Gore-tex a magic sheet for symblepharon prevention!

Background: Symblepharon occurs as chronic sequelae of severe chemical injuries. The risk of recurrence is high due to unpredictable wound healing of conjunctiva and tenons following excision in young patients. Gore-tex aids in prevention of the recurrence of pterygium 1. Purpose: To present a surgical video on role of Gore-tex in grade 4 Symblepharon lysis. Synopsis: A 28-year-old male with a previous history of Grade 4 chemical injury presented with symblepharon and total obliteration of both upper and lower fornices after one year in the right eye. He underwent symblepharon lysis, Living related conjunctival allograft, Amniotic membrane graft and Gore-tex. The video explains the surgical steps in detail. A 360-degree complete peritomy was done, Symblepharon was released from the corneal surface, and the fibrotic tissue was extensively dissected away from the corneal surface and released into the fornix. Further, cryopreserved AMG was placed over the entire raw ocular surface and sutured to the episclera with glue. Prepared Gore- tex was placed on the superior and inferior fornix and sutured with 10-0 nylon suture. Again, AMG was placed over the Gore-tex in the fornices and covered with glue. A small 2x2mm biopsy of limbal stem cells from the superior limbus was already excised from the fellow eye (CLAG) and then Lr-CLAL was prepared from the patient’s mother. These two grafts were placed on the nasal and temporal bulbar surface over the AMG and sutured to the underlying AMG and the episclera with glue. The entire surface was then covered with the AMG to promote epithelisation. At one month postoperative period, patient had stable ocular surface with intact Limbal conjunctival graft with mild conjunctival recurrence of fibrosis superiorly. Highlights: The video clearly explains the surgical steps of Symblepharon and the benefits of using Gore-tex.

Management of a case of symblepharon by freshly prepared amniotic membrane transplantation: a clinical case report

Amniotic membrane transplantation has been in common therapeutic use for a variety of ocular disorders. Authors present a case of a 50-year-old man who was diagnosed to be a case of total symblepharon following an episode of membranous conjunctivitis who was treated with freshly prepared Amniotic membrane transplantation with satisfactory cosmetic result.

Role of amniotic membrane transplantation in symblepharon / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the use of amniotic membrane transplantation(AMT)in symblepharon.<p>METHODS: This non-comparative interventional case study was conducted from January 2013 to December 2015 and included a consecutive series of 14 eyes of 12 patients. Patients were selected for permanent AMT. The amniotic patches were grafted for the treatment of symblepharon. Cryo-preserved or freeze-dried amniotic membrane(AM)was used. Regarded to the 14 eyes(12 patients), their age was ranged from 26-62y, with the mean age of 43.38±11.25, 10 eyes of 8 patients(4 males/4 females)were presented with symblepharon secondary to previous pterygium surgery, and 4 eyes of 4 patients(1 male/3 females)were presented with symblepharon secondary to previous strabismus surgery, at least 6mo after the last surgery. The outcome of success was defined as restoration of a stable-depth fornix and being free of scar or inflammation, and no motility restriction during the follow up of 6mo.<p>RESULTS: The mean follow-up period was 7±4.2mo(range 6-9mo). In all 14 eyes, complete epithelialization of AM was observed 3wk after surgery, resulting in a non-inflamed appearance of the surgical site. Eight eyes out of total 14 eyes showed successful fornix reconstruction with success rate(57%), the fornix was deep, and no recurrence was observed. Four eyes(29%)showed partial success with moderate depth of the fornix and moderate scar. Two eyes(14%)showed failure of reconstruction of the fornix with complete fornix obliteration. The visual acuity improved after surgery in 7 eyes while remained stable in 7 eyes. Post-operative complications from the AMT was very limited as severe conjunctival reaction and motility restriction was occurred only in one eye out of 14 eyes(7%)and pyogenic granuloma occurred in 2 eyes out of 14 eyes(14%)in the first 3mo after surgery and was managed with surgical excision, with local corticosteroid injection.<p>CONCLUSION: AMT alone is a safe and effective method for symblepharon. Considering the potential adverse effects associated with limbal excision, also, AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders.

Application of improved ultrasound biomicroscopy in the clinical diagnosis of moderate and severe symblepharon in patients with thermal and chemical ocular surface burns / 上海交通大学学报（医学版）

Objective· To investigate the value of technique of improved ultrasound biomicroscopy (UBM) in the clinical diagnosis of moderate and severe symblepharon after thermal and chemical ocular surface burns. Methods · The clinical data of 33 patients (33 eyes) who had suffered moderate and severe symblepharon after thermal and chemical ocular surface burns were retrospectively analyzed. Improved UBM was applied in the examination of the anterior segment injury, through which the cornea, anterior chamber, iris, anterior chamber angle, ciliary body and lens were analyzed carefully. Also the connection between severity of symblepharon and anterior segment injury was discussed. Results · All the 33 eyes were examined by the UBM. Corneal opacity of more than 1/2 depth of the corneal was detected in 29 eyes, and detachment of the corneal elastic layer in 1 eye, corneal interstitial fluid in 4 eyes, corneal thinning in 2 eyes, anterior synechia of iris in 6 eyes, posterior synechia of iris in 2 eyes, shallower anterior chamber in 2 eyes, exudate in the anterior chamber in 1 eye, narrow anterior chamber angle in 6 eyes, high echo of lens in 6 eyes. The anterior segment injury in severe symblepharon eyes was worse than that in moderate symblepharon eyes. Conclusion · UBM is a noninvasive diagnostic technique, which can be used in the meticulous detection of the anterior segment of moderate and severe symblepharon patients after a slight improvement of inspection methods. It can show the pathological changes that cannot be revealed by routine ophthalmologic examination, and provide guidance for estimating the severity of the disease, the choice of surgical plan and prognosis of patients.

Corrección del simbléfaron posquirúrgico a través de autoplastia conjuntival autólogaReporte de un caso / Correction of postoperative symblepharon by means of conjunctival autolologous autoplastyA case report

Fundamento: El simbléfaron posquirúrgico es una complicación oftalmológica que consiste en la adhesión total o parcial de la conjuntiva tarsal y el globo ocular causado por una cicatriz; donde resultan complicaciones secundarias que afectan la anatomía oculofacial y la función visual. Objetivo: Ilustrar el resultado de la autoplastia conjuntival autóloga como tratamiento del simbléfaron posquirúrgico. Presentación de caso: Se presenta un caso de simbléfaron posquirúrgico que luego de someterse a varias cirugías de pterigion evolucionó con insuficiencia de células límbicas, conjuntivalización de la córnea y simbléfaron. El paciente evolucionó favorablemente luego de recibir tratamiento quirúrgico por autoplastia conjuntival autóloga, se recuperó la motilidad ocular y se redujo el astigmatismo y un palpable ahorro de recursos sin sacrificar la efectividad del proceder quirúrgico. Conclusiones: El tratamiento del simbléfaron posquirúrgico mediante la autoplastia conjuntival autóloga, permite adoptar una conducta adecuada, reportando un saldo favorable en la recuperación del paciente.

Background: Postoperative symblepharon is an ophtalmalogical complication consisting of a total or partial adherence of the tarsal conjunctiva and the eyeball caused by a scar, resulting in secondary complications that affect both oculofacial anatomy and visual function. Objective: To illustrate the result of the conjunctival autolologous autoplasty as a treatment for postoperative symblepharon. Case presentation: A postoperative case of symblepharon is presented after having various surgical interventions of pterygium, who evolved with an insufficiency of limbic cells, conjunctiva of the cornea and symblepharon. The patient evolved satisfactorily after having the surgical treatment with conjunctival autolologous autoplasty, he recovered eye movement and astigmatism was reduced and there was a notorious saving of resources was achieved without sacrificing the effectiveness of the surgical procedure. Conclusions: The treatment of Postoperative symblepharon with conjunctival autolologous autoplasty allows to adopt an adequate medical conduct with a very favorable patient recovery.

Novel surgical technique for the management of partial cryptophthalmos.

We report a case of a 2‑month‑old baby with bilateral nonsyndromic partial cryptophthalmos presenting with upper eyelid incomplete development and fusion to the cornea with resultant inability to close the eyes. He was managed successfully with bilateral upper lid reconstruction with composite graft using maternal skin and oral mucous membrane, amniotic membrane, and donor scleral graft. After this one stage surgery, lids were well‑formed, and the patient was able to close both eyes, thus achieving good anatomical, functional, and cosmetic outcome.

Management of a Complicated Case of Symblepharon with Amniotic Membrane Transplantation.

Amniotic membrane transplantation (AMT) has gained widespread acceptance in various ocular diseases. Its anti-inflammatory activity and close resemblance to conjunctival epithelium has propagated it as an ideal substitute for ocular surface reconstruction. Here is a case report of a complicated case of recurrent symblepharon and ankyloblepharon after fire cracker injury that was managed successfully with AMT with excellent cosmetic results.

Management of a Complicated Case of Symblepharon with Amniotic Membrane Transplantation.

Amniotic membrane transplantation (AMT) has gained widespread acceptance in various ocular diseases. Its anti-inflammatory activity and close resemblance to conjunctival epithelium has propagated it as an ideal substitute for ocular surface reconstruction. Here is a case report of a complicated case of recurrent symblepharon and ankyloblepharon after fire cracker injury that was managed successfully with AMT with excellent cosmetic results.

A Case of Conjunctival Inclusion Cyst Managed with Marsupialization

PURPOSE: We present a case with conjunctival inclusion cyst at inferior fornix treated by marsupialization. CASE SUMMARY: A 23-year-old woman visited our clinic complaining of left lower eyelid swelling. Ophthalmologic examination and CT scan showed a cystic mass from inferior conjunctival fornix to anterior orbit with shallow fornix and focal symblepharon. The cyst was effectively removed with marsupializaion. Postoperatively, there was no recurrence of cyst and the fornix was deepened. CONCLUSIONS: Marsupialization can be a considerable treatment option in conjunctival inclusion cyst, especially when accompanied by shallow fornix and symblepharon.

The Clinical Effect of Micro-Multiporous Expanded Polytetrafluoroethylene Insertion for Recurrent Pterygium

PURPOSE: To investigate the clinical effect of micro-multiporous e-PTFE insertion for severe recurrent pterygium with symblepharon. METHODS: The present study included a total of 13 cases of recurrent pterygium associated with symblepharon, motility restriction and diplopia which had undergone micro-multiporous e-PTFE insertion after pterygium excision, 0.02% mitomycin C application, human amniotic membrane transplantation (AMT) and/or conjunctivo-limbal autograft (CLAU) between September 2010 and February 2011. One month after surgery, the inserted e-PTFE was removed. Recurrence of pterygium and symblepharon, motility restriction, diplopia and injection of ocular surface were evaluated for 11.92 +/- 1.32 months of mean follow-up period. RESULTS: Pterygial recurrence was not observed in 12 out of 13 eyes, and the 1 eye which recurred showed conjunctival recurrence. No postoperative symblepharon recurrence was observed in any of the 13 eyes. Diplopia and motility restriction disappeared in 11 out of 13 eyes, and were improved in the other 2 eyes. VAS (Visual Analogue Scale) injection scores in the wound site decreased after surgery in all patients. CONCLUSIONS: Micro-multiporous e-PTFE insertion combined with mitomycin C application, AMT and CLAU can be a useful surgical method to lower the postoperative recurrence rate and to improve the pterygium-related symptoms in severe recurrent pterygium.

Conjunctival Hypertrophic Scar Following Cryotherapy for Retinopathy of Prematurity

A 6-year-old boy was referred to our hospital with symblepharon and lateral canthal deformity in both eyes, which developed 6 years ago. The patient was born at 27 weeks gestation. He had received cryotherapy for retinopathy of prematurity. One month after cryotherapy, he developed a conjunctival scar with symblepharon in both eyes and underwent symblepharon lysis at another hospital 5 years prior. Ocular examination revealed an extensive conjunctival hypertrophic scar with symblepharon and limitation of extraocular movements. An excisional biopsy, lateral canthoplasty, and symblepharon lysis with conjunctival autograft from the contralateral eye were performed in the left eye. Histopathologic examination revealed diffuse proliferation and infiltration of collagenous tissue.

Surgical Repair of Canalicular Defects and Congenital Eyelid Colobomas Associated with Tessier No. 3 Cleft

PURPOSE: To report a single case of surgical repair of the canalicular defects and congenital eyelid colobomas associated with Tessier No. 3 craniofacial cleft. CASE SUMMARY: A one-month-old girl presented with eyelid colobomas and discharges from the eyes. The patient was diagnosed with a Tessier No. 3 craniofacial cleft with bilateral lower eyelid colobomas medial to the puncta. At the age of 55 months, examination under general anesthesia revealed mid-canalicular obstructions in both lower canaliculi. After pentagonal excision of eyelid colobomas in the left upper and both lower eyelids, both ends of the canaliculi were found at the cut edge of the lower eyelids. After the repair of canalicular defects and bilateral nasolacrimal duct silicone tube intubation, the primary closure of the eyelid defect was performed layer by layer. Although there was no subjective improvement of epiphora in the left eye, a subjective improvement of epiphora in the right eye was achieved, and tear meniscus height in the right eye was halved. Additionally, the eyelid colobomas were cosmetically well repaired at postoperative 6 weeks. The patient still had mild tearing symptoms, but did not complain any longer of discharge at postoperative 4 months. CONCLUSIONS: Tessier No. 3 craniofacial cleft with eyelid colobomas can be associated with canalicular defects and nasolacrimal duct obstructions. Surgical repair of the canalicular defects associated with eyelid colobomas should be considered to achieve a functional recovery of the lacrimal drainage system.

Congenital Symblepharon Associated with No. 3 Craniofacial Cleft

PURPOSE: To report a case of congenital symblepharon associated with No. 3 craniofacial cleft. METHODS: A 40-month old girl with left eyelid lesion underwent an ophthalmologic examination at the department of ophthalmology and a face examination at the department of plastic and reconstructive surgery. RESULTS: Congenital symblepharon associated with No. 3 craniofacial cleft including bifid uvula, partial cleft lip, and coloboma of the lower medial eyelid was found. She did not have amblyopia or strabismus. A MEDLINE search of the literature revealed only one reported case of symblepharon associated with a craniofacial cleft.

Amniotic Membrane Transplantation and Use of Adjunctive Mitomycin C in the Treatment of Symblepharon

PURPOSE: To evaluate the effectiveness of amniotic membrane transplantation and adjunctive mitomycin C in the treatment of symblepharon. METHODS: Amniotic membrane transplantation was performed and adjunctive mitomycin C was applied in 7 patients with symblepharon, resulting from various causes. Mitomycin C soaking (0.02%, 5 minutes) was used intraoperatively followed by meticulous dissection of adherent tissue. Next, amniotic membrane transplantation was done with 2 layers of removed conjunctival tissue and a silicone band bolster was applied to the reconstructed fornix. Evaluating factors were the depth of reconstructed fornix, limitation of eyeball movement, recurrence and presence of complication. These factors were checked at the last visit. RESULTS: Mean follow-up period was 9.0 x +/-A 4.54 months and all patients showed reconstructed fornix. Six patients showed successful outcome (depth of fornix >or=8 mm) and one patient showed 6 mm of forniceal depth and mild limitation of gaze. CONCLUSIONS: Treatment of symblepharon by amniotic membrane transplantation and adjunctive mitomycin C administration can reduce the recurrence rate of symblepharon without complication.

Preserved amniotic membrane combined with conjunctival autograft transplantation for recurrent symblepharon / 医学研究生学报

Objective:To evaluate the therapeutic effects and value of preserved amniotic membrane combined with conjunctival autograft transplantation for recurrent symblepharon. Methods:A group of 38 eyes in 38 patients with recurrent symblepharon due to recurrent pterygium,chemical burn and other causes were undertaken preserved amniotic membrane combined with conjunctival autograft transplantation.The patients were followed for 6 to 36 monthes.Results:No infections occurred.The amniotic membrane changed into transparent 10 days postoperatively.The conjunctival epithelium emigrated to the surface of amniotic membrane.Impression cytology showed a stable conjunctival epithelium on the surface of amniotic membrane.Efficient movement ability was recovered in 34 eyes(89.5%).Four eyes(10.5%) were still restricted in movement due to partly recurrent symblepharon.Conclusion:The preserved amniotic membrane combined with conjunctival autograft transplantation for is effective recurrent symblepharon

A Case of Progressive Recurrent Symblephron, Treated with Amniotic Membrane and Autograft Limbal-conjunctiva

Although both medical and surgical approaches have been investigated, recurrent symblepharon due to chronic ocular surface inflammation is a difficult disease to manage.This condition can also result in many complications such as cosmetic and visual deteriorations.In this condition, we can use the amniotic membrane transplantation that has a biological contact inhibition effect for the prevention of recurrent symblepharon. We treated successfully a case of a progressive symblepharon involving central cornea from 2-year old. The 14 year-old male patient had suffered from serious cosmetic problem and undergone multiple dissection, argon laser photocoagulation, using cyclosporin eyedrops. He was treated using allograft amniotic membrane, autograft limbal-conjunctiva, and buccal mucosa transplantation. we think that amniotic membrane transplantation was very effective method for the prevention of recurrent symblepharon.

Treatment of symblepharon by transplantation of human amniotic membrane

We have been performed amniotic membrane transplantation in 18 patients (20 eyes) with 23 operations (3 eyes were regrafted). One month after operation, 90% of the eyes had exellent result, 10% were good. Three months following the transplantation of amniotic membrane, 10 of 17 eyes had excellent result, in 4 of 14 eyes, the symblepharon was reduced. 6 months after the procedure showed that 9 of 14 eyes had excellent result and only 1 eye had recurrence. The sudy showed that human amniotic membrane is good material for reconstruction ocular surface in severe symblepharon. In the eyes with successful transplantation, ocular surface was covered with a soft, thin membrane with vascularization as natural conjunctiva. The material can be easily taken at anytime. The procedure can be applied in every ophthalmological department of provincial hospitals.

Treatment of Total Symblepharon Using Vaginal Mucosa

A 51-year-old female patient who has had pemphigoid since 110 years ago visited Seoul National University Hospital with the chief complaint of ocular pain and bilateral cilia touching the cornea. Her visual acuity was light sense in the right eye and finger count/1Ocm in the left eye. She had bilateral severe trichiasis, entropion, corneal opacity and total symblepharon. Bilateral symblepharon lysis and mucous membrane graft with buccal mucosa was done Left side was successful, but in the right side, there was hyperplastic proliferation of the grafted buccal mucosa and recurrence of the symblepharon. We performed symblepharon lysis and mucous membrane graft using vaginal mucosa in the right eye. Grafted vaginal mucosa looked healthy and no recurrence of symblepharon ocurred during the follow-up period of 1 year. We would like to suggest that if there is no available oral mucosa, mucous membrane graft can be done with vaginal mucosa in female patient.

Treatment of Total Symblepharon Using Vaginal Mucosa

A 51-year-old female patient who has had pemphigoid since 110 years ago visited Seoul National University Hospital with the chief complaint of ocular pain and bilateral cilia touching the cornea. Her visual acuity was light sense in the right eye and finger count/1Ocm in the left eye. She had bilateral severe trichiasis, entropion, corneal opacity and total symblepharon. Bilateral symblepharon lysis and mucous membrane graft with buccal mucosa was done Left side was successful, but in the right side, there was hyperplastic proliferation of the grafted buccal mucosa and recurrence of the symblepharon. We performed symblepharon lysis and mucous membrane graft using vaginal mucosa in the right eye. Grafted vaginal mucosa looked healthy and no recurrence of symblepharon ocurred during the follow-up period of 1 year. We would like to suggest that if there is no available oral mucosa, mucous membrane graft can be done with vaginal mucosa in female patient.