Rejuvenating the aging upper periorbita.

PURPOSE: To investigate the efficacy of a comprehensive surgical approach in rejuvenating the aging upper periorbita. METHODS: Three hundred and twenty eyes of 160 patients who were treated for dermatochalasis(D), eyebrow ptosis (EP) and blepharoptosis (BP) were included in the study. One hundred and ninety-eight patients had only dermatochalasis, 74 patients had D and EP, 39 patients had D and BP, 7 patients had D, EP and BP and 2 patients had D, EP and blepharospasm. The patients were evaluated before surgery, at 1 week, 1 month and 6 months after surgery. Dermatochalasis was scored between 0 and 3 points according to upper lid laxity and IP drooping. EP was scored between 0 and 2 points as normal, lateral EP and total EP. Aging was classified as mild in those with a total score of less than 3 points, moderate in those with a score of 3-6 and severe in those above 6 points. RESULTS: Of the patients, 121 were female and 39 were male, with a mean age of 52 (40-87) years. The surgeries were performed as follows: upper eyelid blepharoplasty (UEB) 197(61.6%) patients, UEB + browpexy(B) 77(24.1%) patients, UEB + B + levator resection(LR) 7(2.2%) and UEB + LR 39 (12.2%) patients. While a statistically significant improvement was observed in patients who underwent UEB + B (p < 0.001), postoperative improvements were not found statistically significant compared to preoperative scores in other surgeries. The postsurgical scores showed statistically significant improvement in all age groups (p < 0.001). CONCLUSIONS: A comprehensive surgical treatment can provide effective results in upper periorbital rejuvenation for patients with varying degrees of upper periorbital aging.

Clinical Results of the Use of Amniotic Membrane Transplantation Alone or in Combination with Adjuvant Therapies in Conjunctival Fornix Reconstruction.

Objectives: To evaluate the clinical results of amniotic membrane transplantation alone or in combination with adjuvant therapies in conjunctival fornix reconstruction. Materials and Methods: The clinical results of patients who presented to our clinic between 2002 and 2016 due to conjunctival fornix obliteration and underwent amniotic membrane transplantation alone or in combination with additional treatments were retrospectively analyzed. The Foster and Mondino classifications were used to grade fornix obliteration. In all cases, the area of conjunctival defect formed after symblepharon lysis was covered with amniotic membrane. In advanced fornix obliteration, amniotic membrane transplantation was combined with 0.04% mitomycin-C (MMC), oral mucosal transplantation, fornix formation (anchoring) sutures, symblepharon ring, eyelid surgery, fibrin glue, and limbal autograft. Deep and scarless restoration of the fornix was considered surgical success. Results: Twenty-two men and 5 women with a mean age of 45.54±4.17 years were included in the study. The etiology of fornix obliteration was mechanical trauma in 16 cases, chemical burn in 6 cases, recurrent pterygium in 3 cases, thermal burn in 1 case, and recurrent chalazion surgery in 1 case. Indications for amniotic membrane transplantation were socket insufficiency in 12 cases, cosmetic reasons in 4 cases, keratoplasty preparation in 3 cases, ptosis in 3 cases, entropion in 2 cases, strabismus in 2 cases, and diplopia in 1 case. The mean follow-up period was 45.04±8.4 months. Twenty-four of 27 cases (88.8%) were successful, while 3 (12.2%) failed due to recurrence of symblepharon. Conclusion: Amniotic membrane transplantation is a successful method when used alone in the reconstruction of early-stage conjunctival fornix obliteration and provides safe and effective results in advanced-stage fornix obliteration when performed in combination with topical 0.04% MMC, oral mucosal transplantation, and limbal autograft surgeries.

Long-term comparison of the efficacies of internal and external browpexy combined with blepharoplasty / Comparação a longo prazo da eficácia de browpexy interna ou externa associada à blefaroplastia

ABSTRACT Purpose: To perform a long-term comparison of the quantitative efficacy of internal and external browpexy in combination with upper-lid blepharoplasty based on lateral and central eyebrow positions. Methods: This retrospective study evaluated internal and external browpexy with upper-lid blepharoplasty surgeries that were performed during the period between January 2012 and December 2017 in the oculoplastic surgery department of our hospital. Patients who had undergone periorbital and forehead surgery, who had ophthalmologic or neurological diseases, and who were Botox users were not included in the study. Preoperative and postoperative measurements were made on photographs taken in the same position. The distances from the pupil center and from the point of intersection between the horizontal line passing through the pupil and the vertical line passing through the lateral canthus to the upper eyebrow borders were measured. Photogrammetric analysis of eyebrow position was analyzed using Corel Draw software. Results: Preoperative and postoperative photographs of 70 eyelids were analyzed. Measurements were taken 24 months after surgery. Mean elevations of 2.10 and 3.19 mm were observed in the central region and lateral regions, respectively, in the internal browpexy group. These elevations were 2.66 and 3.03 mm in the external browpexy group and 0.48 and 0.55 mm in the control group. Eyebrow elevations in the central and lateral regions were not significantly different from baseline in the control group (p=0.126 and p=0.25). Internal and external browpexy showed statistically similar elevation values in the central and lateral regions (p=0.636 and p=0.342). Conclusions: External and internal browpexy surgery afforded adequate and similar elevations of the central and lateral brow, which were significantly different from those in the standard blepharoplasty group during long-term follow-up.

RESUMO Objetivo: Avaliar a comparação, a longo prazo, da eficácia quantitativa da sobrancelha interna e externa em combinação com a blefaroplastia da pálpebra superior com base nas posições lateral e central da sobrancelha. Métodos: Este estudo retrospectivo avaliou as cirurgias interna e externa da braquiterapia com blefaroplastia de pálpebra superior realizadas entre janeiro de 2012 e dezembro de 2017 no setor de cirurgia Oculoplástica de nosso hospital. Pacientes submetidos à cirurgia periorbitária e frontal, com doenças oftalmológicas ou neurológicas e usuários de Botox não foram incluídos no estudo. Medidas pré e pós-operatórias foram feitas em fotografias tiradas na mesma posição. Foram medidas as distâncias do centro da pupila e do ponto de intersecção entre a linha horizontal que passa pela pupila e a linha vertical que passa pelo canto lateral do olho até as bordas superiores da sobrancelha. A análise fotogramétrica da posição da sobrancelha foi analisada usando o software Corel Draw. Resultados: Foram analisadas fotografias pré e pós-operatórias de 70 pálpebras. As medidas foram feitas 24 meses após a cirurgia. Elevações médias de 2,10 e 3,19 mm foram observadas na região central e laterais, respectivamente, no grupo de sobrancelha interna. Essas elevações foram de 2,66 e 3,03 mm no grupo da sobrancelha externa e 0,48 e 0,55 mm no grupo controle (p=0,126, p=0,25). A sobrancelha interna e externa apresentou valores de elevação estatisticamente semelhantes nas regiões central e lateral (p=0,636, p=0,342). Conclusões: Cirurgia de sobrancelha externa e interna proporcionam elevações adequadas e semelhantes nas sobrancelhas central e lateral que foram significativamente diferentes daqueles no grupo de blefaroplastia padrão no acompanhamento a longo prazo.

Long-term comparison of the efficacies of internal and external browpexy combined with blepharoplasty.

PURPOSE: To perform a long-term comparison of the quantitative efficacy of internal and external browpexy in combination with upper-lid blepharoplasty based on lateral and central eyebrow positions. METHODS: This retrospective study evaluated internal and external browpexy with upper-lid blepharoplasty surgeries that were performed during the period between January 2012 and December 2017 in the oculoplastic surgery department of our hospital. Patients who had undergone periorbital and forehead surgery, who had ophthalmologic or neurological diseases, and who were Botox users were not included in the study. Preoperative and postoperative measurements were made on photographs taken in the same position. The distances from the pupil center and from the point of intersection between the horizontal line passing through the pupil and the vertical line passing through the lateral canthus to the upper eyebrow borders were measured. Photogrammetric analysis of eyebrow position was analyzed using Corel Draw software. RESULTS: Preoperative and postoperative photographs of 70 eyelids were analyzed. Measurements were taken 24 months after surgery. Mean elevations of 2.10 and 3.19 mm were observed in the central region and lateral regions, respectively, in the internal browpexy group. These elevations were 2.66 and 3.03 mm in the external browpexy group and 0.48 and 0.55 mm in the control group. Eyebrow elevations in the central and lateral regions were not significantly different from baseline in the control group (p=0.126 and p=0.25). Internal and external browpexy showed statistically similar elevation values in the central and lateral regions (p=0.636 and p=0.342). CONCLUSIONS: External and internal browpexy surgery afforded adequate and similar elevations of the central and lateral brow, which were significantly different from those in the standard blepharoplasty group during long-term follow-up.

The Histopathological Findings of Patients Who Underwent Blepharoplasty Due to Dermatochalasis.

PURPOSE: To assess changes in lymphatic vessels, collagen, and elastic fiber structure in excised tissues with dermatochalasis (DC). METHODS: In this prospective histopathological study, 70 upper eyelid skins of 35 patients operated on for dermatochalasis were compared with 10 eyelid skins of 10 patients operated on for other diagnoses. In histopathological examination, the two groups of patients were compared with respect to number of lymphatic vessels, largest lymphatic vessel diameter, number of elastic fibers, number of macrophages, edema between collagen fibers, and depth of stromal collagen bed. RESULTS: As compared to the control group, the study group had a significantly greater number of dilated lymphatic vessels (p = 0.0001), largest lymphatic vessel diameter (p = 0.02), depth of stromal collagen bed (p = 0.0001), edema space between collagen fibers (p = 0.0001), elastic fiber density (p = 0.0001), and number of macrophages (p = 0.001). CONCLUSION: According to the results of the present study, in addition to an increase in the diameter and number of lymphatic vessels, a reduction in elastic fibers that are essential for the structure and function of lymphatic system, disarrangement in collagen fibers, stromal edema, and increased number of macrophages play a role in the development of dermatochalasis.

Surgical amniotic membrane transplantation after conjunctival and limbal tumor excision.

PURPOSE:: To evaluate the clinical results of patients treated by amniotic membrane transplantation (AMT) following excision of conjunctival and limbal tumors. METHODS:: A total of 14 eyes of 14 patients who underwent AMT after total lesion-free tumor excision and perilesional cryotherapy were evaluated. RESULTS:: The excised tumors comprised 7 conjunctival intraepithelial neoplasia, 5 conjunctival nevus, 1 primary acquired melanosis, and 1 squamous cell carcinoma. Limbus was involved in 10 cases, whereas cornea was involved in 6 cases. The average measurement of the tumor base was 14.8 mm (range 6-20 mm, SD 16 mm). The mean follow-up time period was 17.5 months (range 6 -60 months, SD 20 months). Complete healing occurred in eight eyes, but limbal cell deficiency developed in two eyes. Four cases had recurrence and were treated with the same surgical and medical procedures; during follow-up after recurrence, superficial peripheral vascularization and corneal scar were noted to have developed. CONCLUSIONS:: AMT was effective for reconstruction of tissue defect after excision and cryotherapy of limbal and conjunctival tumors. In most of these cases, complete healing was achieved with a smooth, stable, and translucent surface.

Surgical amniotic membrane transplantation after conjunctival and limbal tumor excision / Transplante de membrane amniótica após excisão de tumor limbar e conjuntival

ABSTRACT Purpose: To evaluate the clinical results of patients treated by amniotic membrane transplantation (AMT) following excision of conjunctival and limbal tumors. Methods: A total of 14 eyes of 14 patients who underwent AMT after total lesion-free tumor excision and perilesional cryotherapy were evaluated. Results: The excised tumors comprised 7 conjunctival intraepithelial neoplasia, 5 conjunctival nevus, 1 primary acquired melanosis, and 1 squamous cell carcinoma. Limbus was involved in 10 cases, whereas cornea was involved in 6 cases. The average measurement of the tumor base was 14.8 mm (range 6-20 mm, SD 16 mm). The mean follow-up time period was 17.5 months (range 6 -60 months, SD 20 months). Complete healing occurred in eight eyes, but limbal cell deficiency developed in two eyes. Four cases had recurrence and were treated with the same surgical and medical procedures; during follow-up after recurrence, superficial peripheral vascularization and corneal scar were noted to have developed. Conclusions: AMT was effective for reconstruction of tissue defect after excision and cryotherapy of limbal and conjunctival tumors. In most of these cases, complete healing was achieved with a smooth, stable, and translucent surface.

RESUMO Objetivo: Avaliar os resultados clínicos de pacientes tratados com transplante de membrana amniótica (TMA) após a excisão de tumores conjuntival e limbar. Métodos: Foram avaliados 14 olhos de 14 pacientes submetidos a transplante de membrana amniótica após excisão total de tumor e crioterapia perilesional. Resultados: Os tumores que foram excisados podem ser classificados como neoplasia intraepitelial conjuntival em 7, nevus conjuntival em 5, melanose adquirida primária e carcinoma espinocelular em 1 caso cada. O limbo foi envolvido em 10 casos e a córnea foi envolvida em 6 casos. A medida média da base do tumor foi de 14,8 mm (6-20, DP 16). O tempo médio de seguimento foi de 17,5 meses (6-60, DP 20). A cicatrização completa ocorreu em 8 olhos e deficiência de células limbares ocorreu em 2 olhos. A recorrência foi diagnosticada em 4 casos e tratada com o mesmo procedimento cirúrgico e médico e, após essa recorrência, a vascularização periférica superficial e a cicatriz corneana desenvolveram-se em 4 casos durante o seguimento. Conclusões: O transplante de membrana amniótica é um método eficaz para a reconstrução do defeito do tecido após a excisão de tumores limbares e conjuntivais com a combinação de crioterapia. Na maioria destes casos, a cicatrização completa pode ser conseguida com uma superfície lisa, estável e transparente.

Ocular surface changes in patients treated with oral antidiabetic drugs or insulin.

PURPOSE: To describe and compare ocular surface changes in patients with type 2 diabetes treated with either oral antidiabetic drugs (OAD) or insulin. METHODS: Forty eyes of 20 patients treated with OAD, 40 eyes of 20 patients treated with insulin, and 10 nondiabetic controls seen at Ministry of Health Ankara Educational and Research Hospital, 1st Eye Clinic, were studied. All subjects underwent routine ophthalmic examinations, Schirmer test, tear film break-up time analysis, and conjunctival impression cytologic analysis. Patients treated with OAD or insulin and a control group were compared for tear function parameters, goblet cell density, and squamous metaplasia grade. The relation between status of retinopathy and ocular surface disorder and serum HbA1c levels of diabetic patients were also noted. RESULTS: The tear film break-up time values were significantly lower in patients treated with OAD (p<0.05). There was no statistically significant difference in Schirmer test results of the 3 groups. Goblet cell density and squamous metaplasia grade were similar in all groups. The median grade was grade 1, in which epithelial cells are slightly larger, more polygonal, have eosinophilic staining cytoplasm, and goblet cells are decreased in number. Status of retinopathy did not seem to relate to ocular surface disorder. The serum HbA1c level of diabetic patients treated with insulin or OAD was similar (p>0.05). CONCLUSIONS: Precorneal tear film stability was worse in patients treated with OAD; however, impression cytology analysis and Schirmer test results were similar in all groups.

Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C.

PURPOSE: To compare the results of amniotic membrane transplantation (AMT) combined with mitomycin C (MMC) to the results of free conjunctival autograft (CA) combined with MMC for the treatment of patients with recurrent pterygium. METHODS: In this prospective study, 60 eyes of 55 patients with recurrent pterygium were included and randomly assigned into group I (n = 30) who underwent AMT combined with MMC (AMT-MMC) and group II (n = 30) who underwent CA combined with MMC (CA-MMC). During a mean follow-up of 27.2 ± 20.8 months, recurrence of pterygium, change in uncorrected visual acuity and complications (including pain, corneal, conjunctival or scleral changes) were analyzed and were compared between groups. RESULTS: Five eyes of 5 patients were lost to follow-up and were removed from analysis. The mean age (p = 0.274), the mean follow-up (p = 0.063), the number of prior pterygium excision surgeries (p = 0.641) and the mean preoperative visual acuity (p = 0.959) were similar in both groups. Recurrence was seen in 2 eyes (8%) in AMT-MMC group and 4 patients (13.3%) in CA-MMC group (p = 0.531). Postoperative visual acuity (p = 0.237), change in visual acuity (p = 0.525), severe pain (p = 0.531) and epithelial defect lasting more than 5 days (p = 0.510) were similar in both groups. CONCLUSIONS: Amniotic membrane combined with MMC has similar recurrence rate to CA combined with MMC, in patients with recurrent pterygium. Similar outcomes and complication rates make AMT-MMC a promising method for the treatment of recurrent pterygium cases.

Clinical outcomes of amniotic membrane transplantation in patients with corneal and conjunctival disorders.

PURPOSE: To evaluate the effectiveness of amniotic membrane transplantation (AMT) in management of corneal and conjunctival diseases in large clinical series. METHODS: 130 patients who had undergone AMT between February 2004-March 2011 were evaluated. The cases were selected from two main groups: corneal (105) and conjunctival disorders (25). Results were analyzed by ANOVA test defining the outcomes as success, recurrence, and failure. P values less than 0.1 were defined as significant. The success criteria of the corneal group was complete re-epitelization of cornea in the first month and formation of a deep anterior chamber. The success criteria of conjunctival disorders was regarded as complete re-epitelization by the fifteenth day of follow-up. RESULTS: The cornea healed satisfactorily 85.7% of the corneal group and the success rate of conjunctival group was 92% (p=0.524 for success and p=0.245 for recurrence). There was not a significant difference between subgroups (p=0.167 for cornea subgroups and p=1.00 for conjunctiva subgroups). Corneal epithelial defect rapidly healed and there was significant visual acuity improvement after AMT (p=0.001). CONCLUSION: AMT is effective to promote corneal healing in patients with persistent epithelial defect and appeared to be helpful after surgery to release pain. It can be successfully used as an alternative to conjunctival autograft for conjunctival surface reconstruction.

The histopathology of involutional ectropion and entropion.

OBJECTIVE: Involutional ectropion and entropion are characterized by excessive horizontal eyelid length, which is thought to be secondary to laxity of the medial and lateral canthal tendons and to the stretching of the tarsus. Histopathological features of the surgical eyelid specimens from patients with involutional ectropion and entropion were evaluated. DESIGN: Prospective histopathological study. PARTICIPANTS: Eighteen full-thickness eyelid specimens from patients with involutional ectropion and entropion were obtained during horizontal eyelid shortening procedures performed at the Ministry of Health Ankara Training and Research Hospital. METHODS: All specimens were fixed in 4% formaldehyde solution and sectioned sagittally. Hematoxylin-eosin, periodic acid-Schiff, and Masson's trichrome staining were done for all specimens. Histopathologic alterations of the tarsal plate, the palpebral portion of the orbicularis muscle, and the conjunctiva were examined. RESULTS: The patients ranged in age from 60 to 80 years. The main histopathologic features of the ectropic eyelids included collagen degeneration and elastosis of the tarsal plate, increased amounts of adipose tissue in the distal tarsus, and subacute inflammation and epidermalization of the tarsal conjunctiva. Specimens from patients with involutional entropion generally had milder degrees of these histopathological features. CONCLUSIONS: The causes of the excessive horizontal length of the eyelid, which is thought to be secondary to laxity of the medial and lateral canthal tendons, may be collagen degeneration and elastosis of the tarsal plate and canthal tendons.

Ocular complications in 2 cases with porphyria.

PURPOSE: We aimed to report our observation regarding the long-term follow-up results of 2 cases with similar ophthalmic manifestations of 2 different porphyrias, congenital erythropoietic porphyria (CEP), and porphyria cutanea tarda (PCT). METHODS: Both patients presented with ocular pain and photophobia in both eyes. The patient with CEP had a scleral necrosis of 3 mm in diameter at the lateral limbus of the right eye and medial limbus of the left eye, accompanied with cicatricial ectropion and lid swelling OU. The patient with PCT had scleral necrosis in the interpalpebral area nasally, OU. RESULTS: Both patients were followed-up for 4 years. The patients received intensive topical lubrication and topical and oral immune-suppressive medication. They underwent amniotic membrane grafting, when required, and were advised to wear UV glasses. The case with PCT followed a more salient course and remained symptom free until the end of the follow-up period. In contrast, the patient with CEP developed further scleral necrosis, despite the treatment and evisceration surgery were inevitable owing to endophthalmitis unresponsive to the treatment. CONCLUSIONS: Ocular complications are rarely reported in porphyrias, and the studies on the long-term follow-up results are fewer. Despite careful follow-up and intensive treatment, scleral necrosis can be progressive and results in the loss of vision or even the loss of eye. Further studies regarding the care of patients with porphyrias are required to more effectively treat these rare ophthalmic conditions.

Basal cell carcinoma in lacrimal sac.

A 53-year-old woman was admitted to the hospital one year after the onset of her complaints. She suffered from epiphora and swelling in the lacrimal sac region. Biopsy revealed islets of classical basal cell carcinoma with peripheral formation of palisades within a hyperemic stroma. During surgery, the lacrimal drainage system and neighboring bony structures were completely excised. No local recurrences were detected on orbital tomography performed 6 and 15 months postoperatively. As far as the authors know, this is the first case of basal cell carcinoma in the lacrimal sac reported in the literature.

Comparison of three methods for the treatment of pterygium: amniotic membrane graft, conjunctival autograft and conjunctival autograft plus mitomycin C.

OBJECTIVE: To compare three techniques combined with excision in the treatment of primary and recurrent pterygium: amniotic membrane transplantation, conjunctival autograft, and conjunctival autograft plus mitomycin C. MATERIALS AND METHODS: Forty-nine eyes of 49 subjects (30 primary, 19 recurrent pterygium) were included in this study. Combined with excision, 25 eyes (18 primary, 7 recurrent pterygium) were treated with conjunctival autografts (Group 1), and 16 eyes (12 primary, 4 recurrent pterygium) were treated with amniotic membrane transplantation for the closure of the defect (Group 2). In 8 eyes (all recurrent pterygium) low-dose mitomycin C (0.02%) was applied topically to the defect area and a conjunctival autograft was applied thereafter (Group 3). The three groups were compared with regard to the recurrence of pterygium and the defect area requiring treatment. RESULTS: The number and percentages of recurrence seen in groups 1, 2 and 3 were as follows: 4 (16%), 4 (25%), and 0(-), respectively. For the treatment of primary pterygium cases, amniotic membrane closure and conjunctival autograft closure were comparable in effectiveness (p > 0.05). In the treatment of recurrent pterygium, there was no significant difference between the three techniques (p > 0.05). Amniotic membrane closure and conjunctival autografts were equally effective for the treatment of both primary and recurrent pterygium (p > 0.05). The graft size was significantly larger in the cases with recurrent pterygium (p = 0.016). CONCLUSIONS: Amniotic membrane closure and conjunctival autografts seem to be equally effective in the prevention of recurrence of primary pterygium. Conjunctival autografts combined with mitomycin C are as effective as the above two techniques to prevent recurrence in the treatment of recurrent pterygium. Due to the larger area of subconjunctival fibrosis, a larger defect area is created after the excision of pterygium tissue and a larger graft is needed to close this defect in recurrent pterygium. This factor can guide the surgeon during the planning of the surgery to choose the most appropriate technique for closure of the defect.

Mitomycin C and conjunctival autograft for recurrent pterygium.

PURPOSE: To observe the efficiency of intraoperative low-dose Mitomycin-C combined with conjunctival autograft in the treatment of recurrent pterygium. METHODS: Fifteen eyes with recurrent pterygium were included in this study. The mean age of the patients was 51.6 +/- 11.4 (9 men, 6 women). All patients underwent excision of the pterygium tissue and subconjunctival fibrous tissue with a no cautery approach. 0.2 mg/ml Mitomycin-C (0.02%) was applied for 3 min. Conjunctival autograft was obtained from the superotemporal bulbar conjunctiva of the same eye. Eyes were followed for a mean period of 21.0 +/- 9.1 months. RESULTS: Recurrence was seen in two eyes (13.3%) during the follow-up period. The only complication seen was graft edema (two eyes; 13.3%) which healed after pressure patching. Graft necrosis, scleral melting or failure of revascularization was not noted. CONCLUSION: Intraoperative application of 0.2 mg/ml Mitomycin-C combined with conjunctival autograft reduces recurrence in recurrent pterygium cases, with minimal complications.

Amniotic membrane transplantation to reconstruct the conjunctival surface in cases of chemical burn.

PURPOSE: To evaluate the efficiency of preserved human amniotic membrane transplantation for conjunctival surface reconstruction in cases of chemical burn. METHODS: Preserved amniotic membrane transplantation was performed in 6 patients (6 eyes) having symblepharon and fornix insufficiency due to chemical burn. Amniotic membrane was sutured to the intact conjunctiva after the fibrotic tissue was excised. The fornix was reconstructed in cases having fornix insufficiency. These cases were followed up for 4-24 months. RESULTS: During the mean follow-up period (10+/-7.37 months) adequate bulbar conjunctiva and fornix depth was achieved in 5 patients without recurrence and with mild fibrosis. In 1 patient who did not have a healthy conjunctiva preoperatively, conjunctival fibrosis and symblepharon recurred. CONCLUSIONS: Preserved human amniotic membrane transplantation is a good alternative treatment method for conjunctival surface reconstruction in those cases with some healthy peripheral conjunctival tissue.

Squamous cell carcinoma of the lacrimal sac.

The clinical and histopathological findings in a 40-year-old man with a lacrimal sac tumor are reported. Although the clinical history indicated a lacrimal sac obstruction and recurrent dacryocystitis, the lesion was diagnosed by light microscopy as a squamous cell carcinoma.