Treatment of ligneous conjunctivitis with amniotic membrane transplantation and topical cyclosporine

Abstract

Ligneous conjunctivitis (LC) is a rare form of bilateral chronic recurrent disease in which thick membranes form on the palpebral conjunctiva and other mucosal sites. We report the clinical features and describe the management of two cases. Case 1 was an 8-month-old patient with bilateral membranous conjunctivitis. Case 2 was a 5-year-old patient with unilateral membranous conjunctivitis, esotropia, mechanical ptosis and complicated cataract, and had been treated with a number of medications. Histological investigation of the membrane in both cases showed LC. Treatments with amniotic membrane transplantation and institution of topical cyclosporine have shown good response. There has been complete resolution of the membranes with no recurrence at the end of 40- and 28-month follow-ups, respectively. No treatment related side effects were seen. Thus, it appears that amniotic membrane transplantation and topical cyclosporine are effective alternatives for the treatment of LC.

Amniotic membrane transplantation for ligneous conjunctivitis in a doberman

“…In 2004, Barabino et al first reported the use of amniotic membrane transplantation to reconstruct the conjunctival surfaces in a patient after excision of the ligneous pseudomembranes, with successful prevention of recurrence. There have since been 4 other successful reports of the use of AMT for conjunctival reconstruction after surgical treatment of cases of LC in humans . The amniotic membrane used is produced from the amnion, the innermost layer of the placenta.…”

“…Complete resolution of the LC was seen in all cases, with no recurrence in three of five patients. Small recurrences of softer pseudomembranes occurred in two patients that were treated with repeated surgeries after which they did not recur . At follow‐up examinations ranging from 28 to 40 months postsurgery, all the patients were pseudomembrane‐free .…”

“…Small recurrences of softer pseudomembranes occurred in two patients that were treated with repeated surgeries after which they did not recur . At follow‐up examinations ranging from 28 to 40 months postsurgery, all the patients were pseudomembrane‐free . Postoperative topical therapies to help prevent recurrence of membranes included topical heparin, dexamethasone, and 2% cyclosporine, but all were discontinued within 6 months of surgery …”

“…Medical therapy thus far has failed to produce repeatable satisfactory results in canines. To date, there are four reported cases in the literature describing the successful treatment of LC in humans with amniotic membrane transplantation . This case report describes the clinical features and management of a case of LC in a Doberman Pinscher successfully treated with amniotic membrane transplantation.…”

Ligneous conjunctivitis in a patient of juvenile colloid milia: A rare association

“…Management includes topical plasminogen concentrate,[ 3 ] topical fresh frozen plasma,[ 5 ] with systemic fresh frozen plasma,[ 6 7 ] topical heparin,[ 5 8 9 10 ] with topical corticosteroids or alpha chymotrypsin,[ 1 ] topical cyclosporine A with amniotic membrane,[ 10 ] systemic low-dose lys-plasminogen,[ 1 3 ] surgical excision of pseudomembrane, which has high recurrence rates.…”