Part 2: Conjunctivochalasis (CCH) Dry Eye: The Reservoir Restoration Procedure for CCH

In part one of a two part series, Arla Genstler, MD discussed Conjunctivochalasis (CCH) Dry Eye and how it’s diagnosed, and introduced the Reservoir Restoration Procedure for CCH. Here, she speaks in more depth about this procedure and its clinical results.

What are the keys to performing the Reservoir Restoration Procedure for CCH?

Dr. Genstler: The procedure is fairly straightforward however, one of the keys is to completely remove the abnormal Tenon’s capsule, deeply establish the fornix by getting the prolapse fat to retract, and then re-establish the deep cul-de-sac. Not using too much tissue glue and smoothing the cryopreserved amniotic membrane are also important – I typically wait a few minutes to make sure that it’s adhered adequately. The procedure is quick and easy and takes only about 20-30 minutes.

Part 1: Conjunctivochalasis (CCH) Dry Eye: The Reservoir Restoration Procedure for CCH

In part one of a two part series, Arla Genstler, MD, discusses Conjunctivochalasis (CCH) Dry Eye and how it’s diagnosed, and introduces us to the Reservoir Restoration Procedure for CCH.

What is Conjunctivochalasis (CCH) Dry Eye?

Dr. Genstler: Conjunctivochalasis (CCH) is a mechanical problem caused by the degeneration of the Tenon’s Capsule due to high matrix metalloproteinase (MMP) activity. The unhealthy Tenon’s causes the conjunctiva to loosen and create folds that can interfere with the tear meniscus, block the punctum preventing tear clearance, and occupy the fornix (the tear reservoir) diminishing its volume and ability to adequately hold fluid needed to replenish the tear meniscus. Over time the loose conjunctiva contracts, further shortening the fornix.

Early Intervention with Cryopreserved Amniotic Membrane: A Mindset Shift

I’m a firm believer in evidence-based medicine, which is one of the main reasons I’ve always used cryopreserved amniotic membrane (PROKERA) versus dehydrated tissue for the treatment of dry eye disease (DED). The cryopreserved amniotic tissue is processed using the proprietary CryoTek® technology (Bio-Tissue), which has been proven to preserve the biological properties of amniotic membrane and umbilical cord tissue. These biological components that have been shown to play a major role in controlling inflammation and preventing scarring, include the Heavy Chain Hyaluronic Acid/Pentraxin-3 complex (HC-HA/PTX3).

Comparatively and more importantly, dehydrated amniotic tissue products have demonstrated to have drastically altered structural and biological properties.1  As a result, cryopreserved products are able to achieve a higher quality clinical outcome. Recent work has shown that PROKERA may help the healing of the ocular surface and has demonstrated sustained reduction of DEWS score from 3.25 to 1.44 with one treatment in 3-5 days.2

A Bio-Tissue Employee’s Experience Being Treated with PROKERA

As a post-LASIK patient with severe Dry Eye Disease (DED), I’ve tried many treatments that either didn’t work or that I didn’t like due to the side effects like taste and burning. I’m also not the most compliant patient even though I work in eye care – kind of like cobblers who don’t shoe their kids – so using drops and medication can be challenging. I was starting to develop a lot of problems including a gritty sensation, fluctuating vision, nighttime irritation, and most notably stabbing pains in my left eye at night.

After consulting with my doctor, I realized I had to do something due to the amount of dryness on my ocular surface. From my work in the field, I knew of the many benefits and positive clinical outcomes with PROKERA. I also knew from experience that due to my very large eyes, fairly protruding globes, shallow lower lids, and tight upper lids, that having PROKERA inserted could be a bit of a challenge.  However, in my work with patients and doctors I have rarely seen issues regarding the sensation of PROKERA, so decided to try it again.


Healthier Corneas: A Patient Case of Fuch’s Endothelial Dystrophy

Several months ago, a 74 year-old female presented with symptoms of blurred vision, sometimes-painful foreign body sensation, and frequent tearing while reading. Her ocular history is positive for Fuch's Endothelial Dystrophy and was treated by a combination of Muro-128 ointment hs, and Muro 128 solution b.i.d. daily. She applies non-preserved artificial tears prn, which provides temporary relief for her discomfort. As an avid reader, she was seeking relief to pursue one of her favorite activities and better quality of life. Initial examination results included:

Restoring Corneal Clarity: Cryopreserved Amniotic Membrane and Stromal HSV

A 45 year-old gentleman was referred to me for HSV keratitis. Over the course of a six to eight year period, the patient had at least 10 recurrent stromal herpetic episodes that he could recall. He had been a police officer for over 15 years, and because of his vision, he didn’t feel safe at nighttime and in dim lit conditions. Due to his condition, he was at risk of having to resort to a desk job permanently or possibly leaving his career altogether.

Study Demonstrates Cryopreserved Amniotic Membrane Graft Reduces Recurrence After Pterygium Surgery


We recently issued a press release on study findings, published in Cornea, 2017, showing that the use of cryopreserved amniotic membrane reduces recurrence rates after pterygium surgery.

In this retrospective review, 556 eyes representing 535 patients (291 males 244 females), who had pterygium excision (527 primary, 29 recurrent) were treated with adjunctive cryopreserved amniotic membrane (Amniograft®, Bio-Tissue, Inc. Miami FL). After 17.3 ± 0.8 months (range 6-74 months), corneal recurrence occurred in only 20 eyes (3.6%) and conjunctival recurrence in 12 (2.2%) eyes, for a total recurrence rate of 5.8%.

Impacting a patient’s quality of life – A PROKERA case study


I love what I do, and one of my greatest accomplishments is knowing that I truly impacted a patient’s quality of life. This was the case with one of my patients, a 45 year-old male who works using his computer all day – he also happens to only have one eye. About two years ago, he came to see me and was extremely distraught because he could no longer see his computer without his eye watering and burning. He had moderate glaucoma and was also a steroid responder, meaning we couldn’t give him a standard steroid to help with his symptoms without compromising his glaucoma.

First Study to Demonstrate Corneal Nerve Regeneration in Patients with Dry Eye Disease with the Use of PROKERA


At the recent American Academy of Ophthalmology Meeting in New Orleans, I presented on results of “Corneal Nerve Regeneration after Self-Retained Cryopreserved Amniotic Membrane in Dry Eye Disease” recently published in The Journal of Ophthalmology, 2017 (John, et al.). This study is the first study to show that cryopreserved amniotic membrane is correlated with corneal nerve regeneration in patients with dry eye disease (DED).

Ocular Surface Regeneration in Dry Eye Disease: New Article and Case Study


For patients with chronic dry eye disease causing corneal conditions such as SPK or filamentary keratitis, PROKERA® offers a viable option for immediate intervention as a powerful anti-inflammatory with the long-lasting benefit of regenerative healing.