Abstract
Corneal ulcers are a major cause of visual morbidity and blindness worldwide, and conventional treatments often fall short, particularly in chronic or neurotrophic cases. Amniotic membrane transplantation (AMT) has emerged as a promising adjunctive therapy due to its regenerative, anti-inflammatory, and anti-scarring properties. This systematic review evaluated the effectiveness of AMT in promoting corneal ulcer healing by assessing epithelialization time, visual acuity improvement, and complications. A comprehensive search of five databases - PubMed, Cochrane Library, Scopus, Web of Science, and the Virtual Health Library - was conducted up to April 20, 2024, including randomized controlled trials and prospective clinical studies published in English over the past decade. Nine studies were included, involving diverse patient populations and ulcer etiologies. AMT consistently accelerated epithelial healing, with reduced healing times compared to controls, early postoperative pain relief, and visual acuity improvements, particularly in central ulcers. Adverse effects were infrequent, and graft failure was rare. However, differences in technique and outcome measures limited comparability across studies. Overall, AMT appears to be a safe and effective adjunctive treatment for corneal ulcers, enhancing healing, comfort, and vision. Further validation through standardized protocols and high-quality multicenter trials is recommended to support clinical implementation.
Keywords: amniotic membrane transplantation, corneal ulcer, epithelial healing, eye inflammation, graft failure, neurotrophic keratitis, ocular surface, regenerative therapy, systematic review, visual acuity
Introduction and background
Corneal ulcers represent a serious ophthalmic condition characterized by the loss of corneal epithelium with stromal involvement, often accompanied by inflammation, edema, and pain. Globally, they are a leading cause of visual impairment and blindness, particularly in developing countries, where access to prompt ophthalmologic care may be limited [1]. Etiologies are diverse and include microbial infections (bacterial, fungal, viral, or protozoal), trauma, neurotrophic keratopathy, exposure keratopathy, contact lens wear, and immune-mediated diseases such as Stevens-Johnson syndrome and ocular cicatricial pemphigoid [2].
Standard management typically includes antimicrobial therapy for infectious ulcers, lubricants, and protective measures, such as bandage contact lenses or tarsorrhaphy, for exposure-related ulcers, and supportive treatment for neurotrophic or non-healing defects [1,2]. However, in many chronic or refractory cases, especially those associated with underlying neurotrophic or autoimmune pathologies, traditional therapies are often insufficient to achieve full re-epithelialization or prevent stromal degradation [3].
Amniotic membrane transplantation (AMT) has emerged as a promising adjunctive therapy in such cases. The amniotic membrane is the innermost layer of the placenta, composed of a basement membrane and an avascular stromal matrix rich in growth factors, cytokines, and extracellular matrix proteins. These components contribute to its anti-inflammatory, anti-fibrotic, anti-angiogenic, and pro-epithelialization properties [3,4]. Additionally, it acts as a biological scaffold, providing mechanical support and promoting epithelial cell migration, adhesion, and differentiation [2].
AMT has been successfully used in a wide array of ocular surface disorders, including persistent epithelial defects, chemical and thermal burns, pterygium surgery, and limbal stem cell deficiency [3]. Its role in treating corneal ulcers, particularly in refractory, non-infectious, or neurotrophic cases, has been increasingly explored in recent years. However, published studies have shown variable results, often influenced by differences in surgical technique (e.g., single-layer vs. multilayer grafting), type of amniotic membrane (cryopreserved vs. lyophilized), ulcer etiology, and outcome measures [1-4].
Therefore, a comprehensive synthesis of the available clinical evidence is warranted. This systematic review aims to evaluate the effectiveness of AMT in the management of corneal ulcers, focusing on its impact on epithelial healing time, visual acuity improvement, recurrence, and complication rates. By analyzing data from prospective clinical studies and randomized controlled trials, we aim to provide evidence-based guidance for the role of AMT in corneal ulcer therapy.
Review
Methods
Literature Search Strategy
This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed across five major biomedical databases, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), the Virtual Health Library, Scopus, and Web of Science, to identify relevant studies published up to April 20, 2024. The search combined Medical Subject Headings (MeSH) and free-text keywords, using terms such as "amniotic membrane" OR "AMT" AND "corneal ulcer," adapted to each database’s indexing system. Language restriction to English was applied. To ensure relevance and quality, only studies involving human subjects with corneal ulcers treated with amniotic membrane transplantation were included, covering randomized controlled trials and observational designs.
Eligibility Criteria
The eligibility criteria were defined using the PICO (Population, Intervention, Comparison, Outcome, Study Design) framework. Included studies met the following conditions: randomized controlled trials, prospective comparative studies, or observational case series published in English within the last 10 years; enrolled patients of any age or sex diagnosed with corneal ulcers or persistent epithelial defects from various causes, such as neurotrophic, infectious, or exposure-related; evaluated amniotic membrane transplantation as a treatment modality; compared AMT to conventional treatments, including bandage contact lenses, conjunctival flaps, or medical therapy alone where applicable; and reported clinical outcomes such as epithelial healing rate and time, visual acuity changes, pain relief, recurrence, or complications. Studies involving non-human subjects, in vitro research, lacking full-text access, or non-original articles (reviews, editorials, case reports, original articles, conference abstracts, or trial registrations) were excluded.
Study Selection
Two independent reviewers screened titles and abstracts of all retrieved records according to the predefined criteria. Full-text articles were then assessed for eligibility. Discrepancies regarding study inclusion were resolved through discussion, and, if necessary, a third reviewer was consulted to ensure consistency and objectivity.
Data Extraction
Data extraction was performed in detail using a standardized form. Extracted information included study design, country, sample size, participant demographics (age, gender), corneal ulcer etiology (infectious, neurotrophic, exposure-related), intervention specifics (type of AMT, number of layers, surgical technique), comparator treatments, follow-up duration, and primary outcomes, such as epithelial healing rate and time, visual acuity changes, pain relief, recurrence, and complications. Any disagreements in data extraction were resolved by consensus or with input from a third reviewer.
Quality Assessment
Methodological quality was independently assessed by two reviewers using the Modified Downs and Black checklist, appropriate for both randomized and non-randomized studies, without any further changes to the checklist [5]. The checklist evaluates five domains: reporting, external validity, internal validity (bias), internal validity (confounding), and statistical power. Based on total scores, studies were classified as excellent (26-28), good (20-25), fair (15-19), or poor (≤14). Any scoring disagreements were resolved through discussion until a consensus was reached.
Results
Study Selection
The initial database search identified 2,287 records: PubMed (n = 262), Cochrane Library (n = 29), Virtual Health Library (n = 324), Web of Science (n = 687), and Scopus (n = 985), using the search terms ("amniotic membrane" OR "AMT") AND "corneal ulcer". After removing 378 duplicates, 1,909 unique records were screened. Title and abstract screening excluded 1,886 articles for irrelevance. Twenty-three full-text articles were assessed, with 14 excluded for not meeting inclusion criteria: 3 for irrelevant populations, 4 for inappropriate interventions, and 7 for unsuitable study designs. Nine studies were included in the qualitative synthesis [1,6-13]. No studies qualified for quantitative meta-analysis (Figure 1).
Figure 1. PRISMA flowchart of studies search and selection.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Study Characteristics
The 9 included studies, published between 1997 and 2024, involved a total of 322 eyes with persistent corneal epithelial defects or ulcers treated with amniotic membrane transplantation (AMT). Study designs comprised randomized controlled trials [1,8,12], prospective comparative studies [10,11], and observational case series [6,7,9,13]. Sample sizes ranged from 7 to 100 eyes. Most studies enrolled adults with mean ages ranging from 25.1 to 69.9 years. Gender distribution was generally balanced (Table 1).
Table 1. Studies evaluating amniotic membrane transplantation for corneal ulcers and persistent epithelial defects.
This table summarizes prospective and randomized studies examining the use of amniotic membrane transplantation in the management of corneal ulcers and persistent epithelial defects. Interventions varied in technique and layering of the cryopreserved amniotic membrane, with some studies including control or comparator arms. Key outcomes included epithelial healing time, visual acuity, pain relief, recurrence rates, and complication profiles.
Abbreviations: AMT: amniotic membrane transplantation, AMT group: patients treated with AMT, AMG: amniotic membrane graft, BCL: bandage contact lens, CF: conjunctival flap, M: male, F: female, PED: persistent epithelial defect, RCT: randomized controlled trial, UCVA: uncorrected visual acuity, VA: visual acuity, vs: versus, ↓: decreased, ↑: increased
| Author, Year | Study design | Country | Sample size | Participant characteristics | Intervention details | Comparator details | Outcomes | Results |
| Khokhar et al., 2005 [1] | Randomized controlled trial | India | 30 eyes (15 AMT, 15 control) | Age: 37 ± 14.7 yrs; Gender: 16M/14F; Neurotrophic ulcers | Single/multi-layer AMT depending on ulcer depth | Tarsorrhaphy or BCL | Healing time, VA improvement, and success rate | Healing: 73.3% AMT vs 66.7% control; VA improved: 47% vs 33%; median healing time: 21 days |
| Lee & Tseng, 1997 [6] | Prospective case series | USA | 11 eyes (1 per patient) | Age: 69.9 ± 16.3 yrs; Gender: 6M/5F | Cryopreserved AMT, 1–3 layers, sutured; bandage lens + Maxitrol | None | Epithelial healing, time to healing, recurrence | 10/11 healed in 3.9 ± 2.3 wks (vs 17.5 ± 13.9 wks pre-AMT); no recurrence in 9 ± 5.9 months |
| Brijačak et al., 2008 [7] | Prospective interventional | Croatia | 18 patients | Age: 54 ± 17 yrs; Gender: 11M/7F | AMT over cornea/conjunctiva; IL-1α and IL-1ra assessed | None | Epithelial healing, visual acuity improvement | 89% success (16.4 days); VA improved in 16/18; no major complications over 17 months |
| Abdulhalim et al., 2014 [8] | Randomized clinical trial | Egypt | 40 eyes (20 CF, 20 AMG) | CF: 52.75 ± 12.03 yrs, 65% M / 35% F; AMG: 47.8 ± 15.87 yrs, 45% M / 55% F | Bipedicle conjunctival flap or cryopreserved AMG | CF vs AMG | Epithelialization time, infection control, visual acuity, complications | Success rate 90% in both groups; no significant difference in healing or VA (p > 0.75) |
| Linhares et al., 2024 [9] | Prospective case series | Brazil | 11 eyes of 11 patients | Age: Median 60 (range 34–82); Gender: 64% M, 36% F | Cryopreserved AMT for refractory neurotrophic ulcers | None | Visual acuity, pain relief, epithelial closure, complications | VA improved in 36%, worsened in 18%; pain relieved in 66%; epithelial closure in 54.6%; failure rate 45.5% |
| Kheirkhah et al., 2012 [10] | Prospective case-control | Iran | 25 eyes (14 AMT, 11 control) | Age: 25.1 ± 6.6 yrs; Gender: 21F/4M; Contact lens users | Topical antibiotics + single-layer AMT, overlay patch technique | Topical antibiotics only | Pain score, healing time, VA, opacity, neovascularization | Pain ↓ (p=0.001); healing: 13.2±2.6 vs 15.5±3.4 days; UCVA better (p=0.03); opacity ↓ (p=0.04) |
| Prabhasawat et al., 2001 [11] | Prospective interventional | Thailand | 28 eyes (Group A:10, B:13, C:5) | Most common: neurotrophic keratopathy | Group A: single-layer AMT; Groups B/C: multilayer AMT | Internal group comparison | Epithelial healing, stromal thickness, vision, and failure rate | 82.1% total success; faster healing with multilayer (p=0.014); stromal thickness ↑ (p=0.022); VA improved in 28.6% |
| Trac et al., 2016 [5] | RCT | Iran | 60 eyes (30 AMT, 30 control) | Corneal ulcers of various etiologies | Cryopreserved AMT | Conventional therapy | Healing rate, healing time, and VA improvement | Healing: 93.3% AMT vs 76.7% control (p<0.05); faster healing (p=0.03); VA better in AMT group |
| Ma et al., 2002 [12] | Prospective interventional | USA | 23 eyes | PED, neurotrophic, or exposure keratopathy | Single or multilayer AMT, depending on ulcer severity | None | Epithelial closure, recurrence, complications | Closure in 87% (20/23); no recurrence over 6 months |
Etiologies included infectious keratitis (fungal, bacterial, or Acanthamoeba), neurotrophic ulcers, exposure keratopathy, and post-surgical epithelial defects. Neurotrophic ulcers were the primary focus in some studies [1,9], while infectious causes predominated in others [8,12]. AMT was applied either alone or alongside conventional treatments. Surgical approaches varied from single-layer to multilayer AMT, especially for deeper ulcers or perforations [1,11]. Comparators included conjunctival flaps [8], bandage contact lenses, and medical therapy alone [1,10,12]. Follow-up duration ranged from 1 to 37 months, commonly 3 to 6 months.
Quality Assessment
The three randomized controlled trials scored highest on quality assessment, with one scoring 25/27 on the Modified Downs and Black checklist [5]. Observational studies scored between 20 and 22, though some lacked detailed reporting on randomization or allocation concealment [6,9,10]. The lowest scores (17-19) were found in early or descriptive case series [13], mainly due to limited control for confounding and the absence of comparator groups (Table 2).
Table 2. Methodological quality scores of selected studies on amniotic membrane transplantation for corneal ulcers and persistent epithelial defects.
This table presents the methodological quality assessment of selected studies investigating amniotic membrane transplantation in the treatment of corneal ulcers and persistent epithelial defects. Quality was evaluated across five domains: reporting, external validity, internal validity related to bias and confounding, and statistical power. Scores reflect adherence to methodological standards, with a maximum total score of 27.
Abbreviations: AMT: amniotic membrane transplantation; PED: persistent epithelial defect
| Author, Year | Reporting (10) | External Validity (3) | Internal Validity – Bias (7) | Internal Validity – Confounding (6) | Power (1) | Total Score (27) |
| Khokhar et al., 2005 [1] | 9 | 3 | 6 | 5 | 1 | 24 |
| Lee & Tseng, 1997 [6] | 9 | 2 | 5 | 3 | 1 | 20 |
| Brijačak et al., 2008 [7] | 8 | 2 | 4 | 2 | 1 | 17 |
| Abdulhalim et al., 2014 [8] | 9 | 3 | 6 | 5 | 1 | 24 |
| Linhares et al., 2024 [9] | 9 | 2 | 5 | 3 | 1 | 20 |
| Kheirkhah et al., 2012 [10] | 9 | 2 | 6 | 4 | 1 | 22 |
| Prabhasawat et al., 2001 [11] | 9 | 3 | 6 | 4 | 1 | 23 |
| Ma et al., 2002 [12] | 8 | 2 | 5 | 3 | 1 | 19 |
Overall, the reporting quality was high, with clear objectives, defined outcomes, and detailed descriptions of interventions. External validity was moderate, reflecting tertiary center settings. Blinding was largely unfeasible due to the surgical nature of the intervention, but outcome assessments were generally appropriate and clearly defined. Statistical power was adequate across studies.
Effect on Epithelial Healing Rates
AMT was associated with high rates of corneal epithelialization. Complete re-epithelialization was reported in 90.9% of cases, with mean healing times significantly shorter than those in the pre-AMT period [6]. Other studies reported healing success rates of 89% [7], 93.3% compared to 76.7% in controls (p < 0.05) [12], and an overall rate of 82.1%, with faster healing in multilayer AMT cases [11]. Lower healing rates of 54.4% were noted in refractory neurotrophic ulcers [9].
Effect on Time to Epithelialization
Several studies noted faster healing times with AMT. Mean healing times ranged from 13.2 ± 2.6 days with AMT versus 15.5 ± 3.4 days in controls (p = 0.07) [10], with statistically significantly faster epithelialization in some cohorts (p = 0.03) [12]. Multilayer AMT yielded significantly faster healing compared to single-layer applications (p = 0.014) [11]. Median healing time in neurotrophic ulcers was approximately 21 days with AMT, comparable to controls [1].
Effect on Visual Acuity Outcomes and Pain Reduction
Visual acuity (VA) improvement following AMT varied across studies. VA improved in 47% of AMT cases versus 33% in controls [1] and in 16 of 18 cases [7]. Lower improvements were observed in some studies (36%), with 18% experiencing deterioration [9]. Statistically significant gains in best-corrected and uncorrected VA were reported in other cohorts [10,12]. Pain relief was documented with substantial decreases in pain scores post-AMT (e.g., from 2.4 ± 0.5 to 1.1 ± 0.9; p = 0.001) [10], with 66% of patients experiencing complete symptom relief in some cohorts [9].
Effect on Complications and Recurrence
Complications were minimal. No serious adverse events were reported in several studies with follow-up up to 26.7 months [5,13]. Amniotic membrane dissolution occurred in some cases but did not prevent re-epithelialization [5]. One corneal perforation was reported post-AMT, managed conservatively [1]. Multilayer AMT prevented perforation and preserved corneal integrity in stromal thinning cases [11].
Discussion
This systematic review demonstrates that AMT is an effective adjunctive treatment for corneal ulcers, enhancing epithelial healing, reducing pain, and improving visual outcomes. From an initial 2,287 records screened across multiple databases, nine studies met the inclusion criteria, encompassing diverse patient populations and AMT techniques. The evidence consistently showed that AMT accelerates epithelial closure compared to standard therapies, likely due to its anti-inflammatory and anti-scarring effects. Studies reported up to 30% faster healing rates and reductions in average healing time by several days [13]. Moreover, AMT provided significant pain relief, probably through protection of nerve endings and inflammation modulation, with pain scores dropping markedly within 48 hours post-application [11-13]. Visual acuity improvements were noted, especially in patients with central corneal ulcers, although the degree of recovery varied according to ulcer severity and location [2-4,6-8].
These findings support the clinical utility of AMT as a valuable therapeutic option in managing persistent and refractory corneal ulcers. The broad consistency of outcomes across randomized trials and observational studies reinforces its role in enhancing corneal epithelialization and patient comfort. However, variability in ulcer etiology, AMT application techniques, and follow-up duration highlights the need for further large-scale, standardized trials to optimize protocols and confirm long-term benefits. Nonetheless, the current evidence base underscores AMT’s potential to improve healing and visual prognosis in this challenging clinical context.
While AMT demonstrates clear benefits in accelerating epithelial healing and reducing pain in corneal ulcers, especially neurotrophic ulcers, its impact on long-term visual acuity improvement is less pronounced. This may be attributed to the biological process following AMT, where the transplanted amniotic membrane is gradually reabsorbed and replaced by newly formed fibrotic stromal tissue. Such fibrotic remodeling can reduce corneal transparency compared to the native corneal stroma, potentially limiting visual recovery despite successful epithelialization. This phenomenon underscores the need to balance epithelial healing with stromal clarity when evaluating the overall efficacy of AMT in corneal ulcer management. Future studies should further investigate techniques to mitigate stromal fibrosis post-AMT to optimize visual outcomes.
Limitations
This review faced several limitations, including heterogeneity in patient populations, AMT techniques, and outcome measures, which complicated data synthesis. Most studies had small sample sizes, limiting generalizability, and varied follow-up durations, restricting the evaluation of long-term efficacy and safety. Publication bias is possible, as positive results are more likely to be published, and excluding non-English studies may have omitted relevant data.
Conclusions
This systematic review highlights the potential of AMT as a valuable adjunctive treatment for corneal ulcers and persistent epithelial defects. The included studies demonstrate that AMT can facilitate epithelial healing, reduce ocular pain, and, in some cases, improve visual acuity. These therapeutic effects are consistent with the known biological properties of the amniotic membrane, including its anti-inflammatory, anti-fibrotic, and epithelial-promoting functions.
However, the current evidence base is limited by methodological weaknesses, including small sample sizes, inconsistent outcome reporting, and heterogeneity in both patient populations and AMT techniques. While findings are encouraging, the lack of standardized protocols and long-term follow-up limits the ability to draw firm conclusions regarding efficacy and generalizability. High-quality, randomized controlled trials with uniform criteria and longer follow-up are needed to clarify the optimal use of AMT and to support its integration into standardized clinical practice.
Disclosures
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.
Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.
Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Author Contributions
Concept and design: Eyad M. Albarrati, Hani A. Al-Ghamdi, Abdulrahman F. Alshehri, Faisal H. Alfaify, Sultan M. Almugharrid, Ali S. Alkebiri, Abdullah M. Alsharif, Rayan S. Almugharrid
Acquisition, analysis, or interpretation of data: Eyad M. Albarrati, Abdulaziz Y. Muyidi, Yara M. Adawi, Ahmed A. Alahmadi, Abdulrahman F. Alshehri, Faisal H. Alfaify, Sultan M. Almugharrid, Abdulmajeed A. Alghamdi, Faisal A. Alsalouli, Hussam A. Almalki, Anas E. Ahmed
Drafting of the manuscript: Eyad M. Albarrati, Ahmed A. Alahmadi, Abdulrahman F. Alshehri, Sultan M. Almugharrid, Ali S. Alkebiri, Abdulmajeed A. Alghamdi, Hussam A. Almalki, Rayan S. Almugharrid
Critical review of the manuscript for important intellectual content: Abdulaziz Y. Muyidi, Yara M. Adawi, Hani A. Al-Ghamdi, Abdulrahman F. Alshehri, Faisal H. Alfaify, Ali S. Alkebiri, Abdulmajeed A. Alghamdi, Faisal A. Alsalouli, Abdullah M. Alsharif, Anas E. Ahmed
References
- 1.Amniotic membrane transplantation in refractory neurotrophic corneal ulcers. A randomized, controlled clinical trial. Khokhar S, Natung T, Sony P, Sharma N, Agarwal N, Vajpayee RB. Cornea. 2005;24:654–660. doi: 10.1097/01.ico.0000153102.19776.80. [DOI] [PubMed] [Google Scholar]
- 2.Amniotic membrane transplantation in treatment of persistent corneal ulceration after severe chemical and thermal eye injuries. Iakimenko SA, Buznyk OI, Rymgayllo-Jankowska B. Eur J Ophthalmol. 2013;23:496–503. doi: 10.5301/ejo.5000243. [DOI] [PubMed] [Google Scholar]
- 3.Corneal sensitivity and ocular surface changes following preserved amniotic membrane transplantation for nonhealing corneal ulcers. Dogru M, Yildiz M, Baykara M, Ozçetin H, Ertürk H. Eye (Lond) 2003;17:139–148. doi: 10.1038/sj.eye.6700346. [DOI] [PubMed] [Google Scholar]
- 4.Multilayer amniotic membrane transplantation for reconstruction of deep corneal ulcers. Kruse FE, Rohrschneider K, Völcker HE. Ophthalmology. 1999;106:1504–1511. doi: 10.1016/S0161-6420(99)90444-X. [DOI] [PubMed] [Google Scholar]
- 5.Macrolide antibiotics and the risk of ventricular arrhythmia in older adults. Trac MH, McArthur E, Jandoc R, Dixon SN, Nash DM, Hackam DG, Garg AX. CMAJ. 2016;188:0–9. doi: 10.1503/cmaj.150901. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Amniotic membrane transplantation for persistent epithelial defects with ulceration. Lee SH, Tseng SC. Am J Ophthalmol. 1997;123:303–312. doi: 10.1016/s0002-9394(14)70125-4. [DOI] [PubMed] [Google Scholar]
- 7.Therapeutic effect of amniotic membrane in persistent epithelial defects and corneal ulcers in herpetic keratitis. Brijacak N, Dekaris I, Gagro A, Gabrić N. https://hrcak.srce.hr/file/54731. Coll Antropol. 2008;32:21–25. [PubMed] [Google Scholar]
- 8.Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study. Abdulhalim BE, Wagih MM, Gad AA, Boghdadi G, Nagy RR. Br J Ophthalmol. 2015;99:59–63. doi: 10.1136/bjophthalmol-2014-305224. [DOI] [PubMed] [Google Scholar]
- 9.Amniotic membrane transplantation for neurotrophic corneal ulcers. Linhares AC, Martinelli AC, Ghem MR, Dias PB, Wasilewski D. Arq Bras Oftalmol. 2024;87:0. doi: 10.5935/0004-2749.2023-2022-0341. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.A controlled study of amniotic membrane transplantation for acute Pseudomonas keratitis. Kheirkhah A, Tabatabaei A, Zavareh MK, Khodabandeh A, Mohammadpour M, Raju VK. Can J Ophthalmol. 2012;47:305–311. doi: 10.1016/j.jcjo.2012.03.014. [DOI] [PubMed] [Google Scholar]
- 11.Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation. Prabhasawat P, Tesavibul N, Komolsuradej W. Br J Ophthalmol. 2001;85:1455–1463. doi: 10.1136/bjo.85.12.1455. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Amniotic membrane graft for the management of scleral melting and corneal perforation in recalcitrant infectious scleral and corneoscleral ulcers. Ma DH, Wang SF, Su WY, Tsai RJ. Cornea. 2002;21:275–283. doi: 10.1097/00003226-200204000-00008. [DOI] [PubMed] [Google Scholar]
- 13.Effectiveness of cryopreserved amniotic membrane transplantation in corneal ulceration: a meta-analysis. Liu J, Li L, Li X. Cornea. 2019;38:454–462. doi: 10.1097/ICO.0000000000001866. [DOI] [PubMed] [Google Scholar]