EyeWorld Asia-Pacific June 2013 Issue

50 EWAP CORNEA June 2013 Amniotic membrane use solves numerous severe surface issues by Michelle Dalton EyeWorld Contributing Writer But whether using cryo-preserved or heat-dried, it is “not a magic wand” U sing amniotic membrane to treat some of the most devastating corneal diseases became easier a couple of years ago with the introduction of two new CPT codes (see sidebar). Amniotic membrane is currently used in two forms—in its cryopreserved form as AmnioGraft and ProKera (Bio- Tissue, Doral, Fla., USA) and in its heat-dried form as AmbioDry2 and Ambio5 (IOP Ophthalmics, Costa Mesa, Calif., USA). “Acute chemical and Stevens- Johnson syndrome (SJS) are the most severe indications for amniotic membrane,” said Scheffer C.G. Tseng, MD , director, Ocular Surface Center, Miami, Fla., USA; medical director, Ocular Surface Research & Education Foundation, Miami, Fla., USA; and director, research and development, Tissue Tech, Miami, Fla., USA. “We have observed a critical window in these cases where, if the treatment is given in time, the outcome is as different as night and day.” There are three general categories where using amniotic membrane makes the most sense, said Kimberly C. Sippel, MD , associate professor of ophthalmology, New York- Presbyterian Hospital, New York, NY, USA, and associate professor of ophthalmology, Weill-Cornell Medical College, New York, NY, USA. First, persistent epithelial Post-pterygium surgery, treated with AmbioDry2 amniotic membrane Source: Juan F. Batlle, MD AmbioDry2 being placed in the conjunctiva Source: IOP Ophthalmics continued on page 52 defect (PED) of the cornea, “where it just doesn’t heal. Herpes simplex virus is one of the most common causes of PED,” she said. Second, focal conditions involving the conjunctiva that necessitate having the conjunctiva removed and replaced (as in cases of pterygia or conjunctival tumors). The last main indication is a generalized widespread disease of the ocular surface (alkali chemical injury or SJS). “Amniotic membrane is an The ProKera (top) and AmnioGraft (center) can be used as biologi- cal bandages or permanent grafts and are about 100 microns thick; AmnioGraft-G (bottom) is used as a permanent graft and is about 300 microns thick. Source: Scheffer C.G. Tseng, MD CPT codes at a glance • CPT 65778 – Placement of amniotic membrane on the ocular surface for wound healing; self-retaining • CPT 65779 – Placement of amniotic membrane on the ocular surface for wound healing; single layer, sutured • CPT 65780 –Ocular surface reconstruction, amnioticmembrane transplantation, multiple layers • Surgeons should not report 65778, 65779 in conjunction with 65430 (cornea scraping), 65435 (removal of corneal epithelium), or 65780; for placement of amniotic membrane using tissue glue, use 66999. For placement of amniotic membrane without reconstruction using self-retaining or single layer suture technique, use 65778, 65779.