Efficacy and limitations of amniotic membrane transplantation in cases of severe ocular surface disorders: retrospective analysis over a 21-year period

Kohei Harada; Hideki Fukuoka; Koji Kitazawa; Yulia Aziza; Tsutomu Inatomi; Tomoyuki Hino; Go Horiguchi; Satoshi Teramukai; Shigeru Kinoshita; Masafumi Uematsu; Takashi Kitaoka; Chie Sotozono

doi:10.1007/s10384-025-01209-z

Efficacy and limitations of amniotic membrane transplantation in cases of severe ocular surface disorders: retrospective analysis over a 21-year period

Jpn J Ophthalmol. 2025 Jun 6. doi: 10.1007/s10384-025-01209-z. Online ahead of print.

Authors

Kohei Harada^{1

2}, Hideki Fukuoka¹, Koji Kitazawa¹, Yulia Aziza¹, Tsutomu Inatomi^{1

3}, Tomoyuki Hino¹, Go Horiguchi⁴, Satoshi Teramukai⁴, Shigeru Kinoshita^{1

5}, Masafumi Uematsu², Takashi Kitaoka², Chie Sotozono⁶

Affiliations

¹ Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan.
² Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
³ Department of Ophthalmology, National Center for Geriatric and Gerontology, Obu, Japan.
⁴ Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁵ Department of Frontier Medical Science and Technology for Ophthalmology, Prefectural University of Medicine, Kyoto, Japan.
⁶ Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan. csotozon@koto.kpu-m.ac.jp.

PMID: 40478507
DOI: 10.1007/s10384-025-01209-z

Abstract

Purpose: To examine the reoperation rate of amniotic membrane transplantation (AMT) and clarify the risk factors for AMT reoperation in severe ocular surface (OS) disorders (OSD).

Study design: Retrospective cohort study.

Participants: We reviewed the medical records of all AMT cases between April 1998 and June 2019 at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Methods: Primary diseases and AMT reoperation rates were examined. In severe OSD cases (Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and chemical/thermal burns), preoperative OS Grading Score (OSGS), surgical procedures combined with AMT, and risk factors for reoperation were investigated and assessed.

Results: Over a period of 21 years and 3 months, 750 AMTs were performed on 664 eyes of 594 cases. AMT was repeated on 51 of those 664 eyes (7.7%), and most frequently performed on 25 out of 196 eyes (12.8%) afflicted with severe OSDs. In severe OSDs, OSGS was significantly higher in the reoperation group compared to no-reoperation group (P<0.05), suggesting corneal epithelial defects, conjunctival hyperemia, trichiasis, mucocutaneous junction involvement, and corneal opacity as being risk factors for re-AMT (univariate analysis). In logistic regression analysis, only conjunctival hyperemia was a risk factor, with odds ratios (OR) of 2.65 (95%CI: 1.34-5.22, P=0.005). AMT combined with cultivated or donor corneal epithelial transplantation reduced reoperation risk with an OR of 0.92 and 0.63, respectively.

Conclusions: In severe OSD cases, the effect of AMT is limited. Higher OSGSs, especially in conjunctival hyperemia, are associated with a high risk of repeat AMT.

Keywords: Amniotic membrane transplantation (AMT); Conjunctival hyperemia; Ocular surface grading score (OSGS); Reoperation; Severe ocular surface disorders (OSDs).