Decellularized AMBM graft, pressure patch combination improves corneal epithelial defects
Key takeaways:
- All eyes that received a single-layer graft and a 24-hour pressure patch showed complete healing.
- A three-layer graft with a 72-hour pressure patch may be more appropriate for advanced corneal disease.
A combination of eyelid pressure patching and decellularized, dehydrated pure amniotic membrane basement membrane healed persistent corneal epithelial defects, according to a study published in Ophthalmology and Therapy.
“Patients with persistent corneal epithelial defects (PCED) resulting from neurotrophic keratitis (NK, Mackie stage 1 to 3) and moderate to severe Dry Eye Workshop II (DEWS) level 2 to 4 dry eye disease often complain of pain and/or vision loss in the setting of failed traditional first-line therapies,” study author Kyle Linsey, DO, an ophthalmologist at Clearwater Eye and Laser Center in Florida, told Healio. “Since Biovance (Verséa Ophthalmics) is a novel decellularized pure amniotic membrane basement membrane, I postulated that the concomitant use of Biovance and an eyelid pressure patch would improve healing of PCED.”
Because Biovance is decellularized; lacks pro-inflammatory chorion and donor cell debris; attaches better than conventional grafts, which prevents slippage; and has more efficient cell adhesion, which leads to greater concentrations of growth factors and anti-inflammatory cytokines compared with other amniotic membrane tissue (AMT), it was the ideal graft to choose, according to Linsey.
The retrospective study identified 144 eyes with confirmed PCED that were treated with either a single-layer (n = 129) or a three-layer (n = 15) Biovance amniotic membrane basement membrane (AMBM) combined with a 24-hour eyelid pressure patch; 55.6% of eyes had a diagnosis of NK, and 44.4% had persistent superficial punctate keratitis related to dry eye disease.
All eyes that received a single-layer AMBM graft showed complete healing and AMBM dissolution. Additionally, all eyes that received a three-layer AMBM graft showed 100% corneal staining improvement, but 20% to 30% of the graft remained undissolved. At 1-week follow-up, all eyes that received the three-layer graft experienced full absorption, and all eyes continued to show complete resolution of epithelial staining defects, according to the study.
Given these results, Linsey said that a single-layer AMBM graft with a 24-hour eyelid pressure patch is a better option for less severe corneal pathology, while he recommended a three-layer AMBM with a 72-hour eyelid pressure patch for more advanced corneal disease.
“Patching reduces the risk of corneal anoxia and subsequent pain, corneal edema, sterile infiltrates and anterior chamber reaction that can occur when AMT is used in conjunction with a tight bandage contact lens as well as prevents the pain and discomfort associated with using cryopreserved AMT with a ring,” he said. “It also bathes the eye in high concentrations of healing agents while mechanically protecting the surface.”
There were no reported cases of pain, infection or discomfort in the study.
“Biovance dehydrated, decellularized AMBM includes structural proteins such as elastin and collagen that help create a scaffold with which cells can interact to promote epithelial regeneration as well as extracellular matrix proteins such as fibronectin, laminin and glycosaminoglycans that produce growth factors and anti-inflammatory cytokines,” Linsey said. “The increased efficiency in cellular proliferation, migration and healing compared to other AMT makes this an ideal approach for the clinical management of persistent corneal epithelial defects frequently encountered in patients with DEWS II level 3 to 4 dry eye and Mackie stage 1 to 2 NK, as well as in the clinical setting of filamentary keratitis, band keratopathy, anterior basement dystrophy with visual impairment or recurrent erosions, and infectious keratitis.”
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