CORNEA EWAP JUNE 2023 39 by Liz Hillman EyeWorld (US) Editorial Co-Director Amniotic membrane: When it’s useful vs. overused Contact information Houser: kourtney.houser@gmail.com Hovanesian: johnhova@gmail.com Amniotic membrane, in its various forms, has several ophthalmic applications, but it is also, at times, being marketed for indications that don’t have a lot of evidence in the scientific literature and/or that have other proven alternatives, according to physicians. Kourtney Houser, MD, said there are a number of companies that offer dehydrated and cryopreserved amniotic membrane. John Hovanesian, MD, said amniotic cytokine extract drops are also being produced. Overall, amniotic products are sought after for their anti-fibrotic and anti-inflammatory properties that facilitate healing. Just when use of these products makes sense, however, is up for debate. Dr. Houser said there are several scenarios when she will consider using amniotic membrane, such as in cases of persistent epithelial defect occurring spontaneously or following procedures such as superficial keratectomy, PTK, PRK, band chelation, or crosslinking. Patients with etiologies that are at high risk for prolonged healing following epithelial removal, such as autoimmune disorders, underlying severe dry eye, or neurotrophic keratopathy, can benefit from application of amniotic membrane concurrent with one of the above procedures, she said. “I will occasionally use amniotic membrane in high-risk patients in conjunction with superficial keratectomy. If the epithelium is not healing appropriately and nearly completely healed at 1 week following a procedure involving epithelial removal such as superficial keratectomy or PTK, I will often place an amniotic membrane to facilitate healing,” Dr. Houser said. “ I also find amniotic membrane to be helpful in patients with neurotrophic ulcers and often will use it in conjunction with other treatment modalities such as serum tears or a tarsorrhaphy or while awaiting approval and receipt of cenegermin.” Dr. Hovanesian also mentioned the use of amniotic membrane for persistent ocular surface defects but said that it’s important to address underlying causes of those defects. For example, if a patient has an eyelid defect that is causing the surface issue, the issue will persist if the eyelid problem is not solved. “You have to address the underlying issues,” Dr. Hovanesian said. “Amniotic membrane may still be appropriate in these cases, but you’ve done the patient little good if the surface breaks down 2 weeks later because the eyelid is not closing.” Dr. Hovanesian and Dr. Houser said they sometimes use amniotic membrane after pterygium excision as well. While both use conjunctival autografts, Dr. Hovanesian said research has found that putting an amniotic membrane in the This article originally appeared in the April 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Placement of dehydrated amniotic membrane as a graft after pterygium removal. Source: John Hovanesian, MD
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