Page 341 - IJB-9-3

International Journal of Bioprinting Amniotic fornical ring for ocular surface reconstruction

10-0 nylon sutures to the ocular surface in the conventional Table 1. Demographics and characteristics of patients
SAMT group. When the AM dissolved and could not cover AFR SAMT
the defective keratoconjunctival epithelium, the AFR, AM, P
or suture was removed. The AFR were removed by gently Sex (F:M) 5 : 26 2 : 17
pulling the lower eyelid (Figure 1C). All eyes received Age (years, range) 46 ± 17 (9–89) 38 ± 22 (2–70) 0.187
topical medications (see Figure 1D). The patients with Indications
severe chemical injuries received the administration of Acid 2 (5%) 3 (13.6%)
intravenous dexamethasone and vitamin C if necessary. Alkali 25 (62.5%) 12 (54.5%)
The patients with SJS or TEN were administered tacrolimus Thermal 7 (17.5) 7 (31.9%)
eye drops topically in addition to the above treatments.
SJS and TEN 6 (15%) 0
2.4. Parameter estimation Time of presentation (days)
The collected data included age, sex, etiology, affected 0–1 10 (25%) 5 (22.7%)
eye, degree of chemical burns, patient symptoms, visual 2–7 20 (50%) 8 (36.4%)
acuity (VA), intraocular pressure (IOP), ophthalmological
findings, epithelial defect healing, complications, time of >7 10 (25%) 9 (40.9%)
AFR or AM retention, and follow-up. The patient symptoms Roper-Hall classification
were recorded based on subjective reports at each visit and I 12 (35.3%) 4 (18.2%)
slit-lamp examination. VA was assessed using a fractional II 5 (14.7%) 6 (27.3%)
eye chart at each visit and subsequently converted to III 6 (17.6%) 8 (36.4%)
logMAR values for analysis. “Counting Fingers” were rated IV 11 (32.4%) 4 (18.2%)
by LogMAR 2.0, and “Hand Movements” were rated by
LogMAR 2.3. If the patient’s VA was light perceptive, the Dua’s classification
patient was excluded from the statistical analysis . The I 12 (35.3%) 4 (18.2%)
[12]
degree of ocular surface burns was graded according to II 5 (14.7%) 6 (27.3%)
the Roper-Hall and Dua classifications [13,14] . The patients III 6 (17.6%) 8 (36.4%)
with SJS or TEN were graded according to previous IV 6 (17.6%) 3 (13.6%)
literature . The grading standard of symblepharon was V 3 (8.8%) 0
[15]
referred to in previous literature . Note that all patients VI 2 (5.9%) 1 (4.5%)
[16]
were administered levofloxacin eye drops four times per
day as prophylaxis. Additional treatments
PKP 1 (2.5%) 0
The percentage of healed corneal area (PHCA) was
defined as described in previous literature , i.e., PHCA = Tarsorrhaphy 8 (20%) 3 (13.6%)
[5]
(final area − initial area)/initial area × 100%. We assessed Bandage contact lens 9 (22.5%) 4 (18.2%)
the final corneal epithelial defect area by fluorescein Total number of eyes n = 40 n = 22
staining when AFR or dissolution of AM was removed. In Burned by chemical and n = 34 n = 22
heat
the cost-effective analysis, the cost for 1% healing area was
defined as total cost/PHCA. Data are shown as mean ± SD Abbreviations: AFR, amniotic fornical ring; PKP, penetrating keratoplas-
or median (range). ty; SAMT, sutured amniotic member transplant; SJS, Stevens-Johnson
syndrome; TEN, toxic epidermal necrolysis.
2.5. Statistical analysis
Data analysis was performed with SPSS 25.0. The results thermal burns, SJS, and TEN. Alkaline burns were the
are shown as the mean ± SD or median (interquartile most common cause of ocular surface damage. Data from
range, the 25th percentiles–the 75th percentiles) with a 40 eyes of 31 patients (5 female and 26 male) were collected
significance level of 0.05. To compare collected data with in the AFR group. In the SAMT group, 22 eyes of 19
baseline data, chi-square test or Fisher’s exact test was used patients (2 female and 17 male) were analyzed. The mean
for qualitative data. Independent t-tests or Mann–Whitney age was 46 ± 17 years (range: 9–89 years) in the AFR group
U tests were used for quantitative data. and 38 ± 22 years (range: 2–70 years) in the SAMT group
(Table 1). There was no significant difference in patient age
3. Results and discussion between the two groups. The main indications for using
From January 2019 to July 2022, 62 eyes of 50 patients AFR and SAMT were similar and mainly included ocular
(2–89 years old) were screened, and the eye conditions surface burns. Six patients with SJS or TEN underwent
included alkaline chemical burns, acidic chemical burns, AFR-assisted AMT. Notably, AFR can be used alone in

Volume 9 Issue 3 (2023) 333 https://doi.org/10.18063/ijb.713