International Ophthalmology

, Volume 38, Issue 5, pp 2219–2222 | Cite as

Adjunctive role of self-retained cryopreserved amniotic membrane in treating immune-related dry eye disease

  • Anny M. S. Cheng
  • Sean Tighe
  • Hosam Sheha
  • Scheffer C. G. TsengEmail author
Case Report



To present a case of successful treatment of immune-related severe dry eye disease (DED) by self-retained cryopreserved amniotic membrane (CAM) in conjunction with conventional and systemic immunotherapy.


A 48-year-old female with a 10-year history of rheumatoid arthritis under systemic immunomodulation developed non-resolved severe ocular dryness, pain, photophobia and blurred vision due to corneal epithelial keratopathy OD much worse than OS despite topical artificial tears, steroids, cyclosporine, autologous serum drops, punctal plugs and scleral lens for the last 3 years. During the first year, she received punctal cauterization and a total of 6 CAM, each for an average of 7.2 ± 2.3 days, for recurrent diffuse superficial punctate keratitis (SPK) with filaments to achieve an average symptom-free period of 2.4 ± 0.9 months and visual acuity improvement from 20/400 to 20/200. During the next 2 years, she received surgical closure of puncta for recurrent punctal reopening, additional systemic immunomodulation and a total of 4 CAM, each for an average of 8.5 ± 2 days, for recurrent scattered SPK, to achieve an average symptom-free period of 6.4 ± 1 months and visual acuity improvement from 20/200 to 20/70.


Self-retained CAM can be an adjunctive treatment for immune-related DED, which is refractory to conventional and systemic immunotherapies.


Amniotic membrane Autoimmune Dry eye disease Ocular surface PROKERA 



This study was supported in part by an unrestricted grant from Ocular Surface Research Education Foundation, Miami, FL. The development of PROKERA® was supported in part with Grant Number EY014768 from the National Institute of Health (NIH) and National Eye Institute (NEI). The content is solely the responsibility of the authors and does not necessarily represent the opinion of the NIH or the NEI.

Compliance with ethical standards

Conflict of interest

Dr. Tseng is the founder and a major shareholder of Tissue Tech Inc. that holds patents on the methods of preservation and clinical uses of amniotic membrane graft and PROKERA®. Other authors are employees of Tissue Tech.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patient in the study.


  1. 1.
    Tsubota K, Xu KP, Fujihara T, Katagiri S, Takeuchi T (1996) Decreased reflex tearing is associated with lymphocytic infiltration in lacrimal glands. J Rheumatol 23:313–320PubMedPubMedCentralGoogle Scholar
  2. 2.
    Tong L, Thumboo J, Tan YK, Wong TY, Albani S (2014) The eye: a window of opportunity in rheumatoid arthritis? Nat Rev Rheumatol 10:552–560CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Liu J, Sheha H, Fu Y, Liang L, Tseng SC (2010) Update on amniotic membrane transplantation. Expert Rev Ophthalmol 5:645–661CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Tseng SC, He H, Zhang S, Chen SY (2016) Niche regulation of limbal epithelial stem cells: relationship between inflammation and regeneration. Ocul Surf 14:100–112CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Cheng AM, Zhao D, Chen R, Yin HY, Tighe S, Sheha H, Casas V, Tseng SC (2016) Accelerated restoration of ocular surface health in dry eye disease by self-retained cryopreserved amniotic membrane. Ocul Surf 14:56–63CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Pflugfelder SC, de Paiva CS, Li DQ, Stern ME (2008) Epithelial-immune cell interaction in dry eye. Cornea 27(Suppl 1):S9–S11CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Stevenson W, Chauhan SK, Dana R (2012) Dry eye disease: an immune-mediated ocular surface disorder. Arch Ophthalmol 130:90–100CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Coutinho AE, Chapman KE (2011) The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol 335:2–13CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Ricciotti E, FitzGerald GA (2011) Prostaglandins and inflammation. Arterioscler Thromb Vasc Biol 31:986–1000CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Matsuda S, Koyasu S (2000) Mechanisms of action of cyclosporine. Immunopharmacology 47:119–125CrossRefPubMedCentralGoogle Scholar
  11. 11.
    He H, Tan Y, Duffort S, Perez VL, Tseng SC (2014) In vivo downregulation of innate and adaptive immune responses in corneal allograft rejection by HC-HA/PTX3 complex purified from amniotic membrane. Invest Ophthal Vis Sci 55:1647–1656CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Anny M. S. Cheng
    • 1
  • Sean Tighe
    • 1
    • 2
  • Hosam Sheha
    • 1
    • 2
  • Scheffer C. G. Tseng
    • 2
    Email author
  1. 1.Herbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
  2. 2.Ocular Surface CenterMiamiUSA

Personalised recommendations