Transplantation of amniotic membrane and limbal autograft for patients with recurrent pterygium associated with symblepharon

Abstract

Aim: Treatment of recurrent pterygium associated with symblepharon requires both suppression of fibrosis and reconstruction of limbal barrier. To achieve this, human amniotic membrane was transplanted and limbal autografts performed.

Methods: Four patients with severe symblepharon resulting from multiple surgeries for pterygium were treated. Human amniotic membrane was obtained at caesarean section and preserved until surgery. After excision of the fibrous tissues, the amniotic membrane was placed on the sclera, and a limbal autograft transplantation was performed using limbal tissues taken from the affected eye.

Results: Recurrence of symblepharon was not observed in any of the patients and significant suppression of the subconjunctival fibrosis was achieved. Ocular movement improved in all cases. Complete remission of pterygium regrowth occurred in three cases, and a slight (about 1 mm) recurrence occurred in one case. The limbal donor site showed the presence of mild depressions without the formation of pseudopterygium.

Conclusion: Transplantation of human amniotic membrane with a limbal autograft appears to be a promising surgical treatment for reconstructing the ocular surface in patients with recurrent pterygium associated with symblepharon.

Figure 1

Surgical steps of amniotic membrane and limbal autograft transplantation.(A) Subconjunctival fibrosis tissue is excised and sclera is exposed. (B) Amniotic membrane is placed on the sclera and secured with 9-0 silk sutures. Arrows indicate the margin of amniotic membrane. (C) A limbal autograft with bulbar conjunctiva is dissected from the superior limbal region of the operated eye. (D) The limbal graft (arrows) is transferred and secured to the nasal limbal region. (E) Surgical schema. Note limbal autograft placed on the amniotic membrane.

Figure 2

(A) Preoperative appearance of case 1. Severe symblepharon is formed. Inferior punctum is dislocated (arrow). (B) Postoperatively, symblepharon is lysed almost completely, and the central cornea is clear. (C) Case 2. A stalk-shaped symblepharon is seen preoperatively. (D) Symblepharon is lysed, and no recurrence of pterygium is noted. (E) Case 3. Severe subconjunctival fibrosis at the nasal region is recognised. (F) Postoperatively, the nasal conjunctiva is flat without fibrous tissue regrowth. (G) Case 4. Massive fibrosis is formed around the medial muscle. (H) Adhesion between medial muscle and canthus is lysed after the surgery. Note persistence of slight subconjunctival fibrosis at the 10 o'clock position.