title: Sealing of the gap between the conjunctiva and tenon capsule to improve symblepharon surgery.
abstract: OBJECTIVE
  To report the surgical outcome of "sealing the gap" in treating symblepharon caused by various etiologies other than recurrent pterygium.
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  Sixteen eyes of 14 patients with pathogenic symblepharon were consecutively operated by conjunctival recession, sealing the gap between recessed conjunctiva and Tenon capsule with a running 9-0 nylon suture, and covering of the bare sclera with amniotic membrane. For severe symblepharon where there was conjunctival shortening, oral mucosa graft was added. Outcome measures include ocular surface inflammation, fornix reformation, and restoration of ocular motility.
  
  
  RESULTS
  The underlying causes of symblepharon included Stevens-Johnson syndrome (n = 6), chemical burn (n = 5), ocular cicatricial pemphigoid (n = 1), thermal burn (n = 1), following excision of conjunctival squamous cell carcinoma (n = 1), conjunctival scarring following exposed buckle (n = 1), and immune dysregulation (n = 1). Twelve eyes (75%) had an average of 1.6 ± 0.9 previous surgeries. Before surgery, ocular motility restriction was significantly correlated with the severity of symblepharon. During the follow-up period of 17.1 ± 13.6 months, 13 eyes (81.3%) achieved complete success, 2 eyes (12.5%) achieved partial success, and 1 eye with immune dysregulation had failure (6.3%). There was no correlation between the success rate and the severity of symblepharon. After surgery, the ocular motility and inflammation were significantly improved. Visual acuity had improved in 2 of 15 eyes.
  
  
  CONCLUSIONS
  Sealing the gap between the conjunctiva and Tenon capsule is an important step in the surgical management of pathogenic symblepharon. This method not only avoids the use of mitomycin C, but also creates a strong barrier to prevent recurrence, restore ocular surface integrity, reform a deep fornix, and regain full ocular motility.
authors.affiliation: Department of Ophthalmology, Yan' An Hospital of Kunming City, Kunming, Yunnan, China; Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, Florida.
authors.forename: Dandan
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, Florida.
authors.forename: Han Y
authors.initials: HY
authors.lastname: Yin
authors.affiliation: Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, Florida.
authors.forename: Anny
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, Florida; Department of Ophthalmology, Shenzhen Children's Hospital, Shenzhen, Guangzhou, China.
authors.forename: Rendian
authors.initials: R
authors.lastname: Chen
authors.affiliation: Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, Florida.
authors.forename: Hosam
authors.initials: H
authors.lastname: Sheha
authors.affiliation: Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, Florida. Electronic address: stseng@ocularsurface.com.
authors.forename: Scheffer C G
authors.initials: SC
authors.lastname: Tseng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D002675:Child, Preschool; D003229:Conjunctival Diseases / Q000503:physiopathology / Q000601:surgery*; D005133:Eye Movements / Q000502:physiology; D005141:Eyelid Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013536:Suture Techniques; D058475:Tenon Capsule / Q000601:surgery*; D000267:Tissue Adhesions; D055815:Young Adult