What is an amniotic membrane?
- An amniotic membrane is the inner layer of fetal membrane.
- The membrane has anti-inflammatory, anti-fibrotic, anti-angiogenic and anti-microbial properties.
- An amniotic membrane is a healthy, intact, basal membrane on which the patient’s cells are able to proliferate.
- It returns the ocular surface to healthy level2
What ocular pathologies can amniotic membranes improve?
- recurrent corneal erosion
- infectious keratitis/ulceration
- Salzmann’s nodular dystrophy
- superficial punctate keratitis
- epithelial basement membrane dystrophy
- neurotropic disease2
Who is a good candidate? Who is not a good candidate?
- Any patient who has any of the aforementioned conditions is a potential candidate.
- Patients with mild dry eye who can be treated with standard treatments (Restasis, Lotemax, ATs) are not ideal candidates.2
Treatment has been less successful in the following conditions:
- mucous membrane pemphigoid (79 percent)
- chronic Stevens-Johnson or Lyell’s syndrome (62 percent)
- reconstruction of the conjunctiva and fornix (47 percent)
- neoplasia of the ocular surface (33 percent)
- primary and secondary limbal stem cell deficiency (32 percent)
- physical trauma (30 percent)
- chemical trauma (24 percent)
- pterygium (8 percent)
- recurrent epithelial erosions (5 percent)3
Patient education
Patients should be educated on discomfort due to the size of the membrane and blurred vision during the healing process. Patients should also be placed on Restasis and Lotemax TID while the membrane is on the eye.2
Procedures for application and removal
Storage
Amniotic membranes can be stored in a refrigerator up to 3 months and a freezer up to 1 year.
Application
- Rinse the device with saline when it arrives to prevent burning upon insertion.
- Hold the ring with your thumb and forefinger at the 6 o’clock position.
- Apply topical anesthetic.
- Have the patient look down, and apply the membrane to the superior conjunctival fornix.
- Have the patient look up and apply the membrane to the superior conjunctival fornix.
- Tape the temporal half of the upper eyelid closed to decrease movement and increase comfort.1
Patient should be seen daily until healing occurs.
Removal
- Approved to stay on the eye for a maximum of 8 weeks or until tissued has healed. Healing is usually completed between 1-2 weeks.
- Membrane can be completely absorbed by cornea within 1 week, but plastic ring must be discarded.
- Apply topical anesthetic.
- Have the patient look up and lift the lower edge.
- Apply a gentle pressure to the superior lid in a downward motion.
- Preservative free ATs can be used to improve comfort.1
Billing and coding for amniotic membranes
Commercial carriers:
- Bill procedure code 65778
- Bill material code V2790
Medicare:
- Only need to bill procedure code V2790 (Reimbursement for supplying the lens is included in payment for the procedure)1
Billing and coding for amniotic membranes
Commercial carriers:
- Bill procedure code 65778
- Bill material code V2790
Medicare:
- Only need to bill procedure code V2790 (Reimbursement for supplying the lens is included in payment for the procedure)1
Sources:
- Luong, Paul D., Edward S. Bennett, OD, Stephanie L. Woo, OD, and Raymond J. Brill, OD. “The Role of Amniotic Membrane Transplantation.” The Role of Amniotic Membrane Transplantation. Contact Lens Spectrum, 1 Mar. 2016. Web. 12 May 2016. <http://www.clspectrum.com/articleviewer.aspx?articleID=113936>.
2. Rodriguez, Brandon, MD. “Using Amniotic Membranes for Dry Eye Patients.” Using Amniotic Membranes for Dry Eye Patients. Ophthalmology Management, 1 Nov. 2014. Web. 12 May 2016. <http://www.ophthalmologymanagement.com/articleviewer.aspx?articleID=111777>.
3. Stephenson, Michelle. “Newsletters.” Review of Ophthalmology® Treatment Options with Amniotic Membrane. Review of Ophthalmology, 5 Nov. 2015. Web. 12 May 2016. <http://www.reviewofophthalmology.com/content/t/therapeutics–external_disease/c/58142/#sthash.FEIdRVjB.dpuf>.
