AAO 2025: Effect of cryopreserved amniotic membrane after corneal cross-linking in patients with keratoconus

Reena Gupta, MD, a cornea, cataract, and refractive surgeon at Omni Eye Services, discusses the findings and implications of a retrospective study regarding the use of cryopreserved amniotic membrane for patients undergoing corneal cross-linking (CXL), comparing it to the traditional method of using a bandage contact lens post-procedure. The current standard of care after CXL, which involves ultraviolet A (UVA) irradiation of the corneal stroma and removal of the epithelium, typically includes the placement of a bandage contact lens. However, this approach is associated with pain, discomfort, and an increased risk of infectious keratitis—reportedly in the range of 1-3%—due to the lens acting as both a barrier and a potential harbor for bacteria, especially when the stroma is already compromised by the UVA treatment.

Gupta explains that the retrospective study explored whether utilizing a cryopreserved amniotic membrane might mitigate these risks while providing better clinical outcomes. While the amniotic membrane product used, is less comfortable due to its rigid ring, the group treated with it demonstrated a 0% risk of infection, faster wound healing, and a quicker return to baseline vision compared to those who received only a bandage contact lens. Although the improvement in visual acuity was not statistically significant, the trend favored the amniotic membrane.

Importantly, Gupta suggests that the greatest potential benefit is for younger patients with early-stage keratoconus, who have good visual acuity and for whom infection and early corneal transplant are significant concerns. In advanced keratoconus cases, bandage lens fitting is often suboptimal due to corneal distortion, while the amniotic membrane offers improved support. The meeting concludes with recommended action items, including publishing the study results, further exploring amniotic membrane use in early keratoconus, and assessing feasibility in advanced cases, all assigned to Gupta.