Volume.125 Number.9

Original article : Clinical science

Changes in Amniotic Membrane Transplantation over the Past 21 Years
Kohei Harada1,2, Hideki Fukuoka1, Osamu Hieda1, Tsutomu Inatomi1,4, Norihiko Yokoi1, Tomoyuki Hino1, Masuko Agu3, Riho Ishigaki3, Masafumi Uematsu2, Takashi Kitaoka2, Shigeru Kinoshita5, Chie Sotozono1
1 Department of Ophthalmology, Kyoto Prefectural University of Medicine
2 Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University
3 Tissue Bank, Kyoto Prefectural University of Medicine
4 Department of Ophthalmology, National Center for Geriatric and Gerontology
5 Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine

Purpose: We previously reported the 10-year surgical outcomes of amniotic membrane transplantation (AMT) performed at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, since April 1998. The purpose of this present study was to review the process of how AMT was covered by insurance after clinical research and the efficacy and indications of AMT, reviewing the changes occurred during the past 21 years and 3 months including the progress after the first surgery.
Subjects and methods: In this study, we collected and reviewed the records of all AMTs performed from April 1998 to June 2019 for each year and divided the number of surgeries and the diseases into the following three categories: clinical research, advanced medical treatment, and insurance coverage. In addition, the rate of required AMT re-operation was compared by disease.
Results: We found that 750 AMTs were perform ed on 664 eyes of 594 cases during the 21-year and 3-month period, and that the number of AMTs performed increased since 1998. Thereafter, the number decreased during the period of advanced medical treatment from 2009 to 2013; however, it increased again after insurance coverage began in 2014. The most common disease was pterygium, followed by intractable ocular surface disorders (OSDs; Stevens-Johnson syndrome, ocular cicatricial pemphigoid, chemical and thermal burns, graft-versus-host disease, and idiopathic corneal epithelial disease) and neoplastic disease. AMT for intractable glaucoma and conjunctivochalasis was indicated only in the first decade. In the total number of cases, the rate of AMT re-operation was 7.7%, mostly in cases of intractable OSD, followed by neoplastic disease and pterygium cases.
Conclusions: AMT became a common surgical treatment with insurance coverage following advancements in clinical research and advanced medical treatment, with the most common indication being pterygium, followed by intractable OSDs. AMT showed stable surgical outcomes in most cases; however, has limitations, especially in intractable OSD cases.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 895-901,2021.

Key words
Amniotic membrane transplantation, Clinical research, Advanced medical treatment, Insurance coverage, Intractable ocular surface disorders
Reprint requests to
Chie Sotozono, M. D., Ph. D. Department of Ophthalmology, Kyoto Prefectural University of Medicine. 465 Kajii-cho, Kawaramachi, Kamigyo-ku, Kyoto-shi, 602-0841, Japan