Accelerated Restoration of Ocular Surface Health in Dry Eye Disease by Self-Retained Cryopreserved Amniotic Membrane

Abstract

Purpose To evaluate the clinical efficacy of self-retained cryopreserved amniotic membrane in treating dry eye disease. Methods Retrospective review of 10 patients treated with self-retained cryopreserved amniotic membrane (PROKERA® Slim [PKS], Bio-Tissue, Miami, FL) for moderate-to-severe dry eye refractory to conventional maximal medical treatments. Patients’ symptoms, use of medications, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment. Results PKS was placed in 15 eyes of the 10 patients for 4.9 ± 1.5 days. All patients experienced symptomatic relief for a period of 4.2 ± 4.7 months (p<.001). Such improvement was accompanied by reduction of OSDI scores (p<.001), use of topical medications (p<.001), conjunctival hyperemia (p<.001), corneal staining (p<.001), and improvement of the visual acuity (p=.06). Linear regression analysis estimated that the optimal duration of PKS placement was 5 days to achieve an average symptom-free duration of 4 months in patients with dry eye. Surprisingly, PKS placement also generated improvement in the contralateral eyes. Conclusion This pilot study suggests that self-retained cryopreserved amniotic membrane via PKS can be used to treat moderate dry eye diseases and warrants further prospective controlled studies.

Corneal Nerve Regeneration after Self-Retained Cryopreserved Amniotic Membrane in Dry Eye Disease

“…This finding is consistent with our recently reported retrospective study [12]. Compared to the controls, single placement of PKS for 3.4 ± 0.7 days resulted in a significant improvement of DED symptoms and signs (Figures 2(a) and 2(b)), reduction of corneal surface irregularity (Figure 2(c)), and reduction of DEWS scoring (Figure 2(d)) at one month and three months.…”

Update on corneal neurotisation

“…The efficacy of cryopreserved amniotic membrane in the treatment of severe dry eye disease and ocular surface involvement has been traditionally attributed to its known anti-inflammatory effect 96. However, amniotic membrane has an abundance of neurotrophic factors, particularly NGF, which may also contribute to promoting corneal nerve regeneration.…”

The use of self-retained, cryopreserved amniotic membrane for the treatment of Sjögren syndrome: a case series

“…It is likely that Prokera is helpful in treating ocular surface disease in SS patients because of the anti-inflammatory properties of amniotic membrane. [1][2][3]14 Inflammation has been shown to play a central role in causing ocular surface damage found in patients with SS. 3 For example, patients with SS have been found to have increased tear film concentration of matrix metalloproteinase 9 (MMP-9), a molecule related to the inflammatory process responsible for increased corneal epithelial desquamation, corneal surface irregularity, and ocular surface damage.…”

“…[1][2][3]14 Inflammation has been shown to play a central role in causing ocular surface damage found in patients with SS. 3 For example, patients with SS have been found to have increased tear film concentration of matrix metalloproteinase 9 (MMP-9), a molecule related to the inflammatory process responsible for increased corneal epithelial desquamation, corneal surface irregularity, and ocular surface damage. 15 The anti-inflammatory properties of amniotic membrane have been demonstrated in other disease models of corneal inflammation.…”