BioDOptix 2014 ASCRS Presentation - Dr. Brett Levinson
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Transcript of BioDOptix 2014 ASCRS Presentation - Dr. Brett Levinson
1
Brett Levinson, MD
Presentation and Case studies
ASCRS
www.biodlogics.com2
Overview
1. Role of amniotic membrane in corneal surgery
2. Case studies1. Suture abscess in a corneal transplant
2. Chemical injury
3. Salzmann nodule removal
4. Anterior Basement Membrane Dystrophy
3. Surgical Technique
4. Bio-D Benefits
www.biodlogics.com3
Immune Privileged:• Amnion Epithelial Cells• Mesenchymal Stromal Cells
– No Expression of MHC Class II Antigens
Extracellular Matrix:• Type I, II, III, IV, V, VII
Collagen• Laminin & Fibronectin• Abundant Source of HC-HA
Angiogenic:• VEGF, PDGF
Anti-Microbial:• Ability To Produce β - Defensins
Anti-Inflammatory:• Suppression of IL – 1 α/β
Anti-Adhesion (Fibrosis Suppressant):• Down regulates TGF-β inhibiting fibroblast
production
www.biodlogics.com4
Amniotic Membrane
Basement membrane substitute
Anti-inflammatory effects/ anti scarring effects
Growth factors promote epithelial healing
Structural proteins (laminin and type VII collagen) – epitheliotrophic effects
Inhibition of TGF-β – anti-scarring effects
Pro-inflammatory cytokines
anti-inflammatory cytokines interluekin 10 &1RA
www.biodlogics.com5
INDICATIONS– Persistent Corneal Epithelial
Defects– Corneal Ulcers– Pterygium Surgeries– Conjunctival Surface
Reconstruction– Bullous Keratopathy– Chemical/Thermal Burns– Ocular Surface Reconstruction– SJS– Leaking Filtering Blebs after
Glaucoma Surgery– Cicatricial Entropion
www.biodlogics.com6
Table of Contents
1. Role of amniotic membrane in corneal surgery
2. Case studies
1. Suture abscess in a corneal transplant
2. Chemical injury
3. Salzmann nodule
4. Anterior basement membrane dystophy
3. Surgical technique
4. Bio-D benefits
www.biodlogics.com7
Case 1 - March 2013• 86 y/o woman, s/p PK x2• Suture abscess• Treated with ProKera x2• Fortified Vanco, Tobra• 2.5 weeks to heal• Very uncomfortable• Stinging with insertion
www.biodlogics.com8
Case 1- March 2014• 86 y/o woman, s/p PK x2• Another Suture abscess• Refused ProKera• “I’d rather go blind.”• Bio-D/BSCL placed• Fortified Vanco, Tobra• 2.5 weeks to heal• Much more comfortable
www.biodlogics.com9
Case 2- Chemical truama• 70 y/o man, severe pain,
photophobia• Used body lotion instead of
his glaucoma drops• Vision 20/60• Normal pH• Bio-D/BSCL placed• Vigamox, ProLensa
www.biodlogics.com10
Case 2- Chemical truama• 70 y/o man, severe pain,
photophobia• Used body lotion instead of
his glaucoma drops• Vision 20/60• Normal pH• Bio-D/BSCL placed• Vigamox, ProLensa
www.biodlogics.com11
Case 2- Chemical truama• 70 y/o man, severe pain,
photophobia• Used body lotion instead of
his glaucoma drops• Vision 20/60• Normal pH• Bio-D/BSCL placed• Vigamox, ProLensa• 2 days later • Epi defect healing• No pain
www.biodlogics.com12
Case 2- Chemical truama• 5 days later • Epithelial defect fully healed• Vision 20/20• No corneal inflammation
www.biodlogics.com13
Case 3- Salzmann’s nodules• Paracentral superior nodule
causing decreased quality vision• Plan: epithelial debridement with
nodule peeling and Bio-D AMT• Outcome: epi defect healed in 4
days. Bio-D dissolved by day 8• Vision quality improved
www.biodlogics.com14
Case 3- Salzmann’s nodules• Paracentral superior nodule
causing decreased quality vision• Plan: epithelial debridement with
nodule peeling and Bio-D AMT• Outcome: epi defect healed in 4
days. Bio-D dissolved by day 8• Vision quality improved
www.biodlogics.com15
Case 3- Salzmann’s nodules• Paracentral superior nodule
causing decreased quality vision• Plan: epithelial debridement with
nodule peeling and Bio-D AMT• Outcome: epi defect healed in 4
days. Bio-D dissolved by day 8• Vision quality improved
www.biodlogics.com16
Case 3- Salzmann’s nodules• Paracentral superior nodule
causing decreased quality vision• Plan: epithelial debridement with
nodule peeling and Bio-D AMT• Outcome: epi defect healed in 4
days. Bio-D dissolved by day 8• Vision quality improved
www.biodlogics.com17
Case 4- AMBD/ Map-Dot Dystrophy• Central irregular epithelium (ABMD)• Low quality vision OD (20/40)• Plan: epithelial debridement with Bio-D
AMT• Outcome: epi defect healed in 4 days.
Bio-D dissolved by day 17• Vision quality markedly improved
(20/20)
www.biodlogics.com18
Case 4- AMBD/ Map-Dot Dystrophy
Post Op Day 6
www.biodlogics.com19
Case 4- AMBD/ Map-Dot Dystrophy
Post Op Day 11
www.biodlogics.com20
Case 4- AMBD/ Map-Dot Dystrophy
Post Op Day 17
www.biodlogics.com21
Table of Contents
1. Role of amniotic membrane in corneal surgery
2. Case studies1. Suture abscess in a corneal transplant
2. Chemical injury
3. Salzmann nodule removal
4. Anterior Basement Membrane Dystrophy
3. Surgical Technique
4. Bio-D benefits
www.biodlogics.com22
Preference List• Merocel spears • 2.5 mm fine grit diamond burr• Titanium lid speculum• #3 jewelers forceps• Punctal plugs• 15 blade• Bio- D 12mm disk
• Plan: epithelial debridement with nodule peeling and Bio-D AMT• Outcome: epi defect healed in 4 days. Bio-D dissolved by day 8• Vision quality improved
www.biodlogics.com23
Surgical Pearls• Must maintain orientation (stromal side down)• Keep firm grip on tissue (positive pressure in OR)• Vision will be blurry until Bio-D absorption• Consent form for AMT
www.biodlogics.com24
Table of Contents
1. Role of amniotic membrane in corneal surgery
2. Case studies1. Suture abscess in a corneal transplant
2. Chemical injury
3. Salzmann nodule removal
4. Anterior Basement Membrane Dystrophy
3. Surgical tecnique
4. Bio-D benefits
www.biodlogics.com25
• Product Sizes– 12mm disc– 15mm disc– 1.5 x 2.0 cm2
– 2.5 x 3.0 cm2
www.biodlogics.com26
BENEFITS– AMT available in the office for corneal procedures– Very well tolerated
• Easy to place• No discomfort
– Store at room temperature for 2 years– Easy to prepare for staff– Safe and Efficacious– Cost– Excellent product support
www.biodlogics.com27
Questions