Amniotic Membrane Transplantation

[adam-85]

Hey,

I had this surgery on both eyes 4 days ago now to correct a redundant conjunctiva I had which Dr. Tseng after lots of medicine and testing i've have on my eyes to be the underlying condition. I do have MGD, but I am confident that that was caused by the redundant conjunctiva. ALthough i did not ask him that. the transplantation took place bilaterally in 2 small areas either side of my pupil, which is where it was visibly wrinkled before hand. My eyes are very red and feel very weird at the moment but with time are supposed to get better and hopefully my symptoms largely go away.

If anyone has any question regarding the surgery I would be happy to answer them! And if anyone has MGD, I think it might be a good idea to look into what i have/had which is called Conjunctivochalasis, because i had been told i had MGD which i could see, but Dr. Tseng did not find that a problem. I will keep you posted if my progress which i am nervous about!

Adam

[dianat]

Adam,

I wish you the best of luck. I hope the membrane surgery does the trick for you so you can get on with your life. Please do keep us posted on your progress. I love good news!

Diana

[Cindy]

Hi Adam, I also wish you well and hope your healing goes great. I do have a question...what is 'redundant conjunctiva'?

[adam-85]

hey cindy,

a redundant conjunctiva is where the conjunctiva is 'wrinkled' - there is too much of it and it generally folds up or over itself. its usually bilateral. the conjunctiva is basically not smooth and if you look carefully in a mirror with the right angle of lighting you can see it fold when you rotate your head and the reflection in your eye is not how it should be. at least this is what i experience!

-adam

[adam-85]

just thought id update people if they are at all interested in the surgery!

its been 2 weeks to date since i had the surgery. My eyes are looking and feeling much better since the surgery that is. I do not feel burning anymore, the dryness has practically gone, all thats left with my eyes so far, is the rough feeling my eye has when i move my eyeball around, it doesn't hurt, just doesn't feel normal or smooth rotation. i also have the feeling of a small stone in my eye in the right eye because i have a raised ridgy bit of conjunctiva with blood underneath which makes it feel like that. but that will soon disappear and smooth out, which is what dr. tseng said. my eye have been getting smoother and is improving slowly everyday to a near enough state that they were in since i had this problem. the eye is returning to its normal whiteness, apart from a few very small veins/patches where it is red around where he attached the membrane, however he said when i go back on the 1st august he would sort that out.

overal i am very very happy with the results so far. but i dont want to celebrate until i know my eyes are to the best they can get, i am still on predisolone drops to reduce inflammation from after the surgery, and i am worried that when i stop them things might not look so good. ! but im sure they will be okay since the redundant conjunctiva has been removed and my conjunctiva no longer wrinkles up bilaterally!

hope everyone is doing well, continue researching & finding better doctors! there are very good doctors out there, you might just need to travel further than you would like!

all the best,

adam

[jcorbett]

Thank you for the update, Adam. If you can, please check back periodically to let us know of your progress.
I am happy for you. It is always nice to read a success story! I hope things continue to improve.

[Philipp_from_Germany]

Hi Adam

Congratulations on your sucessful AMT! I do hope you will continue to get benefits.

I just have a few question regarding your MGD:

Did any doctor that saw you before Tseng tell you that you have a "redundant conjunctiva"? And what about your meibomian glands. Have there been any signs of chronic inflammation? Did you notice that they were sort of clogged and have you indeed been diagnosed with an bad lipid layer?
Did you perform hot massages etc. in order to increase you TBUT?

How are your symptoms now in "dry eye hostile environments" like air conditioned shopping malls, smoky bars or on windy spots?

I am just asking this because I would like to find out if AMT or the newly developped AMT Contact lens might be a treatment option for a tear film with a bad lipid layer.

Thanx

Philipp

[adam-85]

Hi Philipp,

Did any doctor that saw you before Tseng tell you that you have a "redundant conjunctiva"? And what about your meibomian glands.

-> well yes and no. two doctors i had seem when i questioned them about the folds i had in my eyes, and they said that was normal. obviously not for me.
only one doctor told me i had MGD, but that was the most recent doctor other than dr. tseng, i noticed MGD then but not when the problem started. I think MGD was encouraged by the redundant conjunctiva.

Have there been any signs of chronic inflammation?

-> i dont like the word chronic, because it sounds really bad, but yes my eyes were inflamed everyday, not so much midday, but in the morning and towards the end of the day, especially if i had a long day at night. quite inflamed yes.

Did you notice that they were sort of clogged and have you indeed been diagnosed with an bad lipid layer?

-> I did notice my MGD were getting blocked about 14 months after i got bad eyes, but not before. I havnt been diagnosed with a bad lipid layer, dr. tseng said my lipid layer was fine after they did some screening for it.

Did you perform hot massages etc. in order to increase you TBUT?

-> yes i occassionally did, but the only time i was ever told to use warm compresses was when i got told i had blepharitis, which i didn't have. i did that for couple of months and it did nothing. I dont know anything about my TBUT, i was never told if it was bad or anything by anyone, not even dr. tseng, but then again i didn't ask him.

How are your symptoms now in "dry eye hostile environments" like air conditioned shopping malls, smoky bars or on windy spots?

-> 2 1/2 weeks after surgery, i found myself coping alot better in air conditioned shopping malls and in windy places, not perfect, but alot better, and it hardly affects me, i notice it affected me a tiny bit, but its so much better than i used to have to put up with, and i think as time goes on, i will be able to cope even better.



... i heard about the AMT Contact lens, it sounds pretty good. it wasn't for me though. hope those answers help you!

all the best,

-adam

[Joey]

Adam,

Hey there. Thanks for writing about your recovery. I have been reading some of your previous posts, and it seems that we have had some similar eye problems. I am 30 years old, and I have been looking for an answer (besides the usual "it's dry eyes") to my eye problems for about 6 years. Like you , I researched and came up with Dr. Tseng and Dr. Maskin, both in Florida. Since I live in Orlando, I went to see Dr. Maskin first. He diagnosed me with Conjunctivochalasis. I went to see Dr. Tseng about 6 months ago for a second opinion. He also diagnosed me with Conjunctivochalasis. I would really like to get the surgery, but the cost is so expensive without help from insurance companies. Plus, I just don't want to end up with worse eyes then I have now.

You mentioned that the surgery costed you around $17,000 for both eyes. Medical insurance didn't pay for any portion of that, right?

I have constant eye redness. I also get some slight burning and dryness. I have all 4 of my tear ducts plugged, so my eyes are pretty moist during the day. Do you have any punctal plugs? If so, did Dr. Tseng mention taking any of them out in the future?

Also, you mentioned that the dryness is completely gone, but you still have some redness. How would you compare the redness that you have now as to what you had before the surgery?

So if you were to look at your eyes, could you see the areas that were cut out and grafted? Has those areas smoothed out any?

Oh, I did not have LASIK surgery, which I know can sometimes lead to Conjunctivochalasis. I wore contacts for many years, which I think is the culprit of my eye problems. Did you have LASIK or wear contacts?

It sounds like you still have a bit of healing to go through. I hope the outcome is what you want, and I hope you are satisfied with the surgery. Sorry for so many questions, but is seems like you are the only one posting your results from the surgery.


Thanks for writing!

-Joey

[Philipp_from_Germany]

Hey Adam,

how are you hanging in there with your new ocular surface?

Thanx for a quick update...

[kdc66]

I'm assumming the surgery they are referring to is the amniotic membrane transplant surgery. I was only able to obtain the abstract but interesting study.

Clinical Impact of Conjunctivochalasis on the Ocular Surface.
Cornea. 24(8) Supplement 1:S24-S31, November 2005.
Norihiko Yokoi, MD, PhD; Aoi Komuro, MD, PhD; Masakazu Nishii, MD; Kayoko Inagaki, MD; Hidetoshi Tanioka, MS; Satoshi Kawasaki, MD, PhD; Shigeru Kinoshita, MD, PhD
Links: Abstract | HTML | PDF (399 K)

Abstract:
Purpose: To report the clinical impact of conjunctivochalasis on the ocular surface by evaluating the effect of a new concept of conjunctivochalasis operation on the resolution of patients' symptoms and corneal epithelial damage. Also, the association of inflammation with conjunctivochalasis is examined.

Patients and Methods: A total of 168 eyes of 131 conjunctivochalasis patients with (50 eyes) or without (118 eyes) dry eye who received the newly designed conjunctivochalasis operation were enrolled. All patients had prominent conjunctivochalasis at the lower tear meniscus and their ocular symptoms were not sufficiently controlled by the usual eyedrop therapy. Subjective symptoms of patients were assessed before and after the operation by questionnaires. Scores of corneal fluorescein staining were evaluated before and after the operation in patients with dry eye. Four samples of the lower part of conjunctiva from non-dry eye conjunctivochalasis patients were investigated by immunostaining and compared with samples from 4 normal conjunctiva and 3 conjunctiva showing inflammation due to Mooren ulcer, ocular cicatricial pemphigoid, and alkali burn.

Results: The most frequent chief subjective symptoms before the operation were irritation (51.7%) and lacrimation (31.4%) in conjunctivochalasis patients without dry eye and irritation (80.0%) in those with dry eye. Improvement of the chief symptoms was obtained in 88.2% and 78.0% of these 2 patient groups, respectively. Furthermore, in patients with dry eye, corneal fluorescein staining scores (mean +/- SD) were significantly improved after the operation compared with before the operation: A (area), 0.6 +/- 0.7 and D (density), 0.8 +/- 0.9 versus A, 1.3 +/- 0.5 and D, 1.9 +/- 0.9; P < 0.0001. Based on the immunostaining study, conjunctival samples from eyes with conjunctivochalasis and normal eyes showed negligible inflammation compared with those from inflamed conjunctiva.

Conclusions: This study suggests that conjunctivochalasis has a great clinical impact on the ocular surface, and the newly developed operation is very effective in resolving patient complaints and also ocular surface damage in conjunctivochalasis with dry eye. It may also be suggested that the conjunctivochalasis has a negligible association with conjunctival inflammation.

[Joey]

who elase has had this surgery? Can you please post your experience?

Thanks,
Joey

[Delilah]

Adam I just read about your surgery and I wanted to say God bless you and good luck and I hope that your doing well. I also wanted to know if this surgery cures severe dry eye and Filamentary Kerititis? Yes Im the girl with the stringy mucus in my eyes all the time. I've noticed that my outside layer gets wrinkly when its really dry and most of all when I do my warm compresses. There are not many good eye doctors here in Idaho where I live, I haven't had all those fancy tests either. I need to do so, anyway's I was wondering if that surgery would cure dry eye sufferes? Does it hurt? Do they put you to sleep for the surgery? Could you see when you woke up? Im still suffering badly from all my eye disorders, MGD, severe dry eye and now I found out that the strings are actually called Filamentary Kerititis, Im having a pharmacist compound me some NAC drops. Well I just had to say how happy I am for you and I hope this is a total cure for you Get back to me when you can. Ciao Delilah

[khasler]

It's been awhile since I've logged in last, but I went to my eye specialist Dr. Robert Mack last week and he recommended I see a specialist Dr. Scheffer Tseng located in Miami FL, who supposedly specializes in amniotic membrane transfers. I live in the Chicago area but am going on a business trip in February and figured I would meet with him for a consultation before considering this kind of surgery.
2 Questions - 1.has anyone had experience with Dr. Tseng in Miami before and 2. where can I get more information about this kind of surgery in terms of who is a good candidate for this, what the outcome should be and what are the successes with this procedure??

Any help would be appreciated!
Kim

[kitty]

It's been awhile since I've logged in last, but I went to my eye specialist Dr. Robert Mack last week and he recommended I see a specialist Dr. Scheffer Tseng located in Miami FL, who supposedly specializes in amniotic membrane transfers. I live in the Chicago area but am going on a business trip in February and figured I would meet with him for a consultation before considering this kind of surgery.
2 Questions - 1.has anyone had experience with Dr. Tseng in Miami before and 2. where can I get more information about this kind of surgery in terms of who is a good candidate for this, what the outcome should be and what are the successes with this procedure??

Any help would be appreciated!
Kim

Scroll up and see Joey's post. You can also search the site for Dr. Tseng. He has been mentioned several times.

[Rebecca Petris]

Hi Kim,

If you do a search on Tseng you'll see posts here about him. I think there are one or two in the "Plug a Doc" forum. He's well known to several patients on the board, I believe. - The Ocular Surface Center is one of only two sources of the tissue for this surgery. I believe the surgery is also by at least two other surgeons in Florida, incl. Dr. Guliani (sp?) and Dr. Maskin.

I'd check out insurance coverage before anything else. Depending who does it it can be very expensive and not all insurers cover it.

Depending when you're going to be in Florida, maybe you could drop in during our special weekend event Feb 17-19 we'd love to see you.

[khasler]

I would love to come to the event, but I was extending my stay too long as it was so I could get an appt with Dr. Tseng. Maybe the next one can be held in Chicago and we can all camp outside of Oprah's studio to plead for a focus on this condition that plagues all of us every minute of every day.
It's so nice to have a place to go to where people really understand what you are going through...

Anyway, this consultation is going to cost $400 (supposedly insurance will cover this) so I want to make good use of my time with him. Any ideas for the kind of questions I should be prepared with? I'm trying to make a list of the things I should ask about this procedure and the benefits/risks of going through with it. I'm hoping Adam can give me some more insight to his experience.

[Joey]

How did you appointment go with Dr. Tseng? If you have any questions about the surgery or conjuctivochalasis, I may be albe to help. I haven't had the surgery yet, but I am hopefully going to get it soon.

[Rebecca Petris]

Joey, just curious: Are you only considering surgery or have you looked into the nonsurgical application? The name escapes me at the moment but it's done with a contact lens-like prosthetic sort of device if I remember right. Seems less invasive and certainly less costly.

[lestacio18]

Hi everyone!

I'm new to the thread and came across it and found it to be very interesting. Especially after reading some of the posts and am hopeful that I'll be able to help.

I'm 18 and suffer from Stevens Johnson Syndrome, I got SJS when I was 14 in august of 2002. I just recently(last week) went to Miami,FL to see Dr. Scheffer Tseng. He is my miracle. I had the amniotic membrane transplant as well as a few other procedures done on my left eye. I had severe scarring in my left eye which attatched from my eye to my eye lid. Dr. Tseng removed all that, and also deepened my fornix. That's the area in your eyelid where if you pull up the eyelid you can see back into the area. Sorry, that wasnt a great explanation! But yes, I had the surgery and everything, according to Dr. Tseng went wonderful, even better than expected. My eye is still somewhat sore at the moment, and having to heal, but after it does I am sure I will be very pleased. I ahve 2 stictches in my left eye that i have to get removed by a local doctor tomorrow. I also had an abrasion on my left eye that just randomly developed from my existing scar tissue. I have to go back in one month for a check up. I highly reccomend Dr. Tseng to anyone, he took excellent care of me and did a great job. I believe the Amniotic membrane Trnsplnt. also keeps the eye from scarring back together, which was always my problem. I 'm hoping to return to him in the summer and maybe open up my tears in my right eye, because right now i have Dry eye synd. in my right eye, and he believes that since when i cry out of my left eye, and my right one gets swollen that the gland is still working! I was so excited when he told me that I could possibly have my tears back one day. WOW! No more eyedrops a million times a day!!! lol.

I was also wondering, does anyone else have eye problems because of Stevens Johnson Syndrome? I know Dr. tseng specializes with SJS patients. I believe he's worked with over 75 of them.

GOOD LUCK TO EVERYONE![/COLOR]

I will check back regularly, and feel free to email me with any comments or questions,

thanks!

Lindsay

[Joey]

Lindsay,

I ws just wondering how much the surgery cost you for the one eye. I have been to see Dr. Tseng, too. And I agree with you, he is a gret doctor.


Rebecca,

I have tried a Scaleral lens. Is that what you are thinking of? If so, unfortunately it didn't help.

Thanks all!

-Joey

[Rebecca Petris]

Rebecca,

I have tried a Scaleral lens. Is that what you are thinking of?

No, I am not talking about scleral lenses. I was referring to nonsurgical application of amniotic membrane with a device called (if I remember right) Pro-Kera.

[lestacio18]

Hi all

Joey, the surgery unfortunately cost arpprox. $8,000. I know, very expensive, but I also had multiple procedures done at one surgery. I had 4 done total and the amniotic membrane was just one of them, I'd imagine it'd be around the same cost though. Unfortunately it's not covered by insurance,but thankfully there have been many people doing fundraisers and things of those sorts to help with the paytment. My grandmother's church recently provided me with a check for 3,000 dollars . I'm sure that if the surgery is the last option for you , and you cant pay the price on your won, something will work out for you and things will come together

Good luck!!


Lindsay

[Rebecca Petris]

No, I am not talking about scleral lenses. I was referring to nonsurgical application of amniotic membrane with a device called (if I remember right) Pro-Kera.

Sorry, I should have posted a link for further info. Here it is:

http://www.biotissue.com/product_prokera.htm

[sazy123]

Hi how would you know if you had Conjunctivochalasis? are the signs quite visable if you looked closely? would it be spotted by most eye doctors- or not? is it quite rare, or do alot of people who have dry eye have it?

thanks

[kakinda]

No, I am not talking about scleral lenses. I was referring to nonsurgical application of amniotic membrane with a device called (if I remember right) Pro-Kera.

Prokera indeed... developed by Dr Tseng and Bio Tissue.
I'll try to post a brochure on it later on but I saw another similar device using AMT post in some other thread on this site.

take care
Kakinda

[Rebecca Petris]

Prokera indeed... developed by Dr Tseng and Bio Tissue.
I'll try to post a brochure on it later on but I saw another similar device using AMT post in some other thread on this site.

take care
Kakinda

Maybe the abstract in February AJO?

[kakinda]

Hi Rebecca... that must be it.

this new method using a a "removable AMT-filled contact lens", is quite interesting because it's certainly less invasive and permits a frequent control of the evolution of the ulcer underneath.

One should bear in mind that AMT is not transparent therefore one will lose some sight until the cornea absorbes it... hoping that in the end, when the device is removed, the scar won't trouble too much one's vision.

Hopefully, someday, they'll be able to extract the growth factors and nutriments from the AM tissue and give it to us in drops .... which seems to me like a more convenient procedure.

The good thing about dry eye treatments is that these can only get better!
take care,
kakinda

[np1981]

Is Adam still updating us on this procedure? I'd be interested to know how things turned out.

[SusieD]

Oh I see you did find it!

He hasnt been on here for a while - I assume he's doing well. He seemed really pleased with the outcome anyway.