The Efficacy of Sutureless Amnion Membrane Transplantation for Corneal Epithelialization in Delayed Corneal Healing: A Systematic Review

Purpose: To review the current evidence on the efficacy and safety of sutureless amniotic membrane transplantation (AMT) for promoting corneal epithelialization in delayed corneal healing disorders. Methods: A comprehensive search was conducted for studies published from January 2003 to December 2023. The inclusion criteria were studies that focused on delayed corneal healing (including persistent epithelial defect, dry eye disease, corneal ulcer, chemical injury, recalcitrant keratitis, or others), observed corneal re-epithelialization as the outcome, with the use of sutureless AM graft. Studies that reported sutureless AM combined with cyanoacrylate or fibrin glue were excluded. Results: A total of 14 studies met the inclusion and exclusion criteria. The most common technique for sutureless AM on the cornea was self-retained cryopreserved AMT. The result of sutureless AMT in various delayed corneal healing disorders showed complete corneal epithelialization occurred in most patients (64.4%) which ranged from 3 to 43 days. There was a low rate of adverse events (pain, 2.9%; displaced AM or lost ring, 1.7%) and complications (sterile infiltrate, 1.8%; corneal perforation, 0.6%; ring trauma, 0.4%; central corneal scarring, 0.2%). Conclusions: Sutureless AMT promotes complete corneal epithelialization. It is easier for multiple application, more comfortable, and has a lower risk of suture-related complications. Overall, sutureless AMT is effective and safe for a variety of corneal delayed healing disorders.