Management of Glaucoma Medication Induced Dry Eye Disease with Self-retained Cryopreserved Amniotic Membrane

BackgroundApproximately half of glaucoma patients have dry eye disease (DED) due to anti-glaucoma medication use. Herein, we evaluated the effectiveness of self-retained cryopreserved amniotic membrane (AM) in managing glaucoma-induced DED. MethodsA retrospective chart review was conducted on consecutive patients treated with self-retained cryopreserved AM (Prokera Slim, BioTissue, Miami, FL) for ocular surface disease induced by chronic use of glaucoma medication. Data collected included demographics, diagnosis, associated signs and symptoms, concomitant therapies, and benefit duration. ResultsEight eyes of eight female patients (aged 80.0 ± 3.9 years) developed DED from chronic use (8.4 ± 2.3 years) of glaucoma medication. DED was refractory despite use of conventional therapies, including topical cyclosporine (n=7), gels (n=5), artificial tears (n=5), and lifitegrast (n=2). However, after treatment with self-retained cryopreserved AM, SPK grade significantly improved from 3.25 ± 0.7 to 0.38 ± 0.5 (p=0.01). Furthermore, visual acuity (VA) improved in all patients by an average of 1.4 ± 0.5 lines (range: 1-2), with a significant improvement in LogMAR VA observed post-treatment (logMAR .28 to .16, p=0.01). This was accompanied by decreased pain (n=5), decreased foreign body sensation (n=5), and improved comfort (n=2) that lasted an average duration of 5.3 ± 1.0 months. ConclusionThis retrospective study suggests that a single placement of self-retained cryopreserved AM can restore corneal surface health with a lasting benefit in patients with glaucoma-induced DED who are refractory to conventional therapy directly or indirectly by promoting blinking and tearing reflexes.