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What Conditions can be Helped With Amniotic Membranes?

Amniotic membranes may be used in eyecare as a protective covering for the surface of the eye, to promote healing, and to reduce inflammation. They may be used in a variety of conditions, including corneal ulcers, dry eye syndrome, and surgical procedures such as corneal transplants.

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What are amniotic membranes?

Amniotic membranes are used in optometry and ophthalmology to promote healing for corneal surface disease and other corneal conditions. They are thin tissue layers that are derived from the inner lining of the placenta and contain growth factors and other substances that help to promote healing. In our clinic, amniotic membranes are often used to treat conditions such as corneal wounds, dry eye syndrome, and persistent corneal epithelial defects. They can also be used to protect the cornea during surgery and to prevent scarring. Amniotic membranes are typically transplanted to the eye in the form of a patch or a sheet, and they may be used alone or in combination with other treatments.

What are ProKera and AmbioDisk?

The two types of amniotic membranes are cryopreserved and dehydrated:

ProKera

ProKera is a type of amniotic membrane that is cryopreserved and wrapped around an elastomeric band or polycarbonate ring. It is thin and clear, similar to the surface of the eye, and can be easily inserted into the eye like a contact lens. ProKera has received FDA clearance as a class II medical device for its anti-inflammatory, wound healing, and protective properties. It contains natural therapeutic properties that promote the healing of damaged eye surfaces, and has been shown to reduce scarring and inflammation when used to treat scarred corneas..

AmbioDisk

AmbioDisk is a form of amniotic membrane that is available for use in optometry and ophthalmology offices. It is dehydrated and placed across the surface of the eye, with healing contact lenses used to keep it in place. This treatment provides essential nutrients that promote healing, and typically takes 5-7 days to be absorbed into the eye. After this time, the AmbioDisk is removed by an eye surgeon. 

Both AmbioDisk and ProKera provide essential nutrients that promote healing of the eye.

What are ProKera and AmbioDisk?

The dry eye workshop study (DEWS) lists amniotic membranes as a recommended method of treating dry eye. In cases where traditional treatment options for dry eye disease, such as artificial tears, lubricating ointments, prescription dry eye drops, thorough lid hygiene, punctal plugs, meibomian gland expression are not effective, amniotic membranes are an advanced treatment option. These thin tissue layers, which cover the surface of the fetus during pregnancy, contain various substances with anti-inflammatory and lubricating properties that may help to improve symptoms of dry eye such as discomfort, redness, and vision problems. If you are experiencing dry eye that is unresponsive to traditional treatment options, it may be worth discussing the use of amniotic membranes with our eye care provider during a dry eye evaluation.

If you are interested in using amniotic membranes to treat your dry eye, it is important to speak with your eye doctor to determine whether they are appropriate for your specific condition. They can also recommend other treatment options that may be more suitable for your needs.

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Who is a candidate for amniotic membrane contact lens?

Who is a candidate for amniotic membrane contact lens?

  • Amniotic membranes may be an excellent solution for those who have struggled with dry eyes in the past and were unable to find relief through medications or other treatments.
  • Amniotic membrane contact lenses may also be suitable for patients who suffer from corneal scarring. The purpose of amniotic membrane is to reduce inflammation, promote healing, and reduce discomfort in the eyes.
  • Amniotic membranes may be an option for those who suffer from a neurotrophic ulcer caused by a neurosurgical procedure or viral infection.

What conditions can amniotic membranes be used for?

Amniotic membrane is utilized in post surgical care after surgeries that involve removing eye tissues, including treating chemical burns, corneal ulcers and conjunctival ulcers, as well as diseases that cause painful ulcerations.

In a 12-year study conducted in Italy, 5,349 surgical procedures using amniotic membrane patches were successfully performed. The treatment's effectiveness was evaluated one year after surgery based on the scope of the surgery, resolution of inflammation, relief of symptoms, restoration of regular and stable corneal epithelium, and restoration of the structural integrity of the eye. 

Consequently, the authors of the study concluded that the proposed procedure for the therapeutic use of amniotic membranes to treat various ocular pathologies is reproducible, and that amniotic membranes can be used in place of conventional medical treatment for certain conditions in the ocular system.

Conditions treated using amniotic membranes included: 

  • Neurotrophic keratitis
  • Keratitis/endophthalmitis
  • Pterygium
  • Post-keratoplasty, glaucoma or cataract
  • Chemical trauma
  • Bullous keratopathy
  • Neoplasm of the ocular surface
  • Reconstruction of the conjunctiva and fornix
  • Corneal degeneration
  • Recurrent epithelial erosion
  • Primary and secondary limbal stem cell deficiency
  • Mucous membrane pemphigoid
  • Dystrophy
  • Mechanical trauma
  • Chronic Stevens-Johnson syndrome or Lyell’s syndrome
  • Reconstruction of the anophthalmic cavity
  • Physical trauma
  • Eyelid reconstruction
  • Dysfunctional tear syndrome

In this study, partial success was achieved if two criteria were met. If any of these criteria were not met, the result was considered a failure. The study achieved a 100% success rate in treating a variety of conditions, including corneal ulcers and neurotrophic keratitis, as well as post-keratoplasty, glaucoma, cataract, bullous keratopathy, corneal degeneration and dystrophy, mechanical trauma, and reconstructing the anophthalmic cavity and eyelids. Additionally, dysfunctional tears were successfully treated in the study.

Amniotic membranes are underutilized despite their many benefits

Although amniotic membranes have many healing properties and could potentially be widely used in optometry and ophthalmology, data suggests that they have not been widely adopted. According to the information from the Centers for Medicare & Medicaid Services (CMS), only 314 doctors of optometry in the U.S. reported using the HCPCS code for amniotic membrane insertion in 2016. This number may have increased slightly to around 400 in 2017, but this still represents only about 1% of optometrists who practice in the United States. In 2021 amniotic membranes sales reached $3.1 billion in the US, and adoption is increasing significantly, a recent report suggests that the US market will triple by 2030.

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