Corneal patch graft for the repair of late- onset hypotony or filtering bleb leak after trabeculectomy: a new surgical technique. Repair of the filtering bleb using only conjunctiva reconstruction often fails when deeper tissue structures do not provide sufficient outflow resistance. Here, we present a technique that uses anterior stromal lamellae left over from donor corneas used for descemet stripping automated endothelial keratoplasty procedures as patch grafts to repair the scleral tissue wound as a way to treat ocular hypotony. MATERIALS AND METHODS: We describe a new surgical technique to reconstruct the outflow resistance of melted trabeculectomy scleral flaps and present the course of 5 cases of severe hypotony treated using this technique. RESULTS: All 5 patients suffered from severe hypotony several years after trabeculectomy with antiproliferative agents. Multiple surgical and nonsurgical attempts to treat hypotony had failed. Lamellar corneal tissue was used as a patch graft to replace the weakened sclera near the site of the earlier trabeculectomy. This procedure successfully reversed hypotony in all cases. During the follow- up periods of at least 9 months, no recurrences of bleb leak or hypotony were observed. Intraocular pressure (IOP) remained controlled with topical IOP- lowering treatment in 4 cases. In 1 case, a glaucoma drainage implant was used to control IOP. CONCLUSIONS: The use of lamellar corneal donor tissue to restore scleral outflow resistance is a safe and effective treatment for severe hypotony after mitomycin C- assisted trabeculectomy with or without filtering bleb leaks. Imaging Ahmed Glaucoma Tubes With a Pericardial Graft and Tissue Glue or Partial-Thickness Scleral Flap and. REIMBURSEMENT FOR AMNIOGUARD. Use 67255 (scleral reinforcement with graft. Tutoplast pericardium patch graft for scleral thinning following strabismus.
Corneal Graft with Amniotic Membrane Transplantation or Limbal Stem Cell Transplantation. Number: 0. 29. 3Policy. Aetna considers preserved human amniotic membrane transplantation or limbal stem cell transplantation for ocular surface reconstruction medically necessary in members with limbal deficiency (hypofunction or total loss of stem cells) refractory to conventional treatment when the member has any of the following conditions: Total loss of stem cells: (one eye involvement only)Chemical/thermal injuries of the ocular surface. Contact lens- induced keratopathy or toxic effects from lens- cleaning solutions. 67255 Scleral reinforcement; with graft 65426 Excision or transposition of pterygium. AVAILABLE CPT CODES For Ophthalmology CPT Code Description. AVAILABLE CPT CODES For Ophthalmology. 15120 Split graft, face, scalp, eyelids, mouth. 66225 repair of scleral staphyloma; with graft 573.60. CPT code 65426 was designed to encompass placement. Patient had an ahmed valve implantatiom and scleral patch graft for scleral. Scleral Patch Graft Cpt Code'. Surgical treatment of Peyronie’s disease with small intestinal submucosa graft patch. VIDEO: Scleral spacing procedure. Multiple surgeries or cryotherapies to the limbal region. Stevens- Johnson syndrome. Hypofunction of stem cells: (one or both eyes can be involved)Aniridia (hereditary)Bullous keratopathy. Chronic limbitis. Keratitis associated with multiple endocrine deficiency (hereditary)Neurotrophic keratopathy (neuronal or ischemic)Peripheral corneal ulcerative keratitis. Pterygium (primary and recurrent) and pseudopterygium. Aetna considers amniotic membrane transplantation for the treatment of conjunctivochalasis medically necessary when conservative therapies (e. Aetna considers amniotic membrane transplantation and limbal stem cell transplantation experimental and investigational for the following indications (not an all- inclusive list) because its effectiveness for indications other than the ones listed above has not been established. Gelatinous drop- like corneal dystrophy (also known as subepithelial amyloidosis of the cornea)Mooren's ulcer. Restrictive strabismus. Use in trabeculectomy for primary open- angle glaucoma. Aetna considers combined HLA- matched limbal stem cells allograft with amniotic membrane transplantation experimental and investigational as a prophylactic approach to prevent corneal graft rejection following penetrating keratoplasty because the effectiveness of this approach has not been established. Background. The normal ocular surface is covered by corneal and conjunctival epithelium. Miranda- Rollon et al (2. Gris et al (2. 01. AMG) in patients with superior limbic keratoconjunctivitis not responsive to medical therapies. In a retrospective study, Guo et al (2. AMT) for treatment of refractory symptomatic giant papillae in vernal keratoconjunctivitis (VKC). Mean best- corrected visual acuity improved from 0. Ijiri et al (2. 00. Pachigolla et al (2. Pro. Kera, Bio- Tissue, Inc., Miami, FL) in the management of various ocular surface and orbital disorders. Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency. Kruse FE, Rohrschneider K, Volcker HE. Tseng SC, Prabhasawat P, Lee SH. Amniotic membrane transplantation for conjunctival surface reconstruction. Shimazaki J, Yang HY, Tsubota K. Amniotic membrane transplantation for ocular surface reconstruction in patients with chemical and thermal burns. Prabhasawat P, Barton K, Burkett G, et al. Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Prabhasawat P, Tseng SC. Impression cytology study of epithelial phenotype of ocular surface reconstructed by preserved human amniotic membrane. Lee SH, Tseng SC. Amniotic membrane transplantation for persistent epithelial defects with ulceration. Kim JC, Tseng SC. Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Kim JC, Tseng SC. The effects on inhibition of corneal neovascularization after human amniotic membrane transplantation in severely damaged rabbit corneas. Batmanov Iu. E, Egorova KS, Kolesnikova LN. Use of fresh amnion in the treatment of corneal diseases. Tsubota K, Satake Y, Kaido M, et al. Treatment of severe ocular- surface disorders with corneal epithelial stem- cell transplantation. Akpek EK, Foster CS. Limbal stem- cell transplantation. Tsai RJ, Li LM, Chen JK. Reconstruction of damaged corneas by transplantation of autologous limbal epithelial cells. Meller D, Maskin SL, Pires RT, et al. Amniotic membrane transplantation for symptomatic conjunctivochalasis refractory to medical treatments. Koizumi N, Inatomi T, Suzuki T, et al. Cultivated corneal epithelial stem cell transplantation in ocular surface disorders. Anderson DF, Ellies P, Pires RT, et al. Amniotic membrane transplantation for partial limbal stem cell deficiency. Stoiber J, Muss WH, Pohla- Gubo G, et al. Histopathology of human corneas after amniotic membrane and limbal stem cell transplantation for severe chemical burn. Lee C, Samuel M, Tan D. Surgical interventions for pterygium (Protocol). Cochrane Database Syst Rev. CD0. 04. 50. 6. Dogru M, Tsubota K. Current concepts in ocular surface reconstruction. Chandra A, Maurya OP, Reddy B, et al. Amniotic membrane transplantation in ocular surface disorders. Hammersmith KM. Diagnosis and management of Acanthamoeba keratitis. Rauscher FM, Barton K, Budenz DL, et al. Long- term outcomes of amniotic membrane transplantation for repair of leaking glaucoma filtering blebs. K. Comparison of conjunctival autograft with amniotic membrane transplantation for pterygium surgery: Surgical and cosmetic outcome. Sangwan VS, Burman S, Tejwani S, et al. Amniotic membrane transplantation: A review of current indications in the management of ophthalmic disorders. Espana EM, Grueterich M, Sandoval H, et al. Amniotic membrane transplantation for bullous keratopathy in eyes with poor visual potential. J Cataract Refract Surg. Chansanti O, Horatanaruang O. The results of amniotic membrane transplantation for symptomatic bullous keratopathy. Suppl 9: S5. 7- S6. Srinivas S, Mavrikakis E, Jenkins C. Amniotic membrane transplantation for painful bullous keratopathy. Georgiadis NS, Ziakas NG, Boboridis KG, et al. Cryopreserved amniotic membrane transplantation for the management of symptomatic bullous keratopathy. Clin Experiment Ophthalmol. Altiparmak UE, Oflu Y, Yildiz EH, et al. Prospective comparison of two suturing techniques of amniotic membrane transplantation for symptomatic bullous keratopathy. Shay E, Kheirkhah A, Liang L, et al. Amniotic membrane transplantation as a new therapy for the acute ocular manifestations of Stevens- Johnson syndrome and toxic epidermal necrolysis. Chawla B, Sharma N, Tandon R, et al. Comparative evaluation of phototherapeutic keratectomy and amniotic membrane transplantation for management of symptomatic chronic bullous keratopathy. Gregory DG. Treatment of acute Stevens- Johnson syndrome and toxic epidermal necrolysis using amniotic membrane: A review of 1. Strube YN, Conte F, Faria C, et al. Amniotic membrane transplantation for restrictive strabismus. Stavrakas P, Georgopoulos G, Milia M, et al. The use of amniotic membrane in trabeculectomy for the treatment of primary open- angle glaucoma: A prospective study. Health Quality Ontario. Limbal stem cell transplantation: An evidence- based analysis. Ont Health Technol Assess Ser. Rama P, Matuska S, Paganoni G, et al. Limbal stem- cell therapy and long- term corneal regeneration. Miri A, Al- Deiri B, Dua HS. Long- term outcomes of autolimbal and allolimbal transplants. Work Loss Data Institute. Encinitas, CA: Work Loss Data Institute; 2. Sangwan VS, Basu S, Vemuganti GK, et al. Clinical outcomes of xeno- free autologous cultivated limbal epithelial transplantation: A 1. Huang T, Wang Y, Zhang H, et al. Limbal allografting from living- related donors to treat partial limbal deficiency secondary to ocular chemical burns. Marchini G, Pedrotti E, Pedrotti M, et al. Long- term effectiveness of autologous cultured limbal stem cell grafts in patients with limbal stem cell deficiency due to chemical burns. Clin Experiment Ophthalmol. Basu S, Ali H, Sangwan VS. Clinical outcomes of repeat autologous cultivated limbal epithelial transplantation for ocular surface burns. Kawasaki S, Kinoshita S. Clinical and basic aspects of gelatinous drop- like corneal dystrophy. Kim KH, Park SW, Kim MK, Wee WR. Effect of age and early intervention with a systemic steroid, intravenous immunoglobulin or amniotic membrane transplantation on the ocular outcomes of patients with Stevens- Johnson syndrome. Sejpal K, Ali MH, Maddileti S, et al. Cultivated limbal epithelial transplantation in children with ocular surface burns. Movahedan H, Anvari- Ardekani HR, Nowroozzadeh MH. Limbal stem cell transplantation for gelatinous drop- like corneal dystrophy. Lavaju P, Sharma M, Sharma A, Chettri S. Use of amniotic membrane and autologous serum eye drops in Mooren's ulcer. Schallenberg M, Westekemper H, Steuhl KP, Meller D. Amniotic membrane transplantation ineffective as additional therapy in patients with aggressive Mooren's ulcer. Alhassan MB, Rabiu M, Agbabiaka IO. Interventions for Mooren's ulcer. Cochrane Database Syst Rev. CD0. 06. 13. 1. Prabhakar SK. Safety profile and complications of autologous limbal conjunctival transplantation for primary pterygium. Farias CC, Sterlenich T, de Sousa LB, et al. Randomized trial comparing multilayer amniotic membrane transplantation with scleral and corneal grafts for the treatment of scleral thinning after pterygium surgery associated with beta therapy. Capozzi P, Petroni S, Buzzonetti L. Combined HLA matched limbal stem cells allograft with amniotic membrane transplantation as a prophylactic surgical procedure to prevent corneal graft rejection after penetrating keratoplasty: Case report. Pelegrin L, Gris O, Adan A, Plazas A. Superficial keratectomy and amniotic membrane patch in the treatment of corneal plaque of vernal keratoconjunctivitis. Miranda- Rollon MD, Sentieri- Omarrementer. Treatment with amniotic membrane in keratolysis secondary to adult gonococcal keratoconjunctivitis. Arch Soc Esp Oftalmol. Gris O, Plazas A, Lerma E, et al. Conjunctival resection with and without amniotic membrane graft for the treatment of superior limbic keratoconjunctivitis. Guo P, Kheirkhah A, Zhou WW, et al. Surgical resection and amniotic membrane transplantation for treatment of refractory giant papillae in vernal keratoconjunctivitis.
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