Jai Parekh, M.D. reports the use of a thicker dehydrated amniotic membrane tissue (Ambio5) in the reconstruction of the ocular surface after penetrating keratoplasty.

1. Surgical Pearls & Technique: Anterior Segment Ophthalmic Surgery
Ocular Surface Reconstruction Using a Thicker Amniotic Membrane: Ambio5™
Jai G. Parekh (“Dr. J”), MD, MBA, FAAO
PURPOSE
To report the use of a thicker dehydrated amniotic membrane
tissue in the reconstruction of the ocular surface after
penetrating keratoplasty.
A 78-year-old-woman, with an eight-year history of one failed
corneal transplant, herpes simplex keratitis, neurotrophic
keratitis, Salzmann’s nodules, and a poor overall ocular
surface of the left eye presents with a failing graft once figure 2 figure 3
again. The patient’s vision was hand-motion and she had
severe ocular irritation including pain, tearing, foreign-body Bausch & Lomb Pharmaceuticals) as well as ointment
sensation, and occasional redness. The patient’s surface was (Ciloxan ophthalmic ointment, ciprofloxacin hydrochloride
compromised with 4+ SPK, areas of epithelial irregularity, ophthalmic ointment; Alcon Laboratories, Inc.) at night, a
two Salzmann’s nodules which were debrided at the slit-lamp, daily topical non-steroidal (Bromday, bromfenac 0.09%; Ista
a failing corneal graft, but no active herpetic disease. The Pharmaceuticals), a topical anti-viral gel (Zirgan, ganciclovir
patient agreed to another penetrating keratoplasty and ocular ophthalmic gel 0.15%; Bausch + Lomb Pharmaceuticals),
surface reconstruction including use of a thicker dehydrated preservative-free artificial tears (Optive Preservative-
amniotic membrane tissue to help restore the ocular surface Free; Allergan Pharmaceuticals) and oral anti-virals (for
and preserve it’s integrity especially after a newer graft. prophylaxis). The patient also had her left lower punctum
plugged to aid with restoration of her ocular surface. A
The complex procedure week later, her ocular surface was maintained (Figure 3).
on the left eye was
performed under general At two-month follow-up, the patient was completely
anesthesia. After the asymptomatic, her BCVA was 20/100, and she had an
penetrating keratoplasty intact ocular surface including the epithelium and corneal
was completed, the thicker transplant. She had virtually no SPK, epithelial irregularity,
dehydrated amniotic or Salzmann’s nodules. Finally, there were no subtle signs
membrane graft (Ambio5, of corneal transplant rejection. The patient continues to
100+ microns, 2.x3 do well.
figure 1 cm) was fashioned and
manipulated to create a
rectangular button. This dry button was layed onto the new
ocular surface, “the IOP mark always facing the surgeon,” Jai G. Parekh (“Dr. J”)
(Figure 1) including the peri-limbal conjunctival area and MD, MBA, FAAO
new corneal graft; after BSS hydration, it was secured via four Dr. J is a board-certified anterior segment
corner 8-0 vicryl sutures and fibrin glue (Tisseel VH, Baxter surgeon in the NJ/NY area. He is a
International). Some of the borders of the button were tucked managing-partner at Brar-Parekh Eye
into the virtual subconjunctival space created by a partial Associates, NJ, Chief of Cornea & External
peritomy. The ocular surface also received a bandage contact Diseases/Director of Research at St.
lens to help secure the newly created ocular surface (Figure 2). Joseph’s Regional Medical Center, NJ, and Clinical Assistant
The patient was seen POD #1 with 20/400 vision and Professor of Ophthalmology on the Cornea Service at the
an intact ocular surface/anterior segment including the New York Eye & Ear Infirmary, NY. He consults and speaks
corneal transplant and amniotic graft, Ambio5. She was for Bausch & Lomb, Inspire, Ista, & IOP Inc.; he is on the
placed on a regimen of frequent topical corticosteroids speaker’s bureau for Alcon and Allergan. He has no financial
(Durezol, difluprednate 0.05%; Alcon Laboratories, Inc.), interest in any of the products mentioned; Dr. Parekh can be
a fluoroquinolone drop (Besivance, besifloxacin 0.06%; reached at kerajai@gmail.com or 973-785-2050.
CASE REPORT IOP, Inc. Customer Service
3184-B Airway Ave, Costa Mesa, CA 92626 1-800-535-3545
April 2011: Ambio5 ™
Tel (714) 549-1185 Fax (714) 549-0557 www.iopinc.com