Fornix reconstruction with amniotic membrane transplantation: A cosmetic remedy for blind patients

Abstract

Purpose:Fornix contracture is an obstacle for fitting a prosthesis in blind or enucleated patients, and may lead to disfigurement and psychological issues. This study evaluates the efficacy of amniotic membrane transplantation (AMT) for fornix reconstruction with the aim of better retention of the ocular prosthesis.Methods:This non-comparative interventional case series includes eighteen blind eyes with fornix deformity in which a cosmetic prosthesis could not be retained. Various causative factors included symblepharon, cyst formation and fornix shortening after enucleation. AMT was performed along with correction of symblepharon, cicatrix release, and excision of the cyst with or without anchoring sutures to reform the fornix.Results:Mean fornix depth pre- and post-operation were 3.72 ± 0.69 and 7.13 ± 0.81 mm, respectively. Fornix deepening was achieved successfully in 15 cases (83.33%). Partial success was achieved in 1 case (5.66%); the remaining two cases (11.11%) were considered as failure despite repeat surgery. Both of these patients suffered from extensive symblepharon formation. Satisfactory results, i.e. formation of a deep fornix to hold the ocular prosthesis, could be achieved in 16 (89.99%) cases. There were no serious complications such as infection or graft rejection.Conclusion:AMT can be a viable option for fornix reconstruction. It has a high success rate in subjects with blind eyes and moderate fornix shortening who are unable to retain an ocular prosthesis.

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

“…As mentioned briefly above, AMT has been suggested as a potential alternative to mucosal membrane transplantation in lid revision, orbital linings or symblepharolysis. Reports exist describing forniceal reconstruction utilising AM, 130 , 132 with other authors stating that AM can be a viable alternative to established mucous membrane grafting, causing less patient morbidity, faster recovery times and better prosthesis fitting in anophthalmic-contracted sockets. 132 , 134 It can also be particularly useful if a patient has an insufficient amount of mucosal membrane available, producing effective results when combined with antimetabolites such as MMC.…”

Modified Treatment of Shallow Fornix for Better Retention of Ocular Prosthesis

“…No expensive consumables were required for this procedure and required less surgical time along with absence of an additional donor site since silicone tubes are widely available. This modified technique had a 96% success rate with minimal risk of complication; whereas other studies reported a 93.3% success rate with fascia lata strips 10 , 83.33% success rate with amniotic membrane grafts 8 and 77.3% with oral mucosal grafts 9 . Since, the silicone bolsters are placed within the fornix, they are cosmetically acceptable for the patient as well.…”

“…15 Amniotic membrane grafts are another way of reconstructing the inferior fornix in order to retain the ocular prosthesis but due to restricted accessibility and longer surgery time makes it unfeasible. 8,16 Fascia lata strips have also been used to deepen the shallow inferior fornix in anophthalmic sockets but necessitates a donor site and has risk of complications. 10 The eventual aim of management is to allow the ocular prosthesis to stay in place and resemble the fellow eye as much as possible as an improper fitting prosthesis can be psychologically disturbing for an individual.…”

“…7 Such an adequate forniceal depth can be attained by an increment of the surface area with the utilization of grafts such as amniotic membrane, buccal mucosa, conjunctival or tarsal grafts whereas shallow fornix in an anophthalmic socket can be made deep with the help of separation of bands followed by placing deepening sutures or fascia lata strips within the fornices. [8][9][10] This present study shares a modified surgical technique for deepening the shallow inferior fornix with a better retention of the ocular prosthesis in anophthalmic contracted sockets.…”

Clinical Results of the Use of Amniotic Membrane Transplantation Alone or in Combination with Adjuvant Therapies in Conjunctival Fornix Reconstruction

“…Fornix obliteration associated with different etiologies may affect ocular surface health through a number of pathogenic mechanisms: reduction of the tear reservoir, interruption of tear flow and spread, blink-related microtrauma resulting from an irregular tarsal surface, cicatricial entropion and trichiasis, limitation of Bell’s phenomenon, inflammation in the conjunctival epithelium, restriction of ocular motility, strabismus and visual loss related to ptosis, and inadequate socket for prosthesis wear. 4 , 5 …”