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OSD patients have new treatment options
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NEW YORK — Here at a continuing education session, "What's New in Eye Care," William Marcolini, OD, outlined a number of new developments in the area of ocular surface disease, including the Maskin Meibomian Gland Intraductal Probe procedure, available from Rhein Medical.
Dr. Marcolini said his practice, a large referral center in New Jersey, has been performing intraductal probing of blocked meibomian glands for about a year.
"Steven Maskin, MD, came up with a theory that the meibomian glands in some patients may work properly but aren't allowing the meibum to get on the surface of the eye," Dr. Marcolini told attendees here at Vision Expo East. "It physically cannot get out."
Before performing the probing procedure, Dr. Marcolini recommends using something more viscous than proparacaine to numb the area. "Buy 3.5% lidocaine and soak a cotton-tip applicator," he said. "Get it nice and numb."
The clinician inserts the probe — available in 2 mm, 4 mm and 6 mm - into the opening of the gland.
"It's sort of like putting in a punctal plug," Dr. Marcolini said. "You pull the lid down and stick it vertically into the opening of the meibomian gland. I started with the 2-mm probes and moved up to 4-mm. When you get better, you can actually put a 6-mm probe down the length of the shaft.
"A doctor in our area has referred at least 10 patients to us," he continued. "If you push on those patients' meibomian gland and nothing is coming out, this might be the answer."
Dr. Marcolini said he most commonly bills with 67999, miscellaneous eyelid procedure. He said practitioners can also use 67700, blepharotomy drainage of abscess, eyelid; or 67800, chalazion excision.
An audience member asked if the procedure needs to be repeated. "We haven't in our practice," Dr. Marcolini said. "But a colleague has done it repeatedly."
He also noted that no post-procedure therapeutic regimen is necessary. "When patients get to this point, the referring optometrist has thrown everything at them but the kitchen sink."
Another relatively new treatment for meibomian gland dysfunction (MGD) is the LipiFlow Thermal Pulsation System by TearScience.
"Current treatment for MGD is to use a hot washcloth and warm compresses," Dr. Marcolini said. "A patient has to have it heated to 113 degrees and administer it four times a day for it to be truly effective."
The Lipiflow uses heat and digital massage.
"It's a 12-minute procedure per eye," he said. "The device goes under the lid with a shell to heat the meibomian glands from the inside. It massages from the outside while it's heating from the inside."
The ProKera (BioTissue) device is designed for patients with severe ocular surface disease.
Dr. Marcolini explained how the device is made.
"After a woman gives birth, they harvest pieces of the amniotic sac and cryogenically freeze the tissue," he said. "ProKera is like a PMMA lens or scleral shell. It's like having this amniotic membrane that can be put on the surface of the eye like a bandage lens.
"What's important is that optometrists can do this," Dr. Marcolini said. "There's no suturing. One of the ODs in our office did this recently. The patient had bad superficial punctate keratitis, surface disease and Sj?gren's syndrome and was developing a dellen."
The ProKera is absorbed into the patient's eye over a period of 7 to 14 days.
"It has all of the great things that make your cornea healthy, such as lactoferrin and metalloproteinases, straight out of the womb," Dr. Marcolini said. "It's like a bandage lens on steroids."
To perform the procedure, the doctor must use Betadine (5% sterile ophthalmic preparation solution, Alcon) to sterilize the eye, hold down the lower lid and place the ProKera on the eye with forceps. He recommended soaking the membrane in saline to reduce stinging upon application.
Dr. Marcolini is affiliated with the New Jersey Omni Eye Institute and is president of the New Jersey Society of Optometric Physicians.
- Disclosure: Dr. Marcolini has no relevant financial interests.