Amniotic membrane transplantation in entropion surgery.
OBJECTIVE
To evaluate the role of amniotic membrane transplantation in the management of cicatricial eyelid entropion.


METHODS
Prospective, noncomparative interventional case series.


METHODS
Eighteen consecutive patients with cicatricial entropion.


METHODS
A gray line lid split procedure with vertical anterior lamella repositioning was performed on 25 eyelids (upper or lower) of 18 patients with moderate to severe cicatricial entropion. Preserved human amniotic membrane (AM) was used to cover the bare tarsus up to the lid margin and secured with running 7-0 Vicryl. Impression cytology of the AM was performed at various stages postoperatively to study the epithelialization process.


METHODS
(1) Reepithelialization of bare tarsus, (2) extent of tarsal shrinkage, (3) recurrence of entropion.


RESULTS
All the AM grafts took well. The most common complication was hemorrhage below the graft, which occurred in six cases. Complete success with no lashes touching the globe was achieved in 22 of 25 (88%) lids after a minimum follow-up of 12.0 months. The mean follow-up was 17.8 months. Two cases (qualified success) had recurrent trichiasis treated successfully with electrolysis. One case with severe trachomatous upper lid entropion recurred 14 months after surgery. The AM accelerated the epithelialization of bare tarsus; this was demonstrated by lack of fluorescein staining and reversion to skin color within 2 to 3 weeks. However, AM could not prevent tarsal shrinkage. Impression cytology demonstrated that features of conjunctival epithelium were present for the first postoperative month, but this was gradually replaced by squamous metaplasia, with keratinization appearing as early as 3 weeks postoperatively.


CONCLUSIONS
The use of AM in a lid split procedure for correction of cicatricial entropion helps the bare tarsus epithelialize rapidly and improves the initial cosmetic result of surgery.
Ti
S E
SE
Singapore National Eye Centre, Singapore.
Tow
S L
SL
Chee
S P
SP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D019882:Blepharoplasty / Q000379:methods; D002921:Cicatrix / Q000601:surgery; D004774:Entropion / Q000601:surgery*; D004847:Epithelial Cells / Q000166:cytology; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome