunctival malignant melanoma and primary acquired melanosis with atypia. Br J Ophthalmol 2001;85 (6) 658- 661
PubMed Link to Article
Goyal  RJones  SMEspinosa  MGreen  VNischal  KK Amniotic membrane transplantation in children with symblepharon and massive pannus. Arch Ophthalmol 2006;124 (10) 1435- 1440
PubMed Link to Article
Lee  SHTseng  SC Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol 1997;123 (3) 303- 312
PubMed
Vail  AGore  SMBradley  BAEasty  DLRogers  CAArmitage  WJ Conclusions of the corneal transplant follow up study. Br J Ophthalmol 1997;81 (8) 631- 636
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure.

Eye of a human immunodeficiency virus–positive 10-year-old girl who had received amniotic membrane transplantation for a central corneal opacification with neovascularization (60th postoperative day). A, The amniotic membrane was fully reabsorbed without any adverse effect. B, After suture removal, the good corneal transparency achieved with mild ocular inflammation is apparent. Only a few residual vessels are observable on the inferior corneal sectors.

Graphic Jump Location

Tables

References

Gomes  JARomano  ASantos  MSDua  HS Amniotic membrane use in ophthalmology. Curr Opin Ophthalmol 2005;16 (4) 233- 240
PubMed Link to Article
Pires  RTTseng  SCPrabhasawat  P  et al.  Amniotic membrane transplantation for symptomatic bullous keratopathy. Arch Ophthalmol 1999;117 (10) 1291- 1297
PubMed Link to Article
Paridaens  DBeekhuis  Hvan Den Bosh  WRemeyer  LMelles  G Amniotic membrane transplantation in the management of conjunctival malignant melanoma and primary acquired melanosis with atypia. Br J Ophthalmol 2001;85 (6) 658- 661
PubMed Link to Article
Goyal  RJones  SMEspinosa  MGreen  VNischal  KK Amniotic membrane transplantation in children with symblepharon and massive pannus. Arch Ophthalmol 2006;124 (10) 1435- 1440
PubMed Link to Article
Lee  SHTseng  SC Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol 1997;123 (3) 303- 312
PubMed
Vail  AGore  SMBradley  BAEasty  DLRogers  CAArmitage  WJ Conclusions of the corneal transplant follow up study. Br J Ophthalmol 1997;81 (8) 631- 636
PubMed Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

476 Views
0 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs