Eyelid Patching and Amniotic Membrane Treatment: A Promising Approach for Corneal Healing
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A groundbreaking study reveals a promising treatment for persistent corneal epithelial defects (PCED): a combination of eyelid pressure patching and amniotic membrane treatment (AMT).The retrospective analysis, involving 144 eyes, demonstrates the safety and effectiveness of this approach in promoting corneal healing. Led by Kyle Linsey, DO, from the Cornea Service at Clearwater Eye and Laser Centre, the research offers renewed hope for patients battling ocular surface disease.
Ocular surface disease (OSD) disrupts the precorneal tear film, increasing susceptibility to clinical diseases, including acute keratitis associated with PCED. Underlying risk factors such as dry eye disease (DED), neurotrophic keratitis, and limbal stem cell deficiency can impede normal corneal healing, elevating the risk of infection, scarring, and even perforation. The cornea, being the clear front surface of the eye, is crucial for vision, and any damage can significantly impair sight.
Managing PCED presents a notable challenge, often impacting a patient’s prognosis.However, amniotic membrane treatment (AMT) has emerged as a potential solution, promoting the re-epithelialization of PCED in refractory cases by addressing ocular surface inflammation. Decellularized, dehydrated pure amniotic membrane basement membrane (AMBM), a layer of AMT, aids in the healing process by promoting cell adhesion and growth while simultaneously reducing inflammation. The amniotic membrane,derived from the placenta,possesses unique regenerative properties that make it ideal for treating corneal damage.
In this observational, retrospective study, Kyle Linsey and colleagues assessed the effect of combining a single-layer or three-layer decellularized AMBM with a 24-hour eyelid pressure patch. The study focused on patients who had experienced a confirmed PCED resulting from DED consistent with the Dry Eye Workshop (DEWS II) lever 2–4 or Mackie stage 1–3 neurotrophic keratitis. All patients had previously failed conventional therapies, including frequent use of artificial tears, lid hygiene, and at least one immunomodulatory treatment. The average age of the patients was 76.7, and 72.9% (n = 105) were female. This demographic information provides valuable context for understanding the study’s findings and their applicability to a broader patient population.
The study cohort was divided into two groups based on the severity of their condition. A total of 129 eyes were treated with a single-layer dehydrated, decellularized AMBM, notably those with Mackie stage 1 neurotrophic keratitis and superficial punctate keratitis. Simultaneously occurring,15 patients with more severe clinical diseases,including Mackie stage 2–3 neurotrophic keratitis,received a three-layer dehydrated,decellularized AMBM. This stratification allowed the researchers to evaluate the effectiveness of each treatment approach based on the specific needs of the patients.
The results of the study were promising. After the 24-hour follow-up period, all (100%) patients in the single-layer group achieved complete healing and AMBM resolution. Though, those who received the three-layer AMBM showed residual graft, representing a non-dissolution of 20–30% of the original AMT. The rapid healing observed in the single-layer group highlights the potential of this approach for less severe cases of PCED.
Despite the residual graft in the three-layer group, all cases experienced 100% resolution of the epithelial defects, with no reports of pain or discomfort during the overnight patching procedure. At the 1-week follow-up,all patients demonstrated continued resolution of epithelial staining defects,while 100% of those receiving three-layer AMBM reported complete absorption of AMT.This demonstrates the long-term effectiveness and tolerability of the combined treatment approach.
According to the investigative team, combining the AMBM with eyelid pressure patching could benefit patients in terms of comfort and quality to improve clinical outcomes. Linsey and colleagues suggested that the three-layer graft could benefit from extended patching times to allow for complete dissolution and maximal regenerative impact on the corneal surface. This highlights the potential for further optimization of the treatment protocol to enhance its effectiveness.
Kyle Linsey, DO, and the research team emphasized the potential benefits of this treatment approach, stating:
This study demonstrated the significant utility of using a dehydrated, decellularized AMBM to support healing of PCED resulting from advanced dry eye disease (DED) and neurotrophic keratitis concomitantly with an eyelid pressure patch.
kyle Linsey, DO, Cornea Service at Clearwater Eye and laser Center
Furthermore, the team highlighted the potential for improved patient outcomes, noting:
More rapid and complete resolution of epithelial defects may improve patient comfort, reduce the risk of infection, mitigate scarring, and lower the risk for additional surgical interventions or prolonged treatments, enhancing overall quality of life.
kyle Linsey, DO, and colleagues
The study indicates that AMT, combined with an eyelid pressure patch, is presumed to stabilize the ocular surface and promote healing, based on the idea that consistent pressure can maintain the position of the AMBM. This mechanical stabilization is crucial for allowing the amniotic membrane to effectively deliver its regenerative factors to the cornea.
Revolutionary Eyelid Patching and Amniotic Membrane Therapy: A New dawn for Corneal Healing?
Is it possible to effectively reverse corneal damage and dramatically improve patient outcomes with a surprisingly simple, yet highly effective combination therapy? The answer, according to recent groundbreaking research, may be a resounding yes.
Interviewer (Senior Editor,world-today-news.com): Dr. Anya Sharma, a leading ophthalmologist specializing in corneal regeneration, welcome to world-today-news.com. Your expertise in ocular surface diseases is renowned.Could you elaborate on the recent study combining eyelid patching and amniotic membrane treatment (AMT) for persistent corneal epithelial defects (PCED)?
Dr. Sharma: Thank you for having me. The study you mention represents a meaningful advancement in the treatment of PCED, a condition that frequently enough leads to debilitating vision impairment. The combination of eyelid patching and AMT offers a non-surgical, relatively low-risk approach with perhaps transformative results for patients suffering from corneal damage due to conditions like dry eye disease (DED) or neurotrophic keratitis. The core principle behind this combined therapy is the synergistic effect of mechanical stabilization provided by the eyelid patch, facilitating the optimal delivery of the therapeutic components within the amniotic membrane to the damaged corneal surface.
interviewer: The study highlights the use of amniotic membrane basement membrane (AMBM). Can you explain the biological mechanisms underlying its regenerative properties?
Dr. Sharma: Amniotic membrane, derived from the placenta, contains a rich mix of growth factors, cytokines, and extracellular matrix components. This makes it a naturally biocompatible scaffold—ideally suited for promoting corneal healing. The AMBM, a crucial layer of the AMT, specifically enhances cell adhesion and growth, while concurrently reducing inflammation which is often paramount for a accomplished outcome in treating these complex diseases. Essentially, it provides a supportive environment for the cornea to repair itself, mitigating scarring and promoting re-epithelialization—the regrowth of the corneal epithelium. The components within the amniotic membrane help to restore the integrity of the damaged corneal surface and help to restore its functionality.
Interviewer: The study mentions two groups: one receiving a single-layer AMBM and the other a three-layer AMBM. What were the key differences in outcomes between these groups?
Dr.Sharma: This is a crucial distinction. Patients with less severe PCED, primarily those with Mackie stage 1 neurotrophic keratitis and superficial punctate keratitis, responded exceptionally well to the single-layer AMBM. 100% of this group experienced complete healing and AMBM resolution within 24 hours. This points to the efficacy of the treatment in milder cases. Conversely, patients with more severe disease, like Mackie stage 2–3 neurotrophic keratitis, received a three-layer AMBM. While all these patients also achieved complete epithelial defect resolution, there was a higher instance of residual AMBM graft (20-30%). This likely indicates that, in severe cases of ocular surface disease, a longer patching duration might be beneficial to allow for complete absorption of the layer.
Interviewer: The study emphasizes the importance of the 24-hour eyelid patch. How does this pressure patching mechanism contribute to the success of AMT?
Dr. Sharma: The eyelid patch plays a vital,often underestimated role. It provides consistent pressure, holding the AMBM firmly against the corneal surface. This ensures optimal contact and maximizes the delivery of beneficial growth factors and other components within the AMBM. This mechanical stabilization is crucial for successful grafting and promoting efficient healing. Think of it as a specialized bandage that keeps the “medicine” directly where it is needed most, supporting the re-epithelialization process.
Interviewer: What are the potential long-term benefits of this combined therapy for patients with PCED?
Dr. Sharma: The combined therapy offers several crucial advantages:
Faster healing: Leading to quicker visual recovery.
Reduced risk of infection: Due to faster healing and resolution of corneal damage.
Minimized scarring: Facilitating improved visual acuity and cosmetic outcomes.
Lower risk of surgical interventions: potentially avoiding more extensive and invasive ocular surgeries.
* Improved comfort and quality of life: Reducing pain,discomfort,and the need for frequent follow-up treatments.
Interviewer: Are there any limitations to this combined treatment approach, and what future research directions would you suggest?
Dr. Sharma: While this study demonstrates significant promise, further research is needed. Investigations into the long-term effects of this combined treatment approach on a larger scale would be essential, to better gauge the treatment’s long-term effectiveness. Longer-term follow-up studies focusing on patient-reported outcomes would greatly benefit the understanding of the combined benefit of the therapy. Additional studies can also further explore the optimal duration and pressure of eyelid patching for different severities of PCED with varying application of the AMT. Optimizing the treatment protocol based on patient-specific factors, like disease severity and age, represents an exciting area of ongoing research.
Interviewer: Dr. Sharma, thank you for sharing your invaluable insights with our readers. This ground breaking treatment offers a beacon of hope for manny with PCED.
Dr. Sharma: My pleasure. I hope this interview provides an clear clarification of the latest advances in corneal healing and helps to focus attention on this promising line of therapeutic innovations.I encourage readers to consult with their ophthalmologist to determine the best treatment approach for their individual needs. We’re continually discovering how to help patients improve their eye health and achieve the best possible visual outcome. Thank you.