Ocular surface reconstruction with AMT - Dr ******

[dryeyehealth]

I am looking for anyone who has undergone ocular surface reconstruction with amniotice membrane transplant(AMT) with Dr ****** (or with anyone else) for aqueous tear deficiency, non-sjogren's (ATD).
I am especially interested in anyone who would be willing to talk to me about their experience and success or failure. I have severe dry eye - formally diagnosed as aqueous tear deficiency, non-sjogrens. I went to see Dr ****** and he told me I have "conjunctivochalasis" (CCh) that he can treat with surgery. I am pondering but am confused. Does dry eye cause CCh or is it an anatomical abnormality that is just identifed in patients who complain of dry eye? Does everyone who has ATD have CCh? It sounds like such a big, not to mention expensive procedure that I would really like to hear about other people's experiences. I am seriously considering it as I am (like most of you are) DESPERATE.

[grant555]

I was recommended for it, but I never went through with it. I believe dry eye/inflammation causes chalasis, which why everyone who sees Dr ******g is told that they have it. It seems like there is mixed results on this board about people who have benefited from it and people who have not. I think it depends on how severe your chalasis actually is. I personally would get a second opinion to see if yours is severe enough to warrant the surgery.

[spmcc]

****** told me I had CCh and recommended the expensive surgery too. That was 3 years ago. I never had the surgery because all of the other doctors I'd seen (or presently see) didn't/don't see any CCh. He was the only one.

Having said that, there are people who have had the surgery with ****** and say it helped. Just search DEZ using the term "******".

[jadavispcfl]

I am a Dr. ****** patient. I had the same problem, dry eyes with CCh, severe MGD, and large, vascular veins in my eyes from overuse of eye whitener drops in 2011. To put it mildly, I was a mess. The CCh, I believe is a complication of dry eye. In my case, my MGD was so bad that my eyelids were inflamed, reducing the tolerance that the conjunctiva has on the eye. The lack of tolerance caused trauma to my eye every time I blinked. The result was the looseness from CCh. I couldn't even travel without this affecting my eyes (perhaps change in pressure?), causing my eyes to be bright red. I only
had about 3 working glands on each eyelid.

Dr. ****** performed meibomian gland probing (MGP) with steroids first, then did AMT on each eye one at a time. Each eye took about 3 weeks to heal after surgery. I had NO complications with any of the procedures. The results were LIFE CHANGING for me. I used to be so self conscious after my appearance. I got my life back with the surgery. Yes, it is expensive, but to me worth every penny. How do you put a price on the quality of life? I've had to have probing again last year and I see Dr. ****** every 4 months for checkups. That is nothing compared to where I used to be. I spent 3 years in misery prior to seeing Dr. ******. The local doctors never saw the CCh. They didn't know what was wrong. I finally sought my own help and found Dr. ******'s book on the internet. I realized that my local doctors were not doing diagnostic tests that were outlined in the book. I had to find someone that REALLY understood the problem. I would definitely do what he recommends. Think of it as an investment in the rest of your life.

[dryeyehealth]

Thank you so much for your reply. I am trying to make an informed decision about the surgery and it is really tough. Did the probing and steroids do anythng to help you before the surgeries? Mine did absolutely nothing. I agree that it would be worth every penny to have my life back but I am worried about the surgery and the recovery. When you said that it took 3 weeks to heal, did you stay in Tampa the whole time? And, after 3 weeks could you go to work/school? What was the worst part of the surgery? Thank you again for your response I am both desperate and scared. (I also sent you a private message).

[peter56]

Hi,
an AMT to treat CCh is not really a ocular surface reconstruction!

The bulbar conjunctiva does rest - is bound tightly on the sclera - white part of the frontal eye ball.
In healthy eyes with a good tear film, the upper eyelid is gliding down almost without resistance.

In dry eyes the upper lid is moving downward more like rubber on rubber.
Thereby pushing the conjunctiva downwards during every blink.
So the conjunctiva is getting loose and slowly detaches from the sclera.

That is causing CCh and the so called LIPCOF folds at the lower lid margin.

The AM is being sutured onto the conjuctiva-sclara and thus the conjuctiva is being re-attached to the sclera.
Some Teams do now use a Surgitron Radio frequence device - Ellmann-NY to treat CCH.
That Treatment is much easier to perform than the AMT.
But also the AMT is a simple procedure.
There are some videos available on CCh-AMT - http://www.osref.org/

That is by the way the same Surgitron that is also being applied to treat trichiasis-Distichiasis - rubbing hairs.

Severe CCh can prevent the tear film build-up and so there is no stable tear film anymore.


Full text articles on CCh:

http://www.ncbi.nlm.nih.gov/pubmed/23981623
http://www.ncbi.nlm.nih.gov/pubmed/23102005

[dryeyehealth]

Thanks for all the info. My understanding is that they call it a resurfacing because they cut out portions of the conjunctiva then suture in the AMT and the cells grow over the transplant.

[jadavispcfl]

AMT Surgery

In answer to your questions: 1) yes, the probing and steroids did help, but I knew that without addressing my co-morbids, the probing alone would only be a short term solution. I still had CCh, large vascular veins, and pterygiums that needed repair. 2) I stayed in Tampa two nights, one before and one after the surgery. I had the surgery on a Monday, and was back at work on either Thursday or Friday of that week. Yes, my eye was red. It took a couple of weeks for that to go away. I had to go back after about 10 days to get the stitches out. I was using drops to keep infection away (had no infection). My eye was back to normal at about 3 weeks, so I had the other one done. The scariest part was just before going in to do the first eye. I just told myself that I had to trust Dr. ******. I guess that the hard part - learning to trust someone else with your life. After I had that done, the other wasn't so bad.

I posted a thread in 2011 that describes my experience.

[neilw]

I am not sure that there is much difference between AMT surgery and trying something like Prokera. There is also AMCL (from Dr Ming Wang in Tennessee). My understanding is that both Prokera and AMCL apply amniotic membrane to the ocular surface using a scleral lens type device. As such no surgery is involved which to me sounds better than the surgical treatments. Phillips55 has just had the Prokera treatment and has described it in this thread - http://www.dryeyezone.com/talk/showt...done-yesterday.

[Phillips55]

This is Phillips55, I just had the Prokera procedure done. I believe it uses the same amniotic fluid as the amt does but it's in the form of a large contact that does not need to be sutured to the eye, although a single stitch can keep it from moving around. Mine was in place for 5 days but it can be left in up to 30 days depending how fast the amniotic fluid dissolves. The prokera can be replaced as needed depending on the severity of the case. I saw Dr. ****** and he suggested AMT. I was extremely impressed with him but he is not covered by private insurance which limited my ability to seek further treatment with him. Prokera is covered in most cases by insurance company and Dr. Robert Mack put mine in. The prokera is very easy to put in and take out, in fact my own doctor took it out so I didn't have to make the 3 hour drive back to Dr. Mack. Mine was fully covered by insurance. With AMT I believe they have to cut it to fit your eye and suture it in place. I had a few up and down days after it was taken out, but substantial has taken place and now feel I have a real tear film/layer present, instead of just the vicious cycle of dry/watery eye. Just look up Prokera on Google and the company can find a Doctor nearest to you that performs it.

[dryeyehealth]

Thank you for the information. Did you have CCh as well because I assume that the Prokera doesn't treat that condition. My insurance will not cover Dr ******'s surgery either so it is not only the anxiety about theprocedure itself but also the cost so I really appreciate the other options. Is Prokera something that is supposed to last or will it have to be done again at some point?

[Phillips55]

Did you have CCh as well because I assume that the Prokera doesn't treat that condition.
I am not sure as I never was given a diagnosis of it, but Dr. ****** highly recommended AMT to me so it's defiantly a possibility. The makers of Prokera do claim on their website that it does treat it, heres the link:
http://www.biotissue.com/medical-pro...dications.aspx

Is Prokera something that is supposed to last or will it have to be done again at some point?
I suppose it depends on your problem, for someone with a chemical burn on their otherwise healthy cornea, a single treatment is effective. But either way the procedure can be repeated as needed. Someone like me who who has dry eye because of issues like lasik may need to do it once a year or so as maintenance. I'm just talking hypothetically as I'll need to see how I am as time goes by.

[dryeyehealth]

Dr Safran's radio frequency procedure for CCh

Has anyone tried Dr safran"s treatment for CCh using in-office radio frequency surgery or, I have read of "electrocoagulative" surgery, both of which seem less invasive and easier to recuperate from. Neither uses AMT. Any information on these procedures would be appreciated.