Application of a practical amniotic membrane ring made on-site for restoration of ocular surface health in dry eye disease

Abstract

Purpose: Dry eye disease (DED) is one of the most common ocular surface disorders worldwide. Despite different underlying pathogenic processes, DED is characterized by ocular surface inflammation, which in turn induces further damage to the corneal epithelium and its underlying structures. Amniotic membrane transplants are known to have potent anti-inflammatory effects and also have the ability to enhance epithelial healing. In this study, we aimed to evaluate the clinical efficacy of amniotic membrane ring (AMR) application in treating refractory dry eye disease.Methods: A retrospective analysis of 22 patients treated with contact lens-like amniotic membrane rings was performed. This amniotic membrane ring was formed using an aspiration catheter covered by a large piece of amniotic membrane graft. The amniotic membrane was sutured to the catheter using eight sutures. In this way, a customized amniotic membrane ring was prepared for each patient. Patients’ demographics, symptoms, use of medications, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment. In addition, the amniotic membrane retention duration, the amniotic membrane's effect on ocular surface healing, follow-up time, and complications were evaluated.Results: Twenty-eight eyes of 22 patients (18 females and 4 males) aged 53.32 ± 13.36 (6-73) years were included. The AMR retention duration ranged from 5 to 16 days, with a mean of 11 ± 3.09 days, at which time the amniotic membrane had dissolved or been removed inadvertently by the patient. Discomfort with the ring was seen in 1 of 28 eyes (3.6 %). The patients reported symptomatic relief for a period of 3.64 ± 1.25 months. Symptomatic relief was accompanied by a reduction of OSDI scores (from 63.39 ± 17.24 to 33.19 ± 12.45) (p<0.001), use of topical medications (from 4.21 ± 1.03 to 2.42 ± 0.50) (p<0.001), conjunctival hyperemia (from 1.57 ± 1.19 to 0.35 ± 0.48) (p<0.001), corneal staining (from 2.89 ± 1.16 to 0.57 ± 0.74) (p<0.001), and improvement in visual acuity (from 0.23 ± 0.16 to 0.16 ± 0.25 logMAR) (p=0.001).Conclusions: Amniotic membrane ring treatment might be used to treat refractory dry eye disease. This technique has an economic advantage over other commercially available amniotic bandage tissues and can be easily removed and replaced during a follow-up examination.