AmbioDisk Amniotic Membrane Transplant Placement with Contact Lens

In this video, John Hovanesian, MD, shows the use of AmbioDisk amniotic membrane disc in a patient with a non healing corneal epithelial defect caused by exposure to mitomycin during the treatment of an ocular melanoma. The AmbioDisk amniotic membrane disc will self-adhere to a corneal epithelial defect that is at least 3 mm in diameter.

The recommended steps for applying the AmbioDisk are as follows:

  • Use a beaver blade to debride 1-2 mm of epithelium surrounding the edge of the defect being treated.
  • Leave the corneal surface relatively dry. (An overly wet surface will impair adherence of the membrane to the cornea.)
  • Using non-toothed forceps, grasp the edge of the dry disk of amniotic membrane and place it basement membrane side down onto the cornea (the embossed "IOP" should be facing down toward the corneal surface and will appear backwards from the surgeon's viewpoint).
  • For best adherence, try to apply the membrane so that the first contact with the cornea is over the epithelial defect. Then, using a second pair of non-toothed forceps, gently press down the other areas of the membrane so it is fully applied to the cornea. The membrane should generally be centered over the whole cornea so that a few millimeters of amnion are overlapping the conjunctiva on each side. This will ensure the best coverage by the contact lens.
  • Apply the wet contact lens to the eye by holding the edge of the lens with non-toothed forceps and laying it down without sliding it back and forth and potentially dislodging the amnion. Before applying it, be sure the contact lens is not inside out by checking to see that the lens edge is fully concave and not saucer-like (same as for any contact lens).
  • Small air bubbles and small folds will normally be visible through the amnion at this stage and are completely normal. Air bubbles will disappear over time, and the cloudy appearance of the amnion will lighten considerably, leaving a fairly normal appearance.
  • Post-op medications should generally include a topical antibiotic, non-steroidal anti-inflammatory drop, and a steroid. These can be discontinued or tapered at the surgeons discretion.
  • The amniotic membrane will generally dissolve over 5-7 days, but the contact lens may be left in place for at least another week, as clinically indicated.

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Comments (5)

i think you ought to do a study where half get it down, half up, have a third, blinded party rate the success- then we'll see if it truly makes a difference. thanking you in advance!

ranchump62 (8 months ago)

The orientation of the basement membrane (BM) of the amnion probably does make a difference in healing. Generally, you want the BM touching the healing epithelial surface whether its from its basal or its superficial side. In applications like this video, where epithelium is healing underneath a blanket of amnion, you want the BM facing down against the healing epithelium's superficial surface. In applications like pterygium, it's different because you tuck the amnion under the surrounding conjunctiva so the epithelium can heal over the top of it. In this case, you want the BM facing up, in this case touching the healing epithelium from its deep (basal) surface.

Hovanesian (8 months ago)

i have a feeling it really makes no difference, as the growth factors will reach the eye no matter what

ranchump62 (8 months ago)

So the "IOP" always should appear **backwards** when placed in the correct orientation? I thought you would want to place the stromal side down (i.e. so the "IOP" faces toward the surgeon). At least that is what Dr. Foster recommends in his instructional video: http://www.youtube.com/watch?v=A3KOH1vfgOI Can you clarify this for us?

sidtc007 (8 months ago)

BEAUTIFUL WAY TO TEACH.I WILL TRY TOMRROW INSHAALLAH FOR A PATIENT ,VERY POOR,DESRVING & SUFFERING FORM RECURRENT NONHEALING CORNEAL ULCER

tanvir (27 months ago)