Intraoperative mitomycin C and amniotic membrane transplantation for fornix reconstruction in severe cicatricial ocular surface diseases.
OBJECTIVE
To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis and fornix reconstruction in severe cicatricial ocular surface diseases.


METHODS
Noncomparative interventional case series.


METHODS
Sixteen patients (8 female, 8 male; 18 eyes) with a mean age of 41+/-23.4 years (range, 3-79) and suffering from severe chemical/thermal burns (7 eyes), multiple recurrent pterygia and pseudopterygia (5 eyes), Stevens-Johnson syndrome (4 eyes), and ocular cicatricial pemphigoid (2 eyes) were consecutively enrolled. All except for 2 eyes had had prior surgical attempts of surgical reconstruction, including 6 eyes with a mucous membrane graft (MMG), but still presented with symblepharon and persistent ocular surface inflammation.


METHODS
After excision of subconjunctival fibrovascular tissues, 0.04% mitomycin C was applied for 5 minutes in the deep fornix before amniotic membrane transplantation.


METHODS
Deeper fornix, noninflamed ocular surface, and full motility.


RESULTS
The mean epithelial healing time was 4.2+/-1.9 weeks. During the follow-up of 14.16+/-5.2 months, all eyes showed a marked reduction of conjunctival inflammation, a deep fornix, and a continuous tear meniscus. Of 12 eyes with motility restriction, 2 eyes with multiple recurrent pterygia and 1 eye with severe thermal burn showed recurrence of partial motility restriction 2 months after surgery. The vision of 9 eyes was successfully restored by an additional keratolimbal allograft with subsequent penetrating keratoplasty (6 eyes).


CONCLUSIONS
Intraoperative application of mitomycin C is an effective means to reduce chronic and deep-seated conjunctival inflammation, and helps amniotic membrane restore a deep fornix after symblepharon lysis, even in eyes that had a failed MMG. Restoration of deep fornix and tear meniscus is an important prerequisite to achieve successful reconstruction by subsequent limbal stem cell transplantation.
Tseng
Scheffer C G
SC
Ocular Surface Center, Miami, Florida 33173, USA. stseng@ocularsurface.com
Di Pascuale
Mario A
MA
Liu
Daniel Tzong-Shyue
DT
Gao
Ying Ying
YY
Baradaran-Rafii
Alireza
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000650:Amnion / Q000637:transplantation*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003229:Conjunctival Diseases / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005133:Eye Movements; D005141:Eyelid Diseases / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D013508:Ophthalmologic Surgical Procedures; D019651:Plastic Surgery Procedures; D014792:Visual Acuity; D014945:Wound Healing
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin