Amniotic membrane in ophthalmology: Historical perspectives, biological properties, and clinical applications

The use of amniotic membrane (AM) in ophthalmology has evolved significantly since its first documented application in ocular surface reconstruction in the 1940s. Widespread clinical interest surged in the late 20th century following the development of improved processing and preservation methods. This comprehensive review covers the history, properties, and clinical applications of AM in ophthalmology. Derived from the innermost layer of the placenta, AM is composed of epithelium, a thick basement membrane and avascular stromal matrix, providing a biologic scaffold that supports epithelial cell migration and adhesion. AM possesses a unique combination of anti-inflammatory, anti-fibrotic, anti-angiogenic, and antimicrobial properties. It contains a rich array of cytokines, growth factors, and extracellular matrix proteins which modulate inflammation and promote tissue regeneration. Clinically, AM is widely used in the management of ocular surface disorders, including pterygium surgery, acute chemical burns, persistent epithelial defects, corneal ulcers, and limbal stem cell deficiency. It serves both as a biological bandage and as a substrate for epithelial growth. The integration of AM into ophthalmic practice has significantly enhanced outcomes in ocular surface healing and remains a cornerstone in the management of complex anterior segment pathologies. AM's applications in non-ocular surface procedures within ophthalmology are also rapidly expanding. Notably, AM has been employed in orbital reconstruction, eyelid surgery, glaucoma filtration surgery, strabismus surgery, and vitreoretinal surgery. These diverse applications along with active development of novel formulations highlight the versatility of AM. Ongoing research continues to explore its full potential and applications in the anterior and posterior segment and adnexa.