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

Abstract

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.

Keywords: Adjuvant treatments; amniotic membrane transplantation; fornix stenosis; mitomycin-C; symblepharon.

Figure 1

A, B) A 19-year-old woman with thermal burn, stage 3c obliteration of the upper fornix, and ptosis. C) Postoperative 1 month after symblepharon lysis, mitomycin-C application, and amniotic membrane transplantation. D) After 65 months, the patient has a deep upper fornix with no ptosis or recurrence

Figure 2

A) A 17-year-old male patient with stage 2c obliteration of the lower fornix, cicatricial entropion, and inability to wear the prosthesis after evisceration surgery. B) Postoperative 1 week after symblepharon lysis, amniotic membrane transplantation, and anchoring suture surgery. C) After 28 months, the patient has a deep lower fornix, no entropion or recurrence, and can wear the prosthesis

Figure 3

A, B) A 25-year-old man with grade 3a obliteration of the upper fornix after alkali burn and entropion. C) Postoperative 6 months after symblepharon lysis, mitomycin C application, and amniotic membrane transplantation. D) Deep upper fornix on downgaze. E) Postoperative 3 weeks after limbal autograft, amniotic membrane transplantation, oral mucosa graft, and anchoring suture surgery. F) After 25 months, the patient has a deep upper fornix with no entropion or recurrences.

Figure 4

A) A 64-year-old man with grade 4 obliteration of the lower fornix and restrictive strabismus after recurrent pterygium. B) Postoperative 3 weeks after amniotic membrane transplantation, medial rectus recession, fibrin glue, and anchoring suture surgery