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  • Cornea/External Disease

    Review of: Comparison of persistent epithelial defect treatment with sutureless cryopreserved and dehydrated amniotic membrane

    Sell S, de la Presa M, Thakur S, et al. American Journal of Ophthalmology, July 2023

    In a cohort study of patients with persistent epithelial defects (PEDs), cryopreserved sutureless amniotic membrane (C-SAM) and dehydrated SAM (D-SAM) appear to be equally effective treatment methods with comparable outcomes.

    Study design

    This was a retrospective cohort study involving patients with persistent epithelial defects (PEDs) who were treated at 2 tertiary care referral practices from 2016 through 2020. Epithelial defects were defined as PEDs if they were present for ≥7 days and had failed conservative therapy (i.e., at minimum, topical lubricating agents with appropriate topical antimicrobial therapy). A total of 220 PEDs (197 patients) were included, with a mean duration of 33.1 days; treatment was done using either C-SAM or D-SAM. The primary outcome was resolution or improvement of the PED.


    Overall, 46.5% of PEDs in the C-SAM group resolved after a single session vs 44.1% in the D-SAM group. However, there were no significant between-group differences in PED resolution, improvement, lack of resolution/improvement, or requirement for surgery. The only risk factor significantly associated with PED nonresolution was systemic or ocular inflammatory disease (p = 0.016). Other risk factors for treatment failure included neurotrophic keratopathy (67.7% of patients), eyelid malposition (26.8%), and limbal stem cell deficiency (20.0%).


    Limitations of this study include its retrospective methodology, lack of corneal sensation data, and challenges surrounding the categorization of PED etiology in patients with several ocular surface comorbidities. Furthermore, prior treatments between the 2 groups were not equivalent.

    Clinical significance

    The study illustrated that C-SAM and D-SAM are similarly effective for the treatment of PEDs, broadening clinicians’ options for therapy. In the presence of risk factors such as inflammatory disease, practitioners may want to consider earlier and more aggressive treatments, including tarsorrhaphy and sutured amniotic membrane.

    Financial Disclosures: Dr. Zeba Syed discloses financial relationships with Bio-Tissue (Lecture Fees/Speakers Bureau); Dompé, Glaukos (Grant Support).