published on July 12, 2016 by
Dry eye is a multifactorial and progressive1 disease for which we use many treatments, but the Prokera® corneal bandage is the first and only biologically active treatment that directly targets the cornea. Prokera has been a game-changer in my practice. I use it not only for DEWS2 Level 3 and 4 patients, but also for those with Level 1 or 2 dry eye with corneal involvement, especially Sjögren’s patients, who are chronically uncomfortable and not responding to conventional therapies, even if there is a disconnect between their signs and symptoms.
Unlike a bandage contact lens, Prokera is a biologically active treatment. The proprietary method by which it is preserved, CryoTek, maintains the integrity of the extracellular matrix of fresh fetal amniotic membrane (AM).3 The components of the extracellular matrix—growth factors, several forms of collagen, fibronectin, laminin, and, most importantly, the HC-HA/PTX3 complex—promote regenerative healing. HC-HA/PTX3 prevents scar formation, suppresses T-cell activation, inhibits giant cell formation, and controls matrix metalloproteinase production, which is a marker for inflammation.
In contrast, HC-HA/PTX3 is degraded or completely absent from amniotic membrane that is preserved by dehydration.3 CryoTek enables us to harness the power of fetal wound healing to immunomodulate the healing process in adults and orchestrate regenerative healing. Because of these unique properties, the family of AM products preserved by CryoTek, which includes Prokera, are the only FDA-approved AM products cleared for anti-scarring, anti-inflammation, and anti-angiogenesis effects and ophthalmic indications.
Case Study: A Marked Improvement
The case of a 56-year-old woman I recently began treating illustrates how Prokera can help patients with chronic dry eye. This particular patient had been self-medicating for several years with OTC vasoconstricting drops 30-60 times a day. When she presented to my office, she reported that she was unable to work as a result of severe dry eye/ ocular discomfort, photophobia, and decreased vision. Her BCVA OU was 20/70. Her workup showed she had severe dry eye OU and bilateral limbal stem cell deficiency.
Because the patient reported more pain in her left eye, I placed a Prokera corneal bandage in her left eye and asked her to return in 5 to 7 days. Also, I prescribed preservative-free dexamethasone drops qid OU. I recommended serum tears but she couldn’t afford them, so she used preservative-free OTC artificial tears every 2 hours while awake.
When the patient returned 9 days later, her left eye was feeling much better and she was seeing so well that she had already returned to work for the first time in months. Her visual acuity in that eye had improved to 20/25-1, and she readily agreed to have a Prokera placed in her right eye. The recovery in her right eye was as swift as her left eye; her visual acuity is now 20/25+ OU. We had been looking for dates when we could perform a limbal stem cell transplant on both eyes sequentially, but because of Prokera, we have avoided the need.
1. Rao SN. J Ocul Pharmacol Ther. 2010;26(2):157-164. 2. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007;5(2):75- 92. 3. Cooke M et al. J Wound Care. 2014;23(10):465-76.
Marguerite McDonald, MD, FACS is a cornea and refractive surgery specialist at Ophthalmic Consultants of Long Island in Lynbrook, NY; clinical professor of ophthalmology at NYU Langone Medical Center, New York; and adjunct clinical professor at Tulane University, New Orleans.