The human amniotic membrane (AM) possesses anti-inflammatory, antifibrotic and antiangiogenic properties, and these attributes makes it ideal for ocular surface reconstruction procedures. In addition, the AM also has antimicrobial properties due partly to its anti-inflammatory effects, and also due to secretion of elafin and secretory leucocyte proteinase inhibitor, both of which have antimicrobial actions and act as components of the innate immune system. It also contains cystatin E, an analogue of cysteine proteinase inhibitors, which has complementary antiviral properties.5 In spite of this, AM transplantation (AMT) is reserved for cases of postinfectious ulcers after an appropriate period of anti-infective treatment when clinical signs are improving. This is because the anti-infective properties of AM are non-specific and not considered to be potent enough to be effective in acute infective keratitis; this is the reasoning behind the concept of fortifying AM with antimicrobial drugs to make it a viable therapeutic modality in the setting of active infections of the cornea.
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