A CCH Case Study: Addressing the Real Cause of Conjunctivochalasis (CCH)


An optometrist in my office referred a 69-year-old male patient, who for years had been treated for dryeye with RESTASIS, and occasionally Lotemax. At the time, he also wore scleral lenses to try to combat his dry eye. After years of struggling and trying different treatments, he still had no relief.

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:

Part 1: The Paradigm Shift in Treating Dry Eye

In part one of a two–part series, Josh Johnston, OD discusses the paradigm shift in treating patients with dry eye.

Treating dry eye disease (DED) has truly evolved over the past years, and even more so recently with new diagnostics, therapies and FDA-approved drugs. We all know DED is progressive and can be hard to treat, which is actually one of the reasons I like it so much. It’s an exciting time for those of us treating DED. The paradigm shift has changed and there are new, novel products and therapies at our disposal that allow us to provide better options to patients and improve clinical outcomes.

The Dangers of Beauty Treatments

We all know using makeup, and particularly not removing it at night, can have a huge impact on eye health and lead to or worsen conditions such as blepharitis, Demodex and also dry eye. As such, it’s becoming increasingly important to discuss cosmetics and ocular hygiene with our patients. A recent case also highlights the dangers of beauty procedures, which are becoming increasingly popular, in this case eye lash tinting.

Optimizing the Ocular Surface Prior to Surgery: Why I Added Prokera to My Refractive Cataract Pre-Surgical Regimen

Refractive cataract surgery requires a high level of attention to the ocular surface. Patients expect perfect outcomes, and any compromise of the ocular surface interferes with preoperative measurements and proper IOL selection. To ensure we don’t end up with a postoperative refractive surprise, we need to be on alert for ocular surface disease and get it under control before proceeding with surgery.

Be Proactive

Our typical cataract surgery patients have all the risk factors for ocular surface problems. They have chronic disease comorbidities, they’re using multiple medications, and so forth. Many are neurotrophic to some degree; therefore, we can’t rely on them to report symptoms. We must proactively look for dry eye as well as epithelial-based diseases, such as Salzmann’s nodular degeneration (SND) and epithelial basement membrane dystrophy (EBMD). EBMD not only leads to irregularities in preoperative measurements and outcomes but also puts patients at risk for epithelial sloughing during surgery and poor wound healing postoperatively.

How to Maintain Patient Vision During Treatment for Ocular Surface Diseases

For the millions of Americans who suffer from symptoms of chronic ocular surface disease, traditional treatments typically provide only temporary relief for patients, primarily because they don’t tackle the corneal damage that may be causing the symptoms. At Bio-Tissue, we strive to continually research and develop groundbreaking regenerative medicine treatments to help these patients and improve their quality of life.

Our innovative PROKERA® products are the only FDA-cleared therapeutic medical devices that reduce inflammation and promote healing in order to rejuvenate and heal the cornea, which is essential for patients to find true relief. PROKERA is clinically proven and has helped more than 50,000 patients worldwide.