Elsevier

Ophthalmology

Volume 112, Issue 5, May 2005, Pages 896-903, 903.e1
Ophthalmology

Original article
Intraoperative Mitomycin C and Amniotic Membrane Transplantation for Fornix Reconstruction in Severe Cicatricial Ocular Surface Diseases

Presented in part at: Association for Research in Vision and Ophthalmology Annual Meeting, April, 2004; Ft. Lauderdale, Florida. Received Award of Best Video at: American Academy of Ophthalmology Annual Meeting, October, 2004; New Orleans, Louisiana.
https://doi.org/10.1016/j.ophtha.2004.11.041Get rights and content

Purpose

To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis and fornix reconstruction in severe cicatricial ocular surface diseases.

Design

Noncomparative interventional case series.

Participants

Sixteen patients (8 female, 8 male; 18 eyes) with a mean age of 41±23.4 years (range, 3–79) and suffering from severe chemical/thermal burns (7 eyes), multiple recurrent pterygia and pseudopterygia (5 eyes), Stevens-Johnson syndrome (4 eyes), and ocular cicatricial pemphigoid (2 eyes) were consecutively enrolled. All except for 2 eyes had had prior surgical attempts of surgical reconstruction, including 6 eyes with a mucous membrane graft (MMG), but still presented with symblepharon and persistent ocular surface inflammation.

Intervention

After excision of subconjunctival fibrovascular tissues, 0.04% mitomycin C was applied for 5 minutes in the deep fornix before amniotic membrane transplantation.

Main Outcome Measures

Deeper fornix, noninflamed ocular surface, and full motility.

Results

The mean epithelial healing time was 4.2±1.9 weeks. During the follow-up of 14.16±5.2 months, all eyes showed a marked reduction of conjunctival inflammation, a deep fornix, and a continuous tear meniscus. Of 12 eyes with motility restriction, 2 eyes with multiple recurrent pterygia and 1 eye with severe thermal burn showed recurrence of partial motility restriction 2 months after surgery. The vision of 9 eyes was successfully restored by an additional keratolimbal allograft with subsequent penetrating keratoplasty (6 eyes).

Conclusion

Intraoperative application of mitomycin C is an effective means to reduce chronic and deep-seated conjunctival inflammation, and helps amniotic membrane restore a deep fornix after symblepharon lysis, even in eyes that had a failed MMG. Restoration of deep fornix and tear meniscus is an important prerequisite to achieve successful reconstruction by subsequent limbal stem cell transplantation.

This article contains additional online-only material available at http://www.ophsource.org/periodicals/ophtha.

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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    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.

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