title: Long-Term Follow-Up of Amniotic Membrane Graft for the Treatment of Symblepharon in a Patient With Recessive Dystrophic Epidermolysis Bullosa.
abstract: OBJECTIVE
  To report a case of symblepharon due to epidermolysis bullosa (EB), surgical treatment, and follow-up to 14 years.
  
  
  METHODS
  A 17-year-old white female with recessive dystrophic EB presented with decreased vision due to extensive symblepharon OU. There was opacification and neovascularization of the cornea OU with limited motility.
  
  
  RESULTS
  The symblepharon was surgically lysed, anterior lamellar keratectomy performed, and amniotic membrane graft transplanted to the cornea and palpebral conjunctiva, first in the OS and subsequently in the OD. Visual acuity improved from counting fingers to 20/40 in the OS and from 20/200 to 20/70 in the OD at 2 months and 6 weeks postoperatively, respectively, with minimal symblepharon, mild corneal scarring, neovascularization, and haze of OU. She recovered full ductions, but noted diplopia and had a 35 prism diopter exotropia. Symblepharon resolved after 6 months, and alignment improved to 4 prism diopter exophoria. At 14 years follow-up, visual acuity was 20/20 in the OD and 20/30 in the OS, with clear cornea, maintained on fluorometholone 0.1% one drop OU at bedtime.
  
  
  CONCLUSIONS
  Surgical symblepharolysis, superficial lamellar keratectomy, and amniotic membrane graft transplantation were effective for our patient with recessive dystrophic EB. Her postoperative exotropia resolved over time with monitoring and convergence exercises.
authors.affiliation: *USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA; †University of Massachusetts Medical School, Worcester, MA; ‡Children's Eye Institute, Upland, CA; and §The Vision Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Koulisis
authors.forename: Stavros N
authors.initials: SN
authors.lastname: Moysidis
authors.forename: Lance M
authors.initials: LM
authors.lastname: Siegel
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Song
mesh_terms: D000293:Adolescent; D000650:Amnion / Q000637:transplantation*; D003229:Conjunctival Diseases / Q000503:physiopathology / Q000601:surgery*; D016108:Epidermolysis Bullosa Dystrophica / Q000503:physiopathology / Q000601:surgery*; D005141:Eyelid Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D014792:Visual Acuity / Q000502:physiology