John Hovanesian, M.D. treats a recurring epithelial defect with AmbioDisk, a dehydrated amniotic membrane overlay graft. 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.