By: Jai G. Parekh ("Dr. J"), MD, MBA
PURPOSE:
To report the use of a thick dehydrated amniotic membrane disk retained with a large contact lens (Kontur Lens) in the reconstruction of the ocular surface "in-office."
Persistent epithelial defect in herpes keratitis patient
A 74-year-old-woman presents with a persistent epithelial defect due to herpes simplex keratitis after uneventful cataract surgery of the right eye. The patient underwent successful cataract surgery of the right eye and was placed on the usual postoperative course of branded fluoroquinolones, steroids, and non-steroidal (NSAIDS). One month postoperatively, she presented with herpes simplex epithelial keratitis which was successfully treated with both an antiviral gel (Zirgan, ganciclovir ophthalmic gel 0.15%; Bausch + Lomb Pharmaceuticals) and oral famciclovir after two weeks. The patient’s vision best-corrected vision was 20/50 and she was maintained on preservative-free artificial tears 6x/day. Seven weeks later, she complained of chronic eye rubbing, ocular irritation and a foreign-body sensation of the right eye; on examination, she had an epithelial defect with no infiltrate, anterior chamber cell or flare. Topical fluoroquinolones drops and ointment, artificial tears, punctal plugs, and tape tarsorraphy had minimal effect on the persistent epithelial defect. In order to restore the ocular surface, the patient agreed to ocular surface reconstruction using a thick dehydrated amniotic membrane tissue in the form of a disk. Given the simplicity of the technique, the case was done “in-office.”
The patient was consented, transitioned to a supine position, and after topical lidocaine gel and fluoroquinolone drops (Besivance, besifloxacin 0.06%; Bausch & Lomb Pharmaceuticals), a lid speculum was placed into the right eye. The thicker dehydrated amniotic membrane disk (15mm Ambio5, 100 microns nominal thickness) was hydrated and manipulated into the concavity of the 18mm Kontur contact lens (Kontur Kontact Lens Co.). The resulting unit was placed onto the new ocular surface with the contact lens retaining the disk. The patient tolerated the procedure well and was sent home with a postoperative course of Besivance drops, Zirgan gel, and preservative-free artificial tears (Optive Preservative-Free; Allergan Pharmaceuticals) prn.
The patient was seen POD #1 with an intact ocular surface while the AmbioDisk remained in place. Her medication regimen remained the same. On POD #7, the surface remained intact with significant closure of the persistent epithelial defect. The AmbioDisk was removed and the besivance/zirgan were also discontinued.
On POD #14, her vision was 20/40 while the ocular surface revealed no epithelial defect. The patient continued the use of Optive preservative-free artificial tears. On POD #28, the patient was asymptomatic; her quality of vision improved and there were no signs of a recurrent epithelial defect.
Persistent epithelial defect covered with AmbioDisk and Kontur Lens
POD#28, resolution of epithelial defect
CONCLUSION:
AmbioDisk (IOP Ophthalmics) – a dehydrated amniotic membrane disk retained with a Kontur (Kontur Kontact Lens Co.) contact lens - is a very effective adjunct in the reconstruction and maintenance of the ocular surface in-office.
Jai G. Parekh (“Dr. J”), MD, MBA, FAAO, is a board-certified anterior segment surgeon in the NJ/NY area. He is a managing-partner at Brar-Parekh Eye Associates, NJ, Chief of Cornea & External Diseases/Director of Research at St. Joseph’s Regional Medical Center, NJ, and Clinical Associate Professor of Ophthalmology on the Cornea Service at the New York Eye & Ear Infirmary/New York Medical College, NY. He consults and speaks for Bausch & Lomb, Ista, IOP Ophthalmics. – and is on the speaker’s bureau for Alcon and Allergan. He has no financial interest in any of the products mentioned; Dr. Parekh can be reached at [email protected] or 973-785-2050.