Purpose: To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis a nd fornix reconstruction in severe cicatricial ocular surf...Purpose: To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis a nd fornix reconstruction in severe cicatricial ocular surface diseases. Design: Noncomparative interventional case series. Participants: Sixteen patients (8 fem ale, 8male; 18 eyes)with amean age of 41±23.4 years (range, 3-79) and sufferin g from severe chemical/thermal burns (7 eyes), multiple recurrent pterygia and p seudopterygia (5 eyes), Stevens-Johnson syndrome (4 eyes), and ocular cicatrici al pemphigoid (2 eyes) were consecutively enrolled. All except for 2 eyes had ha d prior surgical attempts of surgical reconstruction, including 6 eyes with a mu cous membrane graft (MMG), but still presented with symblepharon and persistent ocular surface inflammation. Intervention: After excision of subconjunctival fib rovascular tissues, 0.04%mitomycin C was applied for 5 minutes in the deep forn ix before amniotic membrane transplantation. Main Outcome Measures: Deeper forni x, noninflamed ocular surface, and full motility. Results: The mean epithelial h ealing time was 4.2±1.9 weeks. During the follow-up of 14.16±5.2 months, all eyes showed a marked reduction of conjunctival inflammation, a deep fornix, and a continuous tear meniscus. Of 12 eyes with motility restriction, 2 eyes with mu ltiple recurrent pterygia and 1 eye with severe thermal burn showed recurrence o f partial motility restriction 2 months after surgery. The vision of 9 eyes was successfully restored by an additional keratolimbal allograft with subsequent pe netrating keratoplasty (6 eyes). Conclusion: Intraoperative application of mitom ycin C is an effective means to reduce chronic and deep-seated conjunctival inf lammation, and helps amniotic membrane restore a deep fornix after symblepharon lysis, even in eyes that had a failed MMG. Restoration of deep fornix and tear m eniscus is an important prerequisite to achieve successful reconstruction by sub sequent limbal stem cell transplantation.展开更多
Purpose: To look at the correlation between many factors (time of hospitalizat ion, floppy eyelid syndrome, trichiasis, open lacrimal puncta, symblepharon, and aqueous tear deficiency)-and corneal complications in Ste...Purpose: To look at the correlation between many factors (time of hospitalizat ion, floppy eyelid syndrome, trichiasis, open lacrimal puncta, symblepharon, and aqueous tear deficiency)-and corneal complications in Stevens-Johnson syndrom e (SJS). Design: Observational cases series. Patients: Clinical data were retros pectively reviewed from 38 patients (32.7±20.1 years old) with SJS (n=11) and with toxic epidermal necro lysis (TENS) (n=27) from January 2002 to August 2004. One case report with SJS w as included to verify the presence of tarsal/lid margin ulceration at the acute stage. Methods: The medical history was retrieved regarding presumed causative m edications used within 15 days and the duration of hospitalization. Data of the latest photographic documentation and eye examination were compared and correlat ed in a masked fashion. Main Outcome Measures: Floppy eyelid, trichiasis, lid ma rgin keratinization, meibomian gland orifice metaplasia, symblepharon, tarsal sc ar, and corneal complications. Results: Acute SJS/TENS was characterized by tars al conjunctival ulceration. Keratinization of the eyelid margin with variable de grees of meibomian gland dysfunction was observed in all cases. Floppy eyelid, t richiasis, partially or totally opened lacrimal punctum, symblepharon, and aqueo us tear deficiency were not significantly correlated with corneal complications. In contrast, there was a strong correlation between the severity of eyelid marg in and tarsal pathology and the extent of corneal complications (Spearman r, 0.5 4; P=0.0005). A multivariable regression analysis also showed that the extent of eyelid and tarsal pathology had a significant effect on corneal complications ( coefficient, 0.84; P=0.006). Conclusions: Patients with acute SJS/TENS are chara cterized by severe inflammation and ulceration of the tarsal conjunctiva and lid margins. If left unattended, lid margin keratinization and tarsal scar, togethe r with lipid tear deficiency, contribute to corneal complications because of bli nk-related microtrauma. Attempts to suppress inflammation and scarring by amnio tic membrane transplantation at the acute stage and to prevent microtrauma at th e chronic stage are vital to avoid sight-threatening complications.展开更多
文摘Purpose: To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis a nd fornix reconstruction in severe cicatricial ocular surface diseases. Design: Noncomparative interventional case series. Participants: Sixteen patients (8 fem ale, 8male; 18 eyes)with amean age of 41±23.4 years (range, 3-79) and sufferin g from severe chemical/thermal burns (7 eyes), multiple recurrent pterygia and p seudopterygia (5 eyes), Stevens-Johnson syndrome (4 eyes), and ocular cicatrici al pemphigoid (2 eyes) were consecutively enrolled. All except for 2 eyes had ha d prior surgical attempts of surgical reconstruction, including 6 eyes with a mu cous membrane graft (MMG), but still presented with symblepharon and persistent ocular surface inflammation. Intervention: After excision of subconjunctival fib rovascular tissues, 0.04%mitomycin C was applied for 5 minutes in the deep forn ix before amniotic membrane transplantation. Main Outcome Measures: Deeper forni x, noninflamed ocular surface, and full motility. Results: The mean epithelial h ealing time was 4.2±1.9 weeks. During the follow-up of 14.16±5.2 months, all eyes showed a marked reduction of conjunctival inflammation, a deep fornix, and a continuous tear meniscus. Of 12 eyes with motility restriction, 2 eyes with mu ltiple recurrent pterygia and 1 eye with severe thermal burn showed recurrence o f partial motility restriction 2 months after surgery. The vision of 9 eyes was successfully restored by an additional keratolimbal allograft with subsequent pe netrating keratoplasty (6 eyes). Conclusion: Intraoperative application of mitom ycin C is an effective means to reduce chronic and deep-seated conjunctival inf lammation, and helps amniotic membrane restore a deep fornix after symblepharon lysis, even in eyes that had a failed MMG. Restoration of deep fornix and tear m eniscus is an important prerequisite to achieve successful reconstruction by sub sequent limbal stem cell transplantation.
文摘Purpose: To look at the correlation between many factors (time of hospitalizat ion, floppy eyelid syndrome, trichiasis, open lacrimal puncta, symblepharon, and aqueous tear deficiency)-and corneal complications in Stevens-Johnson syndrom e (SJS). Design: Observational cases series. Patients: Clinical data were retros pectively reviewed from 38 patients (32.7±20.1 years old) with SJS (n=11) and with toxic epidermal necro lysis (TENS) (n=27) from January 2002 to August 2004. One case report with SJS w as included to verify the presence of tarsal/lid margin ulceration at the acute stage. Methods: The medical history was retrieved regarding presumed causative m edications used within 15 days and the duration of hospitalization. Data of the latest photographic documentation and eye examination were compared and correlat ed in a masked fashion. Main Outcome Measures: Floppy eyelid, trichiasis, lid ma rgin keratinization, meibomian gland orifice metaplasia, symblepharon, tarsal sc ar, and corneal complications. Results: Acute SJS/TENS was characterized by tars al conjunctival ulceration. Keratinization of the eyelid margin with variable de grees of meibomian gland dysfunction was observed in all cases. Floppy eyelid, t richiasis, partially or totally opened lacrimal punctum, symblepharon, and aqueo us tear deficiency were not significantly correlated with corneal complications. In contrast, there was a strong correlation between the severity of eyelid marg in and tarsal pathology and the extent of corneal complications (Spearman r, 0.5 4; P=0.0005). A multivariable regression analysis also showed that the extent of eyelid and tarsal pathology had a significant effect on corneal complications ( coefficient, 0.84; P=0.006). Conclusions: Patients with acute SJS/TENS are chara cterized by severe inflammation and ulceration of the tarsal conjunctiva and lid margins. If left unattended, lid margin keratinization and tarsal scar, togethe r with lipid tear deficiency, contribute to corneal complications because of bli nk-related microtrauma. Attempts to suppress inflammation and scarring by amnio tic membrane transplantation at the acute stage and to prevent microtrauma at th e chronic stage are vital to avoid sight-threatening complications.
