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Clin Ophthalmol. 2018 Apr 9;12:677-681. doi: 10.2147/OPTH.S162203. eCollection 2018.

Treatment outcomes in the DRy Eye Amniotic Membrane (DREAM) study.

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Ophthalmic Consultants of Long Island, Lynbrook, NY, USA.
Ocular Surface Center and TissueTech, Inc., Miami, FL, USA.
Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA.
Hofstra University School of Medicine, Hempstead, NY, USA.
Research Institute of Ophthalmology, Cairo, Egypt.
Solinsky Eye Care, Kensington, CT, USA.
Bowden Eye & Associates, Jacksonville, FL, USA.
Florida Eye Specialists, Jacksonville, FL, USA.
Medical Center Ophthalmology Associates, San Antonio, TX, USA.
TX Eye Institute, Houston, TX, USA.
Pepose Vision Institute, Chesterfield, MO, USA.
Eye Surgeons of Indiana, Indianapolis, IN, USA.
Royo Eye Care, Marysville, CA, USA.
Gordon and Weiss Vision Institute, San Diego, CA, USA.



To evaluate the efficacy of cryopreserved amniotic membrane (CAM) in reducing signs and symptoms of dry eye disease (DED) in a large patient population.


A retrospective chart review at 10 clinical sites was done of patients with refractory DED who received CAM and completed at least 3 months of follow-up. Data collected were demographics; medical history including previous and current ocular treatment, diagnosis, clinical presentations, comorbidity, duration and frequency of treatment with CAM; and concomitant medications. The primary outcome was the change in dry eye workshop (DEWS) score after treatment.


A total of 97 eyes of 84 patients exhibited severe dry eye despite maximal medical treatments including topical artificial tears, cyclosporine-A, serum, antibiotics, and steroids. Patients manifested with superficial punctate keratitis (86%), filamentary keratitis (13%), exposure keratitis (19%), neurotrophic keratitis (2%), and corneal epithelial defect (7%). After CAM treatment for 5.4±2.8 days, 74 (88%) patients demonstrated an improved ocular surface along with a notable reduction of the severity as the overall DEWS score was significantly reduced from 3.25±0.5 at baseline to 1.44±0.6 at 1 week, 1.45±0.6 at 1 month, and 1.47±0.6 at 3 months (p<0.001). Ten eyes (10%) required repeated treatment to complete healing. Apart from discomfort during CAM placement, there were no adverse events.


Placement of CAM is promising to enhance the recovery of ocular surface health and reduce signs and symptoms in patients with moderate-to-severe DED.


DEWS; amniotic membrane; dry eye; ocular surface; severity

Conflict of interest statement

Disclosure Dr McDonald and Dr Nanda are consultants and members of the speaker bureau of Bio-Tissue Inc., that distributes PROKERA®. Dr Sheha and Mr Tighe are employees of TissueTech Inc. The authors report no other conflicts of interest in this work.

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