Cryopreserved amniotic membrane after epi-off corneal crosslinking reduces postoperative complications
Reena Gupta, MD, of Omni Eye Services in New Jersey, spoke at AAO 2025 about her study that found utilization of amniotic membrane prevented complications post-corneal crosslinking procedure.
Reena Gupta, MD:
My name is Reena Gupta. I’m one of the cornea/cataract specialists over at Iselin in New Jersey. I trained over at Tulane University for my residency and did my cornea fellowship at Mass Eye & Ear. I came to Omni Eye Services about five and a half years ago.
I came across an idea of utilization of cryo-preserved amniotic membrane post-crosslinking in some of our patients. Originally, I started doing the epi-off crosslinking that is FDA-approved. The device comes from Glaukos, we have their KXL system. Originally, we were basically looking at patients who were put into 2 different arms. One was called the treatment group, which is what we utilize the bandage contact lens post-surgery to help improve the epithelial defect that we’re creating. Then we had a second treatment arm where we had utilized Prokera, which was a cryopreserved amniotic membrane to help ensure better epithelial regeneration and recovery.
The reason why we wanted to do this study was to basically look at if the utilization of the amniotic membrane is superior to a bandage contact lens. As we know from our previous studies, keratoconus is commonly seen in younger patients around the age of 13 and 18. Yes, they can be diagnosed at a later age, but the early treatment is important in terms of preventing progression of the disease itself.
However, epi-off crosslinking does have some complication and risk associated with it. One of the primary risks is non-healing epithelial defects and infectious keratitis, which is one of the biggest reasons why someone may need early corneal transplantation.
In this non-randomized retrospective study, we’re basically looking at 46 eyes that had the bandage contact lens post-surgery and about 62 eyes that had the Prokera or the amniotic membrane utilization after surgery. What we were looking at was best corrected visual acuity at post-op week 1, at 1 month, 3 months, and 6 months. We were also looking at the keratometry readings, the K-max readings, at those time points as well. We were also looking at any complications and how soon the epithelial defect was to recover.
What we found in our results was that the number of complications in the Prokera group were 0% versus in our bandage contact lens group, it was about 3 patients actually developed infectious keratitis. None of those patients required a corneal transplantation. Those patients did well with antibiotic coverage and antibiotic treatment and were later fit into scleral contact lenses to achieve good visual acuity.
Also, what we noticed was patients who had the amniotic membrane, those patients K-max value improved fairly significantly faster. That was actually reported within the 3-month post-treatment, similar to the bandage contact lens. But the Prokera or the amniotic membrane group did better.
We also found that the patients who had the amniotic membrane also had better visual acuity, which started off at the 3-month mark as well and also found out that the amniotic membrane group also returned to baseline vision much faster than the bandage contact lens group.
The 2 statistically significant results in the study were that there were zero complications with the Prokera group and also that the return to baseline visual acuity was faster in the Prokera or the amniotic membrane group as well.
The takeaway point for this study really is that in a patient who comes into your office, who is a candidate for epi-off crosslinking, which is FDA-approved and is covered by insurance, and these patients are younger, around the ages of 13 and 18, and these patients do better long-term in terms of preserving their vision, we want to be able to offer them this crosslinking. Be confident that we can do the surgery without any complications. These patients don’t require a major surgery like a corneal transplant. Utilization of the amniotic membrane early on in terms of recovery is a great treatment modality for them to prevent complications. That is one of the reasons why we wanted to do this study.
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