TY - JOUR
T1 - Surgical Strategies for Fornix Reconstruction Based on Symblepharon Severity
AU - Kheirkhah, Ahmad
AU - Blanco, Gabriela
AU - Casas, Victoria
AU - Hayashida, Yasutaka
AU - Raju, Vadrevu K.
AU - Tseng, Scheffer C.G.
N1 - Funding Information:
This study was supported by a fellowship from Eye Foundation of America, Morgan town, West Virginia (Dr Kheirkhah) and by the Ocular Surface Research and Education Foundation, Miami, Florida. Dr Tseng and his family are more than 5% shareholders of TissueTech Inc, which owns U.S. patents 6,152,142 and 6,326,019 on the method of preparation and clinical uses of human amniotic membrane distributed by Bio-Tissue Inc. Involved design of study (A.K., S.C.G.T.); data collection (A.K., G.B., V.C., Y.H.); analysis and interpretation of the data (A.K., S.C.G.T.); preparation of manuscript (A.K.); and review and approval of the manuscript (V.K.R., S.C.G.T.). This study was approved by Institutional Review Board of Baptist Hospital of Miami/South Miami Hospital Inc, Miami, Florida.
PY - 2008/8
Y1 - 2008/8
N2 - Purpose: To identify surgical strategies of fornix reconstruction for symblepharon graded according to the length from the limbus to the lid margin, to the width, and to associated inflammation. Design: Retrospective, comparative, interventional case series. Methods: In 61 eyes with symblepharon, cicatrix lysis and amniotic membrane transplantation (AMT) were performed with sutures (n = 34) or fibrin glue (n = 27) together with (n = 47) or without (n = 14) intraoperative mitomycin C (MMC), plus fornix reconstruction using anchoring sutures without (n = 30) or with (n = 7) oral mucosal graft or with conjunctival autograft (n = 4). Overall, success was defined as an outcome of complete success (restoration of an anatomically deep fornix) or partial success (focal recurrence of scar), and failure was defined as the return of symblepharon. Results: For a follow-up of 25 ± 10.8 months, the overall success was achieved by the first attempt in 52 eyes (85.2%) and failure resulted in nine eyes (14.8%); however, the success rate improved to 59 eyes (96.7%) with additional attempts. At the first attempt, AMT alone achieved overall successes in 92.8% of grade I eyes and in 100% of grade II eyes. Additional anchoring sutures achieved successes in 100% of grade I eyes, 70% of grade II eyes, and 71.4% of grade III/IV eyes. Additional oral mucosa or conjunctival autograft achieved successes in 100% of grade III/IV eyes. The complete success was correlated positively with lower grades of symblepharon or intraoperative use of MMC, but negatively correlated with younger ages, canthal involvement, or use of anchoring sutures. Anatomic improvement was accompanied by reduction of preoperative conjunctival inflammation (n = 40), improved visual acuity (n = 14), improved ocular motility (n = 18), improved eyelid closure (n = 3), and feasibility of contact lens wear (n = 10). Conclusions: Successful outcome can be achieved by selectively deploying cicatrix lysis and AMT, intraoperative MMC, anchoring sutures, and oral mucosal or conjunctival autograft based on the severity of pathogenic symblepharon.
AB - Purpose: To identify surgical strategies of fornix reconstruction for symblepharon graded according to the length from the limbus to the lid margin, to the width, and to associated inflammation. Design: Retrospective, comparative, interventional case series. Methods: In 61 eyes with symblepharon, cicatrix lysis and amniotic membrane transplantation (AMT) were performed with sutures (n = 34) or fibrin glue (n = 27) together with (n = 47) or without (n = 14) intraoperative mitomycin C (MMC), plus fornix reconstruction using anchoring sutures without (n = 30) or with (n = 7) oral mucosal graft or with conjunctival autograft (n = 4). Overall, success was defined as an outcome of complete success (restoration of an anatomically deep fornix) or partial success (focal recurrence of scar), and failure was defined as the return of symblepharon. Results: For a follow-up of 25 ± 10.8 months, the overall success was achieved by the first attempt in 52 eyes (85.2%) and failure resulted in nine eyes (14.8%); however, the success rate improved to 59 eyes (96.7%) with additional attempts. At the first attempt, AMT alone achieved overall successes in 92.8% of grade I eyes and in 100% of grade II eyes. Additional anchoring sutures achieved successes in 100% of grade I eyes, 70% of grade II eyes, and 71.4% of grade III/IV eyes. Additional oral mucosa or conjunctival autograft achieved successes in 100% of grade III/IV eyes. The complete success was correlated positively with lower grades of symblepharon or intraoperative use of MMC, but negatively correlated with younger ages, canthal involvement, or use of anchoring sutures. Anatomic improvement was accompanied by reduction of preoperative conjunctival inflammation (n = 40), improved visual acuity (n = 14), improved ocular motility (n = 18), improved eyelid closure (n = 3), and feasibility of contact lens wear (n = 10). Conclusions: Successful outcome can be achieved by selectively deploying cicatrix lysis and AMT, intraoperative MMC, anchoring sutures, and oral mucosal or conjunctival autograft based on the severity of pathogenic symblepharon.
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U2 - 10.1016/j.ajo.2008.03.028
DO - 10.1016/j.ajo.2008.03.028
M3 - Article
C2 - 18514608
AN - SCOPUS:47549112845
SN - 0002-9394
VL - 146
SP - 266-275.e4
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 2
ER -