<p>Self-Retained Cryopreserved Amniotic Membrane for the Management of Corneal Ulcers</p>

Abstract

Purpose: To evaluate the clinical outcomes of self-retained cryopreserved amniotic membrane (cAM) for the treatment of corneal ulcers. Methods: This was a single-center, retrospective review of consecutive patients with nonhealing corneal ulcers that underwent treatment with self-retained cAM (PROKERA ® Slim). The primary outcome measure was time to complete corneal epithelialization. Ocular discomfort, corneal staining, corneal signs, and visual acuity were assessed at 1 week, 1 month, 3 months, and 6 months. Complications, adverse events, and ulcer recurrence were also recorded. Results: A total of 13 eyes (13 patients) with recalcitrant corneal ulcers were included for analysis, 9 (69%) of which progressed from neurotrophic keratitis (NK). Prior to cAM application, patients used conventional treatments such as artificial tears (n = 11), antibiotics (n = 11), ointment (n = 11), steroids (n = 6), and antivirals (n = 3). Self-retained cAMs (n = 1.5 ± 0.8) were placed for 6.8 ± 3.4 days, during which time antibiotics were continued. Four cases (31%) were subsequently treated with bandage contact lens (n = 3) and tarsorrhaphy (n = 1). All corneal ulcers healed in a median of 14 days (range: 4-43). This was accompanied by a significant improvement in ocular discomfort, corneal staining, and corneal signs at 1 week, 1 month, 3 months, and 6 months (P<.05). Recurrence was noted in one case. No adverse events were observed. Conclusion: Self-retained cAM may be a valuable, in-office treatment option for healing recalcitrant corneal ulcers of various etiologies, especially those with underlying NK. Further prospective, controlled studies are warranted.

Visual Acuity and Number of Amniotic Membrane Layers as Indicators of Efficacy in Amniotic Membrane Transplantation for Corneal Ulcers: A Multicenter Study

“…In contrast to our postoperative VA findings, Uhlig et al [ 40 ], Letko et al [ 41 ], Prabhasawat et al [ 31 ], and Brocks et al [ 61 ] did not find significant improvements in postoperative VA compared to the baseline values despite reporting high percentages of re-epithelization. Schuerch et al [ 6 ] observed significant improvements in VA in the entire cohort but not in the etiological groups.…”

“…A recent study using self-retained cryopreserved AMs (Prokera ® ; Bio-Tissue, Inc., Miami, FL, USA) has shown significant VA gain in a limited number of cases (n = 24); however, this study only analyzed Prokera ® in infectious ulcers but not in NHCUs. Others studies on Prokera ® did not find this significant VA gain [ 61 ].…”

Update on the application of amniotic membrane in immune-related ocular surface diseases

“…[ 19 ] Since then, AMT has been widely applied in the treatment of a range of ocular surface disorders, including chemical and thermal injuries, persistent epithelial defects (PEDs), corneal ulcers, ocular surface reconstruction after resection of pterygia, ocular surface tumors, symblephara, neurotrophic keratopathies, and immune-mediated ocular surface diseases including SJS/TEN, oGvHD, and SS. [ 2 6 18 20 21 22 23 24 ]…”

Advancement on Sustained Antiviral Ocular Drug Delivery for Herpes Simplex Virus Keratitis: Recent Update on Potential Investigation

“…Some studies suggest topical cyclosporine or topical tacrolimus as supplementary immunosuppressive agents but require further clinical validation [ 26 ]. Debridement and cryopreserved amniotic membrane (CAM) may aid in re-establishing epithelial healing [ 27 , 28 ]. Lastly, corneal transplant may be an option for patients with severe corneal scarring, yet corneal graft rejection is another treatment challenge [ 29 ].…”