Amniotic membrane transplantation in children with symblepharon and massive pannus.
OBJECTIVE
To report our pediatric experience with amniotic membrane transplantation for ocular surface and forniceal reconstruction.


METHODS
Retrospective case review of children who underwent superficial keratectomy, symblepharon lysis, and forniceal reconstruction using amniotic membrane transplantation. The underlying diagnosis, visual acuity, level of discomfort at first and last visits, and surgical details were noted.


RESULTS
Four patients (5 eyes) were included. Two patients had epidermolysis bullosa (1 recessive dystrophic and 1 junctional), 1 had laryngo-onychocutaneous syndrome, and 1 had measles-related keratitis and was positive for human immunodeficiency virus. Their mean age when initially seen was 8.7 years (age range, 4-16 years), and mean follow-up was 18.25 months (range, 12-29 months). The mean visual acuity preoperatively was 1.1 logMAR (logarithm of the minimum angle of resolution) (range, 1-1.3), and postoperatively was 0.7 (range, 0.2-1.2). All patients experienced increased ocular comfort with anatomical restoration of corneal and conjunctival surfaces. Visual acuity improved in 3 eyes. Only the patient with laryngo-onychocutaneous syndrome had recurrence of granuloma, at 9 months after surgery.


CONCLUSIONS
Amniotic membrane transplantation with symblepharon lysis is effective for ocular surface reconstruction in the management of epidermolysis bullosa and other conditions that cause corneal scarring and symblepharon in children. In this small series, children with epidermolysis bullosa fared better and the effects of surgery lasted longer compared with patients with other causes of symblepharon and massive pannus.
Goyal
Raina
R
Department of Ophthalmology and VCB Theatres, Great Ormond Street Hospital for Children, and Visual Sciences Unit, Institute of Child Health, London, England.
Jones
Sophie M
SM
Espinosa
Marcela
M
Green
Vanessa
V
Nischal
Ken K
KK
D000293:Adolescent; D000650:Amnion / Q000637:transplantation*; D002648:Child; D002675:Child, Preschool; D003229:Conjunctival Diseases / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D005141:Eyelid Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013536:Suture Techniques; D014792:Visual Acuity