Ocular Surface Pain Management

Finger’s Amniotic Membrane Buffer Technique: Protecting the Cornea During Radiation Plaque Therapy

Patients receiving radioactive plaque therapy to treat iris, iridociliary and ciliary body malignant neoplasms frequently have severe pain associated with the plaque’s placement over the cornea. Cryopreserved amniotic membrane has been used as a barrier between the cornea and the radioactive plaque to successfully reduce patient pain using the following method

Surgical Technique

Before the epibulbar radiation eye plaque is inserted, a 360 degree peritomy is created at the corneal scleral limbus.
The conjunctival tissue is loosened around the cornea and a pocket is created for the radiation plaque.
The area of the melanoma and free margin was marked and the epibulbar radiation eye plaque is inserted in the area under the previously loosened conjunctiva.
5/O Vicryl sutures are used to secure three sides of the plaque to the sclera.
The cryopreserved amniotic membrane (AMNIOGRAFT, 1.0 x 1.5 cm)is removed from the carrier paper and placed stromal side up on the cornea.
Using .12 forceps, the surgical tech holds up the radiation plaque while the surgeon pulls the membrane underneath the plaque to cover the cornea.
The conjunctiva is then pulled over the plaque and closed using continuous 6/O Vicryl sutures.
A subconjunctival Garamycin-Decadrone injection is administered and the eye is closed.

Videos

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Finger’s AM Buffer Technique: Protecting the Cornea During Radiation Plaque Therapy Video

Technique detailed in: Finger, PT. Finger’s Amniotic Membrane Buffer Technique: Protecting the Cornea During Radiation Plaque Therapy. Archives of Ophthalmology. 2008;126, 4:531-4