Surgical Technique ANovel Technique ofModified Continuous Blanket Suture for Amniotic Membrane Fixation in Severe Ocular Surface Diseases

Human amniotic membrane (AM) transplantation (AMT) has been widely used to treat various ocular surface diseases (OSDs) because of its unique properties.1-3 The firm fixation of the AM to the ocular surface is a prerequisite for providing a stable basement membrane for epithelial cell migration and propagation before complete epithelialization is achieved.4 The literature describes several techniques to fix the AM. Traditional suture techniques for AM fixation are the interrupted suture, a continuous (or running) suture, or a combination of these techniques. Recently, sutureless techniques, such as tissue adhesives and diverse ring-AM complexes, have been introduced and tested in different studies.5,6 Cautery was also used in pterygium surgery.7 However, there are a number of complications and inherent drawbacks associated with those fixation methods,3,8 especially in cases of severe OSD. In severe patients, the AM could dissolve or be lost early because of serious inflammation. Some patients may need repeated AMT. Thus, it is necessary to develop new AM fixation techniques to overcome these drawbacks. Since 2002, we have routinely used a modified continuous blanket suture (MCBS) technique to anchor the AM in more than 300 cases with various OSDs. In this article, typical cases are presented to demonstrate the application of these new techniques in different zones of ocular surface defects caused by severe OSD.