Table 2.
Summary of all clinical studies (excluding RCTs) evaluating the use of amniotic membrane transplantion (AMT) for infectious keratitis.
| Authors | Year | Study design | Total eyes (AMT) | Total eyes (control) | Causative organisms (in AMT group) | Severity of ulcer$ | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| BK | FK | VK | AK | MK | NSK | ||||||
| Kheirkhah et al.23 | 2012 | NRCS | 14 | 11 | 14 | Mean = 32% (AMT) versus 33% (control) | |||||
| Li et al.34 | 2014 | NRCS | 53 | 45 | 53 | Not reported | |||||
| Naeem et al.35 | 2004 | NRCS | 34 | 34 | 34 | > 3 mm | |||||
| Altay et al.36 | 2016 | Case series | 84 | – | 42 | 42 | 3 mm | ||||
| Berguiga et al.37 | 2013 | Case series | 5 | – | 1 | 4 | Central, deep ulcer/perforation (< 2 mm) | ||||
| Bourcier et al.38 | 2004 | Case series | 6 | – | 6 | Stromal lesions | |||||
| Chen et al.39 | 2006 | Case series | 23 | – | 12 | 11 | 2–13 mm; > 50% depth to perforation | ||||
| Chen et al.40 | 2002 | Case series | 6 | – | 6 | Mean = 29 mm2, depth of 25–33% (50%), descemetocele (50%) | |||||
| Eleiwa et al.41 | 2020 | Case series | 5 | – | 5 | Perforated corneal ulcer (3–5 mm) | |||||
| Eraslan Yusufoglu et al.42 | 2013 | Case series | 46 | – | 21 | 25 | Paracentral and central ulcer; depth of > 50% in viral (56%) and bacterial (33%) cases | ||||
| Fu et al.43 | 2012 | Case series | 35 | – | 35 | Median = 3–5 mm | |||||
| Gicquel et al.44 | 2007 | Case series | 12 | – | 12 | Mean = 5 mm | |||||
| Hoffmann et al.45 | 2013 | Case series | 12 | – | 3 | 5 | 4 | 4–20mm2, depth of 10–90% | |||
| Kim et al.46 | 2001 | Case series | 21 | – | 9 | 2 | 7 | 3 | Not reported | ||
| Li et al.47 | 2010 | Case series | 18 | – | 18 | < 5 mm (67%), > 5 mm (33%), perforation (6%) | |||||
| Mohan et al.48 | 2014 | Case series | 28 | – | 28 | Not reported | |||||
| Rao et al.49 | 2012 | Case series | 21 | – | 21 | Not reported | |||||
| Shi et al.50 | 2007 | Case series | 15 | – | 15 | 20–45mm2, depth of 20–33% | |||||
| Spelsberg et al.51 | 2008 | Case series | 12 | – | 12 | – | |||||
| Wan & Huo52 | 2010 | Case series | 35 | – | 9 | 20 | 6 | Not reported | |||
| Wu et al.53 | 2013 | Case series | 18 | – | 18 | 1–7 mm | |||||
| Xie et al.54 | 2014 | Case series | 19 | – | 19 | 3–6 mm | |||||
| Yildiz et al.55 | 2008 | Case series | 14 | – | 14 | Not reported | |||||
| Zhang et al.56 | 2010 | Case series | 26 | – | 26 | Median = 3–6 mm; 5 perforation | |||||
| Authors | Preop vision* | Time to AMT | AMT technique** | Combined with SAT | Outcomes (i.e. healing rate and time) | Adverse event*** | Postop vision* | Follow-up (months) | |||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Kheirkhah et al.23 | 2.0 (AMT) versus 2.0 (control) | 2–3 days | Overlay (Single) | Y |
Complete healing = 100%, Mean healing time = 13 days (AMT) versus 16 (control) |
None | Mean = 0.5 (AMT) versus 0.7 (control) | 11 | |||
| Li et al.34 | 0.6 | Not reported | Inlay | Y | Mean healing time = 23 days (AMT) and 35 days (control) | Not reported | Mean = 0.3 (AMT) versus 0.4 (control) | 2 | |||
| Naeem et al.35 | Not reported | Not reported | Not reported | Y | Complete healing = 96% (AMT) versus 30 (87%) (control) | Not reported | Not reported | 2 | |||
| Altay et al.36 | Majority ≤ 1.0 | 2–5 days | Overlay (Single or double) | Y |
Complete healing = 100% (BK) and 95% (VK), Mean healing time = 19 days |
5% (VK) | Improved in vision = > 50% (BK); 2% (VK) | 15 | |||
| Berguiga et al.37 | Mean = 1.0 | 7 days | Mixed (Multiple) | Y | Complete healing = 100% (BK) and 75% (VK) | 25% (VK) | Improved in 40% cases | 15 | |||
| Bourcier et al.38 | All ≤ CF | Not reported | Inlay or overlay (Single–multiple) | Y | Complete healing = 67% | None | Improved in 50% | 14 | |||
| Chen et al.39 | CF–LP | Not reported | Inlay (Single or double) | Y |
Complete healing = 87%, Mean healing time = 16 days |
13% | 20/20-LP | 21 | |||
| Chen et al.40 | HM–LP | 21 days | Inlay (Single) | Y |
Complete healing = 83%, Mean healing time = 9 days |
17% | Improved in 83% | 13 | |||
| Eleiwa et al.41 | Median = CF | 12 days | Inlay (Double) | Y |
Complete healing = 100%, Mean healing time = 26 days |
None | Median = 0.3 | 14 | |||
| Eraslan Yusufoglu et al.42 | Median = ≤ 20/200 | Not clear | Overlay (Double) | Y |
Complete healing = 100% (BK), 88% (VK), Mean healing time = 23 days |
12% (VK) | Improved in 57% (BK) and 8% (VK) | 12 | |||
| Fu et al.43 | Median = < 20/200 | Not reported | Overlay (Double) | Y |
Complete healing = 94%, Mean healing time = 14 days |
3% | Improved in 94% | 12 | |||
| Gicquel et al.44 | Median = ≤ 6/60 | 2 days | Overlay or mixed (Single–multiple) | Y |
Complete healing = 100%, Mean healing time = 26 days |
None | Median = 20/40 | 8 | |||
| Hoffmann et al.45 | Median = 20/20,000 | Not reported | Mixed (Multiple) | Y |
Complete healing = 83%, Mean healing time = 24 days |
17% | Median = 20/200 | 22 | |||
| Kim et al.46 | 20/40—LP | Not reported | Inlay or overlay (Single–multiple) | Y | Complete healing = 100% | None | Improved in 76% | 18 | |||
| Li et al.47 | ~ 20/120 | ~ 1 week | Overlay (Double) | Y | Complete healing = 100% | None | Improved in 78% | 3–18 | |||
| Mohan et al.48 | < 20/200 | 4 weeks | Mixed (Multiple) | Y | Complete healing = 75% | 25% | Improved in 7% | 6 | |||
| Rao et al.49 | Not mentioned | ~ 2 weeks | Mixed (Multilayer) | Y | Complete healing = 76% | 10% | Not reported | 3 | |||
| Shi et al.50 | Median = 20/400 | 2 weeks | Overlay (Multiple) | Y |
Complete healing = 100%, Mean healing time = 15 days |
None | Median = 20/40 Improved in 93% | 9 | |||
| Spelsberg et al.51 | Median = < 6/60 | Not reported | Inlay (Single) | Y |
Complete healing = 75%, Mean healing time = 25 days |
25% | Improved in 8% | 7 | |||
| Wan and Huo52 | Not reported | Not reported | Mixed (Multiple) | Y | Complete healing = 94% | 6% | > 20/200 = 83% | 1–2 | |||
| Wu et al.53 | > 20/200 = 7 (39%) | 1–3 days | Mixed (Multiple) | Y |
Complete healing = 100%, Mean healing time = 17 days |
None | > 20/200 = 72% | 4 | |||
| Xie et al.54 | Mean = 1.3 | 1 week | Mixed (Double) | Y |
Complete healing = 42%, Mean healing time = 36 days |
Not reported | Mean = 0.9 | 3 | |||
| Yildiz et al.55 | Not reported | Not reported | Overlay (Single) | Y | Complete healing = 100% | Not reported | Not reported | 22 | |||
| Zhang et al.56 | Not reported | Not reported | Mixed (Double) | Y | Complete healing = 81% | 8% | Improved in 80% | 3–36 | |||
BK bacterial keratitis, FK fungal keratitis, VK viral keratitis, AK acanthamoeba keratitis, MK mixed keratitis, NSK non-specified keratitis, SAT standard antimicrobial treatment, NRCS non-randomized controlled studies, CF counting fingers, HM hand movement, PL perception of light.
$Severity of the corneal ulcer is presented either in maximum linear diameter (mm), in area (mm2) or in percentage of total cornea (%).
*Vision is presented in either Snellen vision or logMAR vision.
**AMT technique is categorized by the type of grafting (inlay as graft vs. overlay as patch vs. mixed inlay/overlay) and number of layers (single layer vs. double layer vs. multiple layers).
***Adverse event was defined as uncontrolled/worsening infectious keratitis requiring tectonic keratoplasty or evisceration.