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The Amniotic Membrane Bandage

The “natural” remedy for stubborn dry eye disease

KEVIN GEE, O.D.

Despite the use of artificial tears, corticosteroids, cyclosporine 0.05% (Restasis, Allergan), omega-3 essential fatty acid supplementation, autologous serum drops and punctal occlusion, among other treatments, your dry eye disease patient continues to complain of ocular dryness, burning, foreign-body sensation and fluctuating vision. What’s more, examination reveals a negligible change in her ocular surface inflammation. What do you do? The answer is use an amniotic membrane bandage.

Overview

Obtained from full-term, caesarian-born placentas and tested for infectious disease, the graft tissue of the bandage decreases ocular surface inflammation and accelerates regeneration via producing stem cells on the ocular surface. As a result, the likelihood of the development of neovascularization and/or a corneal infiltrate (or scarring, if an infiltrate is already present) is slim.

Amniotic membrane bandages are available in two forms: cryo-preserved or frozen (requiring refrigeration) and dehydrated (the latter stored at room temperature). Currently, no conclusive evidence is available that reveals one is more effective toward a particular condition.

The cryo-preserved and frozen form rests on a 16mm retainer ring, comes in varying thicknesses and may cause some foreign-body sensation. (Depending on the severity of the condition, a doctor may choose to use a thicker profile membrane. That said, no documentation is available to substantiate such a claim.) To minimize the foreign-body sensation, perform a tarsorrhaphy, which is the taping of the temporal canthus, so the patient can still administer topical medications. In cases of bacterial corneal ulcer, herpes lesion or a viral corneal infiltrate, anti-infective drops may be needed.

The dehydrated amniotic membrane can be ordered in varying sizes as well, though the most common diameter is a 11mm disc that is placed directly on the cornea and covered with a standard bandage contact lens. Due to its similarity to a bandage contact lens, patient discomfort is usually less.

Both forms fall within the scope of practice for practically all optometrists and are well within our comfort zone of skill, as they are similar to a bandage contact lens. You leave them on the eye for as long as you deem necessary, but there is a 10-day global period for post-operative care. As usual, check with your LCD and private insurers for indications and reimbursement policies. OM

DR. GEE PRACTICES IN HOUSTON, TEXAS, AND IS AN ASSISTANT CLINICAL PROFESSOR AT THE UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY. IN ADDITION, HE IS A FELLOW OF THE AMERICAN ACADEMY OF OPTOMETRY, AN ABO DIPLOMATE AND AN OCRT MEMBER. ALSO, HE’S ON ALLERGAN’S ADVISORY BOARD AND IS A CONSULTANT FOR SOLUTION REACH. E-MAIL HIM AT DRGEE@GEEEYECARE.COM, OR VISIT TINYUR.COM/OMCOMMENT TO COMMENT ON THIS ARTICLE.