Gaining control of persistent corneal epithelial defects using AMT and a pressure patch

(Image credit: AdobeStock/Nattle)

A new therapeutic approach that combines eyelid pressure patching with application of amniotic membrane tissue (AMT) was highly successful and safe for healing persistent corneal epithelial defects,¹ according to Kyle Linsey, MD, who is from the Cornea Service, Clearwater Eye and Laser Center, Clearwater, FL, and HCA Florida Bayonet Point Hospital, University of South Florida, Tampa.

Managing persistent corneal epithelial defects can be tricky, and, according to Linsey, typically consists of treatments such as frequent lubrication, immunomodulators, steroids, autologous serum or platelet-rich plasma tears, bandage contact lens, punctal occlusion, and in more advanced disease, pressure patching, epithelial debridement, scleral contact lenses, cenegermin, and AMT.^2-5

AMT offers a number of advantages to patients that includes rapid re-epithelialization of the persistent corneal epithelial defects in cases refractory to treatment,^6-8 by addressing the ocular surface inflammation,^9,10 at rates of re-epithelialization of 45.5% to 74.7%, independent of ulcer etiology.^11,12 The treatment does not transfer viable stem cells¹³ but “supports damaged tissue, protects and shields defects from further degeneration or breakdown from external factors and promotes re-cellularization,¹⁴” he explained.

In addition, AMT stimulates proliferation and migration of limbal stem cells, suppresses neo-angiogenesis, inflammation, and scarring, contributes to AMT’s ability to support the healing of ocular surface disease¹⁵ and physically acts as a substrate for epithelial cell growth.^16-18

Multilayer AMT has been proposed for treating deep neurotrophic corneal ulcers¹⁹ and is more effective than autologous serum at healing corneal ulcers resulting from herpetic neurotrophic keratitis.²⁰ Finally, it retards infection.

Retrospective findings

In his retrospective study, Linsey analyzed 144 eyes treated with either a single-layer or three-layer decellularized amniotic membrane basement membrane (AMBM) combined with a 24-hour eyelid pressure patch; 90% were treated with a single layer of AMBM and 10% with three layers of AMBM.

In the former group, Linsey reported, all cases healed completely and the AMBM dissolved. In the three-layer group, all cases had improvements in the corneal staining; however, the AMBM did not dissolve in 20% to 30% of cases. No patients reported pain, discomfort, or infection.

This study found that combining eyelid pressure patching with AMT is a safe and effective approach for healing persistent corneal epithelial defects.

“AMT promotes epithelial cell proliferation, reduces inflammation and neuropathic pain, and limits scar formation.²¹ AMT can act as a mechanical barrier to protect the ocular surface, prevent evaporation and dryness, and maintain a stable tear film while serving as a scaffold for donor–recipient cell migration and integration.²¹ The integration of an eyelid pressure patch with dehydrated, decellularized AMBM treatment for advanced ocular surface disease leads to accelerated corneal healing and increased patient comfort,” Linsey concluded.

References

1. Linsey K. Use of an eyelid pressure patch concomitantly with a decellularized dehydrated amniotic membrane for ocular surface disease management. Ophthalmol Ther. 2025;14:573–584. https://doi.org/10.1007/s40123-025-01094-2

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18. Thiex NW, Chames MC, Loch-Caruso RK. Tissue-specific cytokine release from human extra-placental membranes stimulated by lipopolysaccharide in a two-compartment tissue culture system. Reprod Biol Endocrinol. 2009;7:117.

19. Sacchetti M, Lambiase A. Diagnosis and management of neurotrophic keratitis. Clin Ophthalmol. 2014;8:571–9.

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21. Tighe S, Mead OG, Lee A, Tseng SCG. Basic science review of birth tissue uses in ophthalmology. Taiwan J Ophthalmol. 2020;10:3–12.