Amniotic membrane transplantation for reconstruction of the conjunctival fornices.
OBJECTIVE
To describe the clinical outcome of amniotic membrane transplantation (AMT) for fornix reconstruction in a variety of ocular surface disorders.


METHODS
Noncomparative interventional case series.


METHODS
Seventeen eyes in 15 patients with symblepharon. Four eyes had ocular-cicatricial pemphigoid, two eyes had symblepharon after pterygium excision, four eyes had chemical or mechanical trauma, two eyes had strabismus surgery, two eyes (one patient) had Stevens-Johnson syndrome, one eye had toxic epidermal necrolysis, and two eyes (one patient) had chronic allergic conjunctivitis.


METHODS
The subconjunctival scar tissue was dissected from the episclera, and the freed conjunctival flap was recessed to the fornix. A layer of amniotic membrane (AM) was applied to cover the exposed episclera. The fornical edge of the membrane was anchored with sutures passing through the full thickness of the lid.


METHODS
A deep conjunctival fornix, lack of motility restriction.


RESULTS
The mean follow-up period was 37 +/- 24 months (range, 9-84 months). Complete fornix reconstruction was demonstrated in 12 of 17 eyes (70.6%), whereas 2 eyes had a partial success, and 3 eyes (3 patients) had recurrence of symblepharon with restricted motility. In eyes that demonstrated partial success or failure, the underlying etiology was either an autoimmune disorder or a recurrent pterygium. The most successful outcome was observed in eyes with symblepharon associated with trauma.


CONCLUSIONS
AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders. Future modifications, including an epithelial cellular component on the AM (conjunctival autograft or ex vivo expanded epithelial stem cells) may improve the outcome of this surgical procedure.
Solomon
Abraham
A
Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA.
Espana
Edgar M
EM
Tseng
Scheffer C G
SC
D000328:Adult; D000368:Aged; D000650:Amnion / Q000637:transplantation*; D002675:Child, Preschool; D003228:Conjunctiva / Q000601:surgery*; D003229:Conjunctival Diseases / Q000601:surgery*; D005141:Eyelid Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*