The Effect of Amniotic Membrane Extracted Eye Drop on Repairing The Corneal Epithelial in Patients after Trans-Epithelial Photorefractive Keratectomy: An Interventional and Historical Study

Document Type : Original Article


1 Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Chemical Injures Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran


Objective: Recent studies imply extensive applications for the human amniotic membrane (hAM) and its extract in
medicine and ophthalmology. The content of hAM meets many requirements in eye surgeries, such as refractive
surgery as the most important and commonly used method for treating the dramatically increasing refractive errors.
However, they are associated with complications such as corneal haziness and corneal ulcer. This study was designed
to evaluate the impact of amniotic membrane extracted eye drop (AMEED) on Trans-PRK surgery complications.
Materials and Methods: This interventional and historical study was performed during two years (July 1, 2019-September
1, 2020). Thirty-two patients (64 eyes), including 17 females and 15 males, aged 20 to 50 years (mean age of 29.59 ±
6.51) with spherical equivalent between -5 to -1.5 underwent Trans Epithelial Photorefractive Keratectomy (Trans-PRK)
surgery. One eye was selected per case (case group) and the other eye was considered as control. Randomization
was done using the random allocation rule. The case group was treated with AMEED, and the artificial tear drop every
4 hours. The control eyes received artificial tear drops instilled every 4 hours. The evaluation continued for three days
after the Trans-PRK surgery.
Results: A significant decrease in CED size was found in the AMEED group on the second day after surgery (P=0.046).
Also, this group had a substantial reduction in pain, hyperemia, and haziness.
Conclusion: This study showed that AMEED drop can increase the healing rate of corneal epithelial lesions after Trans-
PRK surgery and reduce the early and late complications of Trans-PRK surgery. Researchers and Ophthalmologists
should consider AMEED as a selection in patients with persistent corneal epithelial defects and patients who have
difficulty in corneal epithelial healing. We understood AMEED has a different effect on the cornea after surgery;
therefore, the researcher must know AMEED’s exact ingredients and help expand AMEED uses.


  1. Plumer C. The use of amniotic membrane transplantation for ocular surface reconstruction: a review and series of 58 equine clinical cases (2002-2008). Vet Ophthalmol. 2009; 12(1): 17- 24.
  2. Baradaran Rafii A, Ebrahimi M, Shayan N, Shahabi K, Shams M. In-vivo cultivation of limbal stem cells for ocular surface reconstruction. Bina J Ophthalmol. 2015; 20(3): 255-263.
  3. Litwiniuk M, Grzela T. Amniotic membrane: new concepts for an old dressing. Wound Repair Regen. 2014; 22(4): 451-456.
  4. Malhotra C, Jain AK. Human amniotic membrane transplantation: different modalities of its use in ophthalmology. World J Transplant. 2014; 4(2): 111.
  5. Shayan Asl N, Nejat F, Mohammadi P, Nekoukar A, Hesam S, Ebrahimi M, et al. Amniotic membrane extract eye drop promotes limbal stem cell proliferation and corneal epithelium healing. Cell J. 2019; 20(4): 459-468.
  6. Lyons VN, Townsend WM, Moore GE, Liang S. Commercial amniotic membrane extract for treatment of corneal ulcers in adult horses. Equine Vet J. 2021; 53(6): 1268-1276.
  7. Murri MS, Moshirfar M, Birdsong OC, Ronquillo YC, Ding Y, Hoopes PC. Amniotic membrane extract and eye drops: a review of literature and clinical application. Clin Ophthalmol. 2018; 12: 1105-1112.
  8. Giloyan A, Khachadourian V, Petrosyan V, Harutyunyan T. Prevalence and determinants of uncorrected refractive error among a socially vulnerable older adult population living in Armenia. Public Health. 2021; 190: 30-36.
  9. Evangelos P, Chrisi K. Prevalence and distribution of refractive errors among adults in Athens-Greece (urban area). Opth Clin Ther. 2020; 4(2): 3-8.
  10. Adib-Moghaddam S, Soleyman-Jahi S, Sanjari Moghaddam A, Hoorshad N, Tefagh G, Haydar AA, et al. Efficacy and safety of transepithelial photorefractive keratectomy. J Cataract Refract Surg. 2018; 44(10): 1267-1279.
  11. Hassan Mohammad H, Mohamed Tag El-Din AE-M, S Al- Sheikh M. Postoperative corneal haze after transepithelial photorefractive keratectomy (trans prk) versus conventional photorefractive keratectomy (prk). AIMJ. 2020; 49(3): 979-986.
  12. Efron N, Morgan PB, Katsara SS. Validation of grading scales for contact lens complications. Ophthalmic Physiol Opt. 2001; 21(1): 17-29.
  13. Tandon R, Gupta N, Kalaivani M, Sharma N, Titiyal JS, Vajpayee RB. Amniotic membrane transplantation as an adjunct to medical therapy in acute ocular burns. Br J Ophthalmol. 2011; 95(2): 199-204.
  14. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016; 123(5): 1036-1042.
  15. Varadarajan AV, Poplin R, Blumer K, Angermueller C, Ledsam J, Chopra R, et al. Deep learning for predicting refractive error from retinal fundus images. Invest Ophthalmol Vis Sci. 2018; 59(7): 2861-2868.
  16. Kundu G, D’Souza S, Lalgudi VG, Arora V, Chhabra A, Deshpande K, et al. Photorefractive keratectomy (PRK) prediction, examination, treatment, follow-up, evaluation, chronic treatment (PERFECT) protocol - a new algorithmic approach for managing post PRK haze. Indian J Ophthalmol. 2020; 68(12): 2950-2955.
  17. Zarei-Ghanavati S, Shandiz JH, Abrishami M, Karimpour M. Comparison of mechanical debridement and trans-epithelial myopic photorefractive keratectomy: a contralateral eye study. J Curr Ophthalmol. 2019; 31(2): 135-141.
  18. Sanchez-Avila RM, Uribe-Badillo EE, Sanz JF-V, Muruzabal F, Jurado N, Alfonso-Bartolozzi B, et al. Plasma rich in growth factors versus Mitomycin C in photorefractive keratectomy. Medicine (Baltimore). 2021; 100(3): e24139.
  19. Shah MN, Misra M, Wihelmus KR, Koch DD. Diffuse lamellar keratitis associated with epithelial defects after laser in situ keratomileusis. J Cataract Refract Surg. 2000; 26(9): 1312-1318. 20. Fini ME, Cook JR, Mohan R. Proteolytic mechanisms in corneal ulceration and repair. Arch Dermatol Res. 1998; 290(1): S12- S23.
  20. Sabater-Cruz N, Figueras-Roca M, Ferrán-Fuertes M, Agustí E, Martínez-Conesa EM, Pérez-Rodríguez ML, et al. Amniotic membrane extract eye drops for ocular surface diseases: use and clinical outcome in real-world practice. Int Ophthalmol. 2021; 41(9): 2973-2979.
  21. Kordić R, Popović Suić S, Jandroković S, Kalauz M, Kuzman T, Škegro I, et al. Application of the amniotic membrane extract (AMX) for the persistent epithelial defect (PED) of the cornea. Coll Antropol. 2013; 37 Suppl 1: 161-164.
  22. Sheha H, Liang L, Hashem H, Ramzy M, ZaKi A. Amniotic membrane extract for acute ocular chemical burns. Tech Ophthalmol. 2010; 8(4): 146-150.