title: Fresh frozen amniotic membrane for conjunctival reconstruction after excision of neoplastic and presumed neoplastic conjunctival lesions.
abstract: PurposeSuspicious neoplastic conjunctival lesions often require wide excision with tumour-free margins, leaving significant conjunctival defects requiring reconstruction. In this study we report the results of using fresh frozen amniotic membrane grafts (AMG) after wide excision of potentially malignant lesions.MethodsRetrospective review of 53 patients; between January 2011 and April 2014. Conjunctival lesions were excised with a non-touch technique (2 mm margin) and sent for histopathological analysis. The surgical margins were treated with cryotherapy and a fresh frozen AMG was used to cover the defect. The main features examined were for any signs of recurrence, the conjunctivalisation of the AMG, complications and cosmetic appearance.ResultsFifty-three patients; 35 males and 18 females. Mean age was 54.9 (range 19-88). The mean follow up to January 2015 for all lesions was 21.4 months (range 8-48 months). The most common lesions were invasive malignant melanoma. There were no local surgical complications in 77.3% of patients; minimal scarring (11.3%), symblepharon (11.3%), and granuloma (7.5%). Five patients with conjunctival melanoma developed in-transit metastasis and orbital extension, none of it was at the site of the AMG.ConclusionOur case series is the largest reported to date, with the largest number of melanomas. The use of fresh frozen AMG has improved the local surgical outcomes by improving healing and reducing scarring as well as allowing for a wider surgical margin.
authors.affiliation: Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.
authors.forename: U
authors.initials: U
authors.lastname: Agraval
authors.affiliation: Ocular Oncology Centre, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: P
authors.initials: P
authors.lastname: Rundle
authors.affiliation: Ocular Oncology Centre, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: I G
authors.initials: IG
authors.lastname: Rennie
authors.affiliation: Ocular Oncology Centre, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: S
authors.initials: S
authors.lastname: Salvi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D001706:Biopsy; D003228:Conjunctiva / Q000000981:diagnostic imaging / Q000601:surgery*; D003230:Conjunctival Neoplasms / Q000473:pathology / Q000601:surgery*; D015925:Cryopreservation / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult