Catalytic Health

13 4. Use a soaked Weck-Cel with saline to evenly distribute the AM on the cornea 5. Lastly, insert a bandage contact lens overtop of the AM. You may prescribe a prophylactic topical antibiotic for 7 days. In 3-7 days, the AM will dissolve and the bandage contact lenses will need to be removed. Vision will be hazy but there is usually no discomfort. Limitations of Amniotic Membrane Adding AM into a clinician's dry eye management armamentarium is exciting, but there are limitations with its usage. Cryopreserved AM cannot be used for patients with filtering blebs or glaucoma drainage devices. However, there are no limitations with blebs or drainage devices with dehydrated AM as there is no PMMA ring. Additionally, patients with any active infections should be treated prior to application. Prescribe 7-10 days' worth of prophylactic oral antivirals to reduce the occurrence of HZO re-emerging for patients with a past history of herpes zoster ophthalmicus (HZO). A patient with severe blepharospasm is not a good candidate for AM as insertion and removal will be extremely difficult. However, if the clinician believes AM would greatly improve their corneal conditions, the patient could practice inserting and removing a soft contact lens in the office with a staff member. This can help reduce anxiety so the patient can understand the essence of the AM process. 3. Instill proparacine and recline the patient's chair. Insertion is more comfortable in free space as it is similar to inserting a contact lens 4. Patients may feel discomfort due to the PMMA ring, but tape tarsorrhaphy will minimize the lens movement. The clinician can use a medical grade tape to reduce the movement. 5. The AM usually dissolves within 3 to 7 days, but the patient must return to the clinic to remove the PMMA ring. Again, removal is similar to removing a contact lens. It is important to inform patients that their vision will be hazy until the AM adheres to the cornea. Dehydrated AM (LabAmnio™, Labtician, Oakville, ON) is safely preserved by gently air-drying the allograft tissue while maintaining the AM's key properties (Figure 3). It can also be stored at room temperature with a shelf life of 3 years and does not need to be rinsed or thawed prior to application. Due to its dehydrated nature, insertion differs slightly from that of the cryopreserved AM. 1. The clinician will need an eye speculum, a tweezer, a Weck-Cel® cellulose spear and a bandage contact lens 2. Insertion involves instilling proparacine, reclining the patient's chair and inserting the eye speculum on the indicated eye 3. Carefully remove the dehydrated AM from its package with tweezers. The dehydrated AM may curl up as it approaches the cornea due to difference in temperatures of the room and the cornea. Figure 2. Cryopreserved AM with PMMA ring; Courtesy of www.Biotissue.com. Figure 3. Dehydrated AM; Courtesy of www.labtician.com

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