Adjunctive role of self-retained cryopreserved amniotic membrane in treating immune-related dry eye disease
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To present a case of successful treatment of immune-related severe dry eye disease (DED) by self-retained cryopreserved amniotic membrane (CAM) in conjunction with conventional and systemic immunotherapy.
A 48-year-old female with a 10-year history of rheumatoid arthritis under systemic immunomodulation developed non-resolved severe ocular dryness, pain, photophobia and blurred vision due to corneal epithelial keratopathy OD much worse than OS despite topical artificial tears, steroids, cyclosporine, autologous serum drops, punctal plugs and scleral lens for the last 3 years. During the first year, she received punctal cauterization and a total of 6 CAM, each for an average of 7.2 ± 2.3 days, for recurrent diffuse superficial punctate keratitis (SPK) with filaments to achieve an average symptom-free period of 2.4 ± 0.9 months and visual acuity improvement from 20/400 to 20/200. During the next 2 years, she received surgical closure of puncta for recurrent punctal reopening, additional systemic immunomodulation and a total of 4 CAM, each for an average of 8.5 ± 2 days, for recurrent scattered SPK, to achieve an average symptom-free period of 6.4 ± 1 months and visual acuity improvement from 20/200 to 20/70.
Self-retained CAM can be an adjunctive treatment for immune-related DED, which is refractory to conventional and systemic immunotherapies.
KeywordsAmniotic membrane Autoimmune Dry eye disease Ocular surface PROKERA
This study was supported in part by an unrestricted grant from Ocular Surface Research Education Foundation, Miami, FL. The development of PROKERA® was supported in part with Grant Number EY014768 from the National Institute of Health (NIH) and National Eye Institute (NEI). The content is solely the responsibility of the authors and does not necessarily represent the opinion of the NIH or the NEI.
Compliance with ethical standards
Conflict of interest
Dr. Tseng is the founder and a major shareholder of Tissue Tech Inc. that holds patents on the methods of preservation and clinical uses of amniotic membrane graft and PROKERA®. Other authors are employees of Tissue Tech.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from the patient in the study.