[Diseases of the adnexa in the tropics: amnion membrane transplantation for noninfectious trachoma-associated corneal ulcers].
BACKGROUND
Corneal ulcers with fornix shortening associated with late stages of cicatrizing trachoma contribute significantly to blindness in many developing countries. We report on the outcome of ocular surface and fornix reconstruction using amnion membrane transplantation.


METHODS
From 2001 to 2005, cryopreserved human amnion membrane without mitomycin C was grafted to 25 eyes of 17 patients with trophic corneal ulcers and symblepharon (cicatrizing trachoma: 19 eyes of 14 patients, Stevens-Johnson syndrome: 4 eyes of 2 patients, alkali burns: 2 eyes of 1 patient) in a controlled case series. Follow-up was done up to 6 months.


METHODS
Fischer's exact probability test.


RESULTS
Of 25 eyes, 9 of 19 eyes with trachoma, 3 of 4 eyes with Stevens-Johnson syndrome, and 2 of 2 eyes with chemical burns showed complete reepithelialization and stromal recovery after 28-35 days (mean: 31+/-2.3 days). The primary success rate of trachoma eyes was not significantly different from the other indications (p=0.256). At 6 months post-op, 15 of 19 trachoma eyes (79%) compared to 2 of 6 non-trachoma eyes (33.3%) had developed a recurrence of symblephara (p=0.0592), and 13 of 15 eyes (86.6%) with a cicatricial trachoma compared to 1 of 6 with non-trachoma diagnosis experienced a recurrence of corneal vascularization (difference nonsignificant: p=0.1752). Persistent long-term reepithelialization was observed only in 1 of 19 trachoma eyes (5.3%) versus 4 of 6 non-trachoma eyes (66.7%, p=0.005); 3 of 19 trachoma eyes with a recurrence of ulcers had perforated after 6 months.


CONCLUSIONS
Human amnion membrane without mitomycin C can be used for ocular surface reconstruction in selected patients with cicatrizing trachoma. Its efficacy in the long-term rehabilitation of cicatrizing trachoma seems to be limited due to the progressive scarring.
Bialasiewicz
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Department of Ophthalmology and School of Ophthalmic Technicians, College of Medicine and Health Sciences of the Sultan Qaboos University, 123 Al Khod, Muscat, Oman. alexander@squ.edu.om
Shenoy
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R
Al-Muniri
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Thakral
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A
D000328:Adult; D000650:Amnion / Q000637:transplantation*; D002057:Burns, Chemical / Q000601:surgery*; D002921:Cicatrix / Q000601:surgery; D016510:Corneal Neovascularization / Q000601:surgery; D003318:Corneal Opacity / Q000601:surgery*; D003320:Corneal Ulcer / Q000601:surgery*; D005126:Eye Burns / Q000139:chemically induced* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012008:Recurrence; D013262:Stevens-Johnson Syndrome / Q000601:surgery*; D014141:Trachoma / Q000601:surgery*; D014329:Tropical Climate; D014792:Visual Acuity; D014945:Wound Healing