Sir,

We read with interest the article entitled ‘Amniotic membrane in ophthalmology: indications and limitations’ by Rahman et al,1 in which the authors provide a comprehensive review of the use of amniotic membrane (AM) transplantation in ocular surface reconstruction.

In the article the authors describe a new method of using the AM, retaining it in the eye with a conformer.

We would like to describe an alternative method, which we have found to be very well tolerated by the patient.

Technique

The AM is obtained from Tissue Services, National Blood Services (Liverpool, UK, L24 8RB) as a 2 × 2 or 3 × 3 cm2 sheet on nitrocellulose mounting paper in transport medium frozen at −40 °C. The AM is provided stromal side down and the overlap reflected onto the reverse of the paper.

The amnion is allowed to thaw and is rinsed according to the supplier's instructions. The mounting paper is taped flat onto a suitable surface (eg, a plastic kidney dish), having first peeled the AM from the corners to allow this (Figure 1a). A Flieringa ring, of an appropriate size to fit comfortably into the patient's fornices, is selected and placed on the uppermost, epithelial surface of the amnion. The peripheral amnion is lifted and placed at the centre of the ring. The amnion is then sutured in position with one running 7/O Vicryl suture (Figure 1b).

Figure 1
figure 1

(a) The mounting paper is taped flat to a suitable surface using steristrips. A Flieringa ring (previously measured to fit comfortably in patient fornices with minimal mobility) placed on the AM's epithelial surface. (b) The amnion is sutured with one 7/O Vicryl running suture around the ring. (c) The BBCL is easily placed upon the eye. (d) The eye with BBCL in is easy to examine, here showing tectonic penetrating keratoplasty with anterior chamber haemorrhage.

Full size image

The amnion biological bandage contact lens (BBCL) is then placed on the patient's eye, stromal side down (Figure 1c).

Comment

The AM can be held on the eye by various methods: glue, suturing, or, as recently described, with a conformer.1 We have found all these methods to have disadvantages. Sutures can cut out, cause haemorrhage, and irritate, and we have found conformers to be uncomfortable for the patient.

We believe the method described here has several advantages; it is cheap and can be easily performed, and is well tolerated by the patient. Examination of the eye is possible through the amnion (Figure 1d), and the BBCL can be removed and replaced whenever necessary with negligible trauma to the eye.