Evaluation of the outcome of amniotic membrane transplantation for ocular surface reconstruction in symblepharon

Abstract

Aims Symblepharon is a condition that can inflict serious morbidity on the affected patients. Our aim was to evaluate the efficacy of amniotic membrane transplantation in the surgical treatment of symblepharon by determining the rate of epithelization of the graft, the incidence of complications, and the rate of recurrence of cicatrization. Methods In all, 20 eyes of 18 patients with symblepharon due to various causes and with varied indications for surgery underwent symblepharon excision and amniotic membrane transplantation (AMT). Results We observed recurrence of symblepharon in eight out of the 20 eyes operated upon, but in two of these the cicatrization was focal in nature and did not afford any functional impairment to the patients. Four out of the six eyes that failed had preoperative severe dry eye, and four had undergone previous conjunctival surgery. Conclusions AMT appears to be a safe and effective procedure for the surgical treatment of symblepharon. We observed a 100% rate of epithelization of the graft with no significant postoperative complications and a 30% rate of cicatrization. Pre-existing dry eye and previous conjunctival surgery influence the success of the surgery and these eyes may need medical or surgical supplementation along with AMT to limit the amount of subconjunctival fibrosis for better surgical results.

Implante de membrana amniótica en la corrección de úlceras corneales profundas de caninos y felinos

“…En estos casos se pretende conseguir una reducción en la inflamación y un aumento en la epitelización debajo de la membrana (29). Brevemente, restos necróticos de la base y la pared de las úlceras se eliminan con un hisopo estéril.…”

“…Alrededor de la úlcera también fue despojada de 1-2 mm epitelio para exponer la membrana de Bowman, que proporciona una base firme para la fijación de la membrana amniótica (45). Por lo tanto, cuando quitamos las suturas de fijación, la membrana se separa por completo sin ningún tipo de restos de implante que permanece en la superficie ocular (29,46).…”

“…Recientemente se han descritos hallazgos histológicos después de injerto de membrana amniótica en la cór-nea humana (29). En estos se observa que el fragmento de membrana amniótica intraestromal no causa una reacción inflamatoria o rechazo en córneas avasculares y que la reabsorción de estos pacientes es lenta.…”

Sealing of the Gap between the Conjunctiva and Tenon Capsule to Improve Symblepharon Surgery

“…Outcome measures include ocular surface inflammation, fornix reformation, and restoration of ocular motility. RESULTS: The underlying causes of symblepharon included Stevens-Johnson syndrome (n [ 6), chemical burn (n [ 5), ocular cicatricial pemphigoid (n [ 1), thermal burn (n [ 1), following excision of conjunctival squamous cell carcinoma (n [ 1), conjunctival scarring following exposed buckle (n [ 1), and immune dysregulation (n [ 1). Twelve eyes (75%) had an average of 1.6 ± 0.9 previous surgeries.…”

“…A variety of surgical approaches have been reported for the treatment of symblepharon. Tissue substitutes such as conjunctiva, 1,2 oral mucosa graft, [3][4][5] or amniotic membrane [6][7][8][9][10] were used for ocular surface reconstruction after symblepharon lysis. Anchoring sutures were also useful to secure the released conjunctiva deep into the fornix.…”