Eyeworld

84 | EYEWORLD | APRIL 2023 C ORNEA Contact Houser: kourtney.houser@gmail.com Hovanesian: johnhova@gmail.com Relevant disclosures Houser: None Hovanesian: None "I regularly use amniotic membrane for double pterygium excisions or in patients with limited conjunctiva available for an autograft who are undergoing pterygium excision, high- risk corneal transplants, keratolimbal auto- grafts, persistent epithelial defects after corneal ulcer resolution, and in a multi-layered fashion in microperforations in patients at high risk for patching or transplantation," Dr. Houser said, adding another cause where she'd use amnion. "Glued and sutured amniotic membrane with a symblepharon ring in patients with active Stevens-Johnson syndrome or following chem- ical burns is also key in preventing long-term irreversible damage to the ocular surface." Where use of amniotic membrane might be overkill, Dr. Hovanesian said, is in many cases of dry eye. He said that optometric colleagues often ask him about it, telling him that they're hearing promotion about its use for dry eye patients. "Some of the reps seem to be over repre- senting the utility of amniotic membrane for routine dry eye," Dr. Hovanesian said, noting that "financially there is a strong incentive for reps to sell amnion and for doctors to use it, but that's not what we're here for." There is promising anecdotal evidence for liquid amniotic cytokine drops, for example, but Dr. Hovanesian said that physicians prefer more rigorous science to support the use of these products. "There are cases where we feel desperate because whatever we use doesn't seem to work. In those patients, it seems very unlikely that you're going to harm them by trying products like this. If you get a positive result, you're going to be doing them a big favor and you're going to feel good about giving them that prod- uct," Dr. Hovanesian said. Dr. Houser said that amniotic membrane might be a nice adjuvant though not always necessary in situations like autoimmune dry eye disease flares, which can respond well to amniotic membrane. However, it is important to initiate other long-term therapies such as au- tologous serum, cholinergic agonists, or anti-in- flammatory drops in conjunction with amniotic membrane to prevent future flares. "Especially in cases where we would like to heal the ocular surface quickly, such as patients having a flare from their baseline dry eye or patients in whom we are trying to optimize the ocular surface prior to cataract surgery and who can't tolerate steroid drops, amniotic membrane can be a useful adjuvant treatment to other lon- ger-term maintenance therapies," she said. While Dr. Houser thinks that amniotic mem- brane has a strong ability to heal the ocular surface, she doesn't find it offers a lasting effect for patients with underlying structural abnor- malities, such as epithelial basement membrane dystrophy. "While amniotic membrane could provide some short-term relief from the irritation or dryness, the underlying structural abnormality still remains and will continue to cause visual symptoms or discomfort until surgically ad- dressed with superficial keratectomy or photo- therapeutic keratectomy," she said. continued from page 83 "Especially in cases where we would like to heal the ocular surface quickly, such as patients having a flare from their baseline dry eye or patients in whom we are trying to optimize the ocular surface prior to cataract surgery and who can't tolerate steroid drops, amniotic membrane can be a useful adjuvant treatment to other longer-term maintenance therapies." —Kourtney Houser, MD

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