ReviewOphthalmology and therapy2026
Amniotic Membrane in Excimer Laser Surface Ablation (ELSA): Mechanisms for Haze Prevention and Broader Ocular Surface Optimisation.
Review in Ophthalmology and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Subepithelial corneal haze remains a clinical risk after excimer laser-based surface ablation (ELSA), especially with deep ablations, high myopia or retreatments, with downstream effects on vision and quality of life. Mitomycin C (MMC) is widely used intraoperatively for haze prophylaxis and has multi-study support; however, its antiproliferative, anti-fibrotic action does not directly address early inflammation, epithelial barrier restoration or neuroregeneration, and use remains off-label with heterogeneous protocols. This narrative review synthesises preclinical, early clinical (non-randomised/small trials) and established clinical evidence (randomised trials/systematic reviews or guidelines) on amniotic membrane transplantation (AMT) as a complementary adjunct in ELSA. We emphasise modern, sutureless, dehydrated AMT (dAM), including vision-preserving formats suited to peri-operative workflows. Across adjacent ocular-surface indications, AMT demonstrates multi-modal properties: anti-inflammatory/immunomodulatory, antioxidant, anti-proteinase (including matrix metalloproteinase-9 suppression) and support of epithelial and nerve recovery. In ELSA-specific work, preclinical photorefractive keratectomy (PRK) models show reduced haze and faster epithelialisation with patch-AMT; one prospective laser-assisted sub-epithelial keratectomy (LASEK) human study reports faster healing and lower opacity versus standard care. By contrast, small fellow-eye studies using ring-mounted cryopreserved-AMT devices showed no superiority for routine myopic PRK, underscoring the importance of format and protocol. This review outlines a complementary paradigm: MMC targets downstream fibrosis, whilst patch-AMT acts earlier on inflammation, epithelial repair, protease imbalance (including MMP-9) and neurotrophic support. With major international guidelines now recognising sutureless patch-AMT for regeneration and inflammation/oxidative stress control in dry eye, prospective refractive-cohort trials with standardised product/placement protocols, long-term follow-up, patient-reported outcomes and embedded health-economic evaluation are warranted to define AMT's role alongside MMC in routine ELSA.
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