When Melanie met Sally

September 11, 2015

I met Sally in the spring of 2015. The air was light and cool, the birds were starting to sing, and the flowers were just starting to reveal their blooms. The deliveryman dropped her off on our doorstep in the morning, and we carefully transported her to her new home in our fridge in the back room. We were all so excited for her arrival.

The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

I met Sally in the spring of 2015. The air was light and cool, the birds were starting to sing, and the flowers were just starting to reveal their blooms. The deliveryman dropped her off on our doorstep in the morning, and we carefully transported her to her new home in our fridge in the back room. We were all so excited for her arrival.

We don’t put all of our friends in the fridge, but Sally was different. She was an amniotic membrane graft given her name by our patient.

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So, how in the world did a serious thing like an amniotic membrane graft come to be given her own name? You can thank the patient for that! It seems that by the time you’re getting someone ready to have a graft inserted, you have seen him-a LOT.

Sally the amniotic membrane graft

This particular patient suffered from a neurotrophic persistent epithelial defect resulting from trigeminal impairment after an activation of herpes zoster. The epithelial breakdown and poor healing had persisted despite our best efforts with copious lubrication and autologous serum. By the time I was made aware of the biological tissue bandage lens, both the patient and myself were beyond ready to finally get his cornea to heal. I immediately thought of him as I heard my company rep explain the graft.

The graft I used was called Prokera Slim (Bio-Tissue), a biologic corneal bandage device. It has natural therapeutic actions that can help damaged eye surfaces heal. Prokera and the other products within its family are indicated to reduce inflammation and promote regenerative healing of the ocular surface and are cleared by the U.S. Food and Drug Administration (FDA).

The bandages can be used in conjunction with topical agents and do not carry the risk of increased intraocular pressure (IOP) or delayed healing. They are indicated for use in neurotrophic corneas, like my patient had, but they are also used for recurrent corneal erosions, filamentary keratitis, persistent epithelial defects, herpetic ulcers, and other ocular surface diseases.

The graft can be inserted in clinic-if you can insert a contact lens, you can insert an amniotic membrane graft!

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Luckily, my patient is a lively, story-telling type who takes everything in stride, so you can bet that if he was going to be living with this graft for the next five days, it was going to have a name! We had become friends over the course of his multiple visits, and typically about half of the visit was spent shootin’ the breeze.

After agreeing to my plan, I turned to chart on the computer. He considered the options for a moment before he said, “I think we should call her Sally.”

Next: Meeting Sally 

 

It was just a few days until she arrived, and we were able to call him back with an exuberant, “Sally’s ready for you!”

We checked on him frequently, each time calling to ask, “How’s Sally treating you?"

After five days, the graft had separated from its ring. After removing the ring, we were finally able to assess if it had had an effect. After just five days in place, his cornea had healed beautifully. He asked if he could see her, and I had to laugh as he gazed at her lovingly hanging from her ring and said his “goodbye and thank you” to this piece of biologic tissue.

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In the end, the amniotic membrane graft was a great success, and the patient has maintained improved vision and comfort following the procedure. I wonder how much of his improvement was due to science and how much was due to the bond he had with the graft. All I know is, for the right circumstance, I would order Sally or one of her sisters again in a heartbeat.

Dr. Denton has no affiliation with any biologic tissue companies.