[Amniotic membrane transplantation for oculopalpebral and reconstructive surgery]. / Utilisation de la membrane amniotique dans la chirurgie de reconstruction oculo-palpébrale.

INTRODUCTION: Amniotic membrane has been used for many years for ocular surface defects. It is also commonly used in laboratories for cellular growth. Amniotic membrane has antiadhesive properties, can promote epithelialization, and decrease neovascularization, inflammation, and fibrosis. There is no histocompatibility problem, as amniotic membrane has no HLA antigens. In this study, amniotic membrane transplantation was used for oculopalpebral and reconstructive surgery as an alternative to the oral mucous graft, particularly in the reconstruction of the conjunctival fornices after inflammatory disease, burns, conjunctival tumors, and enucleation with orbital implants. MATERIAL AND METHOD: Forty-eight interventions using amniotic membrane transplantation were done on 44 patients. In 16 cases conjunctival fornices were created or reconstructed, allowing the installation of an ocular prosthesis; 14 had reconstruction of fornices for inflammatory disease, or chemical or thermal burns; 11 had palpebral skin and conjunctival reconstruction (malformations or skin tumours); and seven cases had conjunctival reconstruction after conjunctival tumor excision. RESULTS: Thirty-nine cases presented good functional and cosmetic results. One case had no follow-up. Eight cases gave poor results: four cases of conjunctival fornix refection (with two irradiated cavities), three cases of fornix reconstruction after chemical burn, and one case in whom palpebral reconstruction partially failed (coloboma). DISCUSSION AND CONCLUSION: Functional and cosmetic results were good for 39 cases, allowing ocular prosthetic equipment when necessary. In nine cases, two complete fornix retractions and two partial fornix retractions were observed; one palpebral reconstruction for malformation partially failed; and four cases (two with amniotic membrane and two with oral mucus graft) required a second surgery to obtain a satisfactory result. Amniotic membrane transplantation is an excellent alternative material to oral mucous membrane in oculopalpebral and reconstructive surgery except when graft rigidity is necessary. Its use is more difficult in cases of chemical burns or after orbital irradiation.

Idiopathic cyclitic retrolental membrane in children.

BACKGROUND: Cyclitic retrolental membranes (CRM) in children are usually associated with chronic uveitis or genetic syndromes. We report two rare cases of idiopathic CRM. PATIENTS AND METHODS: Two girls aged 9 and 13 years with visual acuities (VA) of 0.05 underwent lensectomy and anterior vitrectomy with dissection of the central part of the retrolental membrane and intraocular lens (IOL) implantation. RESULTS: The clinical evolution was excellent for the 9 year old girl who recovered 1.0 VA after 2 months. Histological examination revealed a fibroelastic tissue of unknown origin without inflammatory components. The 13 year old girl showed VA of 0.6 within 1 month. However, a recurrent CRM developed with retinal detachment and proliferative vitreoretinopathy (PVR). Vitrectomy, complete excision of the CRM and 360 degrees retinotomy with silicon oil tamponade attached the retina with limited visual recovery. Histology showed fibrovascular tissue with inflammatory components infiltrating the CRM. CONCLUSIONS: Idiopathic CRM in children are rare and can be composed of different histological tissues with very different clinical outcomes.

Multiple intraorbital neurofibromas: a rare cause of proptosis.

BACKGROUND: Orbital neurofibromas are rare, accounting for 0.5 to 2.4 % of all orbital tumors. Generally, they manifest as slowly progressive proptosis, in a young adult or middle-aged person, and are usually solitary lesions. Sometimes, they can be associated with type 1 neurofibromatosis. We present a case of proptosis related to multiple intraorbital neurofibromas in an 82-year-old woman without type 1 neurofibromatosis. HISTORY AND SIGNS: An 82-year-old woman was referred for slowly progressive left proptosis associated with an ocular burning sensation. Neuro-ophthalmic examination revealed 9.5 mm of left exophthalmos, signs of minimal left optic neuropathy but normal extraocular movements. Magnetic resonance imaging revealed the presence of 4 intraorbital lesions. THERAPY AND OUTCOME: The two most anterior tumors were removed. Pathological studies showed these tumors to be neurofibromas. Post-operative evolution was favorable with reduction of left proptosis to 7 mm and disappearance of the burning sensation of the left eye. No other signs of neurofibromatosis were found. CONCLUSIONS: Multiple circumscribed intraorbital tumors are rare. Slowly progressive proptosis with radiological imaging of multiple round lesions should evoke the diagnosis of orbital neurofibromas, even in patients outside the typical age range or without neurofibromatosis.