Original articleIntraoperative Mitomycin C and Amniotic Membrane Transplantation for Fornix Reconstruction in Severe Cicatricial Ocular Surface Diseases
Section snippets
Patients and Methods
This study was approved by the institutional review board of Baptist Hospital of Miami/South Miami Hospital, Inc. Informed consent was obtained in a total of 16 patients (18 eyes) seen at the Ocular Surface Center during the period of 2002 to 2004. Except for 2 patients, all others had had prior surgical attempts to reconstruct the fornix but still presented with conjunctival inflammation despite maximal medical therapies. They all manifested cicatricial complications that had caused an
Results
As shown in online-only Table 1 (available at http://www.ophsource.org/periodicals/ophtha), there were 8 females and 8 males, with a mean age of 41±23.4 years (range, 3–79). Their diagnoses included severe chemical/thermal burns (7 eyes), multiple recurrent pterygia (5 eyes), SJS with toxic epidermal necrolysis (4 eyes), and OCP (2 eyes). Before surgery, all eyes presented with persistent conjunctival inflammation grade 3 and severe symblepharon leading to partial or total obliteration of the
Discussion
In this study, we report that intraoperative application of MMC with AMT achieves successful fornix reconstruction in a total of 18 eyes with severe cicatricial diseases manifesting symblepharon and fornix obliteration. Among them, 12 eyes also had motility restriction. The severity of cicatricial process could be judged by the nature of these diseases being SJS/toxic epidermal necrolysis, chemical burns, and OCP, which, as shown in our previous report, tend to result in partial success or
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Long-term outcomes of fornix reconstruction and cicatricial entropion repair in ocular mucous membrane pemphigoid and drug-related secondary pemphigoid
2023, Canadian Journal of OphthalmologyChallenges in the management of bilateral eyelid closure in Stevens-Johnson Syndrome
2022, American Journal of Ophthalmology Case ReportsCitation Excerpt :Amniotic membrane is widely used as the substitute tissue in symblepharon surgery,30–32 as amnion acts as a substrate to help epithelialization, reduce scarring, suppress immunological responses, and decrease inflammation.33,34 The application of MMC inhibits fibroblast proliferation and controls inflammatory activity, thus helping to prevent re-adhesion.32,35 In cases of end-stage total LSCD, the ‘one-step method’ of symblepharon surgery combined with ocular surface reconstruction is one treatment option.
Long-term follow up of oral mucosa autograft sutured to the sclera in severe symblepharon
2021, American Journal of Ophthalmology Case ReportsOcular surface repair using decellularized porcine conjunctiva
2020, Acta BiomaterialiaCurrent and Upcoming Therapies for Ocular Surface Chemical Injuries
2017, Ocular SurfaceCitation Excerpt :However, no differences in long-term benefits were detected in these studies and a systematic review of the literature found insufficient evidence for the use of AMT in the setting of acute ocular burns.65 Nonetheless, AMT is most often employed as an adjunct to medical therapy in patients with severe ocular injuries.12,56,66-73 More recently, AMT has been applied to the cornea using a carrier with the amniotic membrane secured to a flexible plastic ring (ProKera, Bio-Tissue, Inc., Miami, FL).
Manuscript no. 240602.
Supported in part by an unrestricted grant from Ocular Surface Research and Education Foundation, Miami, Florida.
Dr Tseng and his family are >5% shareholders of TissueTech, Inc., which owns United States patents nos. 6 152 142 and 6 326 019 on the method of preparation and clinical uses of human amniotic membrane, which is currently distributed by Bio-Tissue, Inc.