Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 2727
  • Home
  • Print this page
  • Email this page

   Table of Contents      
LETTER TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 10  |  Page : 1520-1521

Comment on: Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation


Neera Eye Centre and Laser Vision, Daryaganj, New Delhi, India

Date of Web Publication24-Sep-2018

Correspondence Address:
Dr. Pooja Jain
Neera Eye Centre and Laser Vision, Bharat Ram Road, Daryaganj, New Delhi - 110 002
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_938_18

Rights and Permissions

How to cite this article:
Jain P, Agrawal N. Comment on: Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation. Indian J Ophthalmol 2018;66:1520-1

How to cite this URL:
Jain P, Agrawal N. Comment on: Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation. Indian J Ophthalmol [serial online] 2018 [cited 2019 Dec 7];66:1520-1. Available from: http://www.ijo.in/text.asp?2018/66/10/1520/242030



Sir,

We read with great interest the article on continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation and would like to congratulate the authors for introducing a new technique of shield ulcer management.[1]

While we agree with the authors regarding the benefit of multiple layers of amniotic membrane transplantation (AMT) in faster healing of shield ulcer, we have certain doubts regarding the technique.

The authors have described that the first amniotic membrane was applied with stromal side up with margins tucked in the subepithelial pockets created in the surrounding de-epithelized edges and the second membrane was put with the stromal side down.[1] We would like to ask the authors about how the stromal side up type of AMT would have lead to rapid epithelial healing. It is the basement membrane (BM) of amniotic membrane which promotes migration, adhesion, and differentiation of surrounding epithelial cells, and therefore, AMT should be done with the epithelium or BM side up when used as a graft in persistent epithelial defects or nonhealing ulcers.[2],[3]

The stromal side of amniotic membrane inhibits the fibroblastic proliferation by inhibiting the TGF-B signaling pathway and should be placed towards conjunctival or corneal side when used for reducing the scarring.[4] It also reduces inflammation by acting as a barrier to the toxic effects of tears when used as a patch.[5]

We are also of the same opinion that when used as a graft it should be put with BM side up, and when used as a patch, it should be put with the stromal side down.

Besides we would also like to ask the opinion of authors about their experience of topical immunosuppressants (tacrolimus, cyclosporine, etc.) in such cases of severe vernal keratoconjunctivities.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sharma N, Singhal D, Maharana PK, Jain R, Sahay P, Titiyal J. Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation. Indian J Ophthalmol 2018;66:816-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sridhar MS, Sangwan VS, Bansal AK, Rao GN. Amniotic Membrane Transplantation in the management of shield ulcers of vernal keratoconjunctivities. Ophthalmology 2001;108:1218-22.  Back to cited text no. 2
    
3.
Kruse FE, Rohrschnieder K, Volcker HE. Multilayered Amniotic membrane transplantation for reconstruction of deep corneal ulcers. Ophthalmology 1999;106:1504-11.  Back to cited text no. 3
    
4.
Lee SB, Li DQ, Tan DT, Meller DC, Tseng SC. Suppression of TGF B signalling in both normal conjunctival fibroblasts and pteryigial body fibroblasts by amniotic membrane. Curr Eye Res 2000;20:325-34.  Back to cited text no. 4
    
5.
Sangwan VS, Burman S, Tejwani S, Mahesh SP, Murthy R. Amniotic Membrane transplantation: A review of the current indication in the management of ophthalmic disorders. Indian J Ophthalmol 2007;55:251-60.  Back to cited text no. 5
[PUBMED]  [Full text]  




 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed297    
    Printed0    
    Emailed0    
    PDF Downloaded66    
    Comments [Add]    

Recommend this journal