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    Using amniotic membrane in the primary care office

    This biologic contact lens may help treat a variety of conditions

    It’s easy to take for granted the enormous growth that has occurred in eye care and optometry. Interested in fitting contact lenses? The market has seen expansion from yearly and two-week soft lenses and small-diameter RGPs to daily, monthly standard, and silicone hydrogels and small, medium, and scleral RGPs. Interested in treating ocular disease? It’s easy to forget that 35 years ago, optometrists were worried about having the opportunity to dilate eyes. Practice scope has grown to routinely include dilation and treatment of eye infections, and management and treatment of eye disease.

    Time will tell, but it is possible that we are poised to see new changes in the management of keratitis (microbial, HSV), recurrent corneal erosions, corneal abrasions, and other anterior segment conditions with amniotic membrane. Recently approved for reimbursement in optometry, this specially designed biologic corneal bandage will likely make a significant improvement in the recovery from injury or disease for some patients.

    Amniotic membrane in ocular surface disease

    What is amniotic membrane?

    Simply stated, amniotic membrane is a turbocharged biologic contact lens. Practitioners have been keenly aware of the fact that an approved bandage contact lens will improve patient comfort and support healing by reducing eyelid and corneal surface interaction. Amniotic membrane such as Prokera (BioTissue) is an active carrier of amniotic membrane cells and utilizes, as a result of harvesting, a number of chemical mediators including heavy chain hyaluronic acid, PTX 3 [HC-HA activator], collagens (types I, III, IV, V, and VI), fibronectin, laminin, proteoglycans, and growth factors.1 It is believed that the heavy chain hyaluronic acid is the key component and that it works by neutralizing neutrophil activity and downgrading the inflammation pathway. This is important because the reduction of inflammation decreases the likelihood of scarring.

    What are the indications for using amniotic membrane? A number of options include neurotrophic persistent epithelial defects, dry eye, exposure keratopathy, filamentary keratitis, infectious keratitis, recurrent corneal erosion, Salzmann’s degeneration, post-DSEK bullous keratopathy, and post-PRK haze. In situations where the epithelium is broken, amniotic membrane can be used to cover the wound and speed the recovery. In situations where there are no epithelial breaks, such as basement membrane changes or Salzmann’s, the pathology is debrided, and amniotic membrane is applied. Do the anti-inflammatory properties of amniotic membrane make a difference in healing? Let’s look at some studies.

    Gregg Eric Russell, OD, FAAO
    Dr. Russell practices at the Marietta Eye Clinic in Marietta, GA, where he primarily focuses on specialty contact lenses for disease and ...

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    Optometry Times A/V