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
Background: Treatment of eyes with multirecurrent pterygia associated with severe symblepharon and motility restriction is challenging. A combined surgical procedure of intraoperative mitomycin C, amniotic membrane tr...Background: Treatment of eyes with multirecurrent pterygia associated with severe symblepharon and motility restriction is challenging. A combined surgical procedure of intraoperative mitomycin C, amniotic membrane transplantation and conjunctival limbal autograft was applied for treating such eyes. Methods: Seven eyes of seven patients who had previously undergone an average of four operations for pterygial removal and who manifested recurrent pterygia associated with severe symblepharon and motility restriction were involved in this retrospective study. The surgical procedures involved clearing fibrovascular membrane over the cornea, extensive excision of epibulbar fibrovascular tissue to the bare sclera, application of 0.02% mytomycin C onto the bare sclera for 5 min and transplantation of preserved human amniotic membrane and conjunctival limbal autograft. Results: Postoperatively, all seven eyes showed rapid epithelialization on the corneal surface in 3- 5 days and, on the conjunctival surface, in 10- 18 days. For a mean follow-up period of 22.46.± 1 months, six eyes recovered deep fornices, smooth and stable ocular surface and full ocular motility without recurrence. One eye showed regrowth of fibrovascular tissue and motility restriction but less severe than before surgery. No complication was noted due to mitomycin C. Conclusions: Combined intraoperative mitomycin C, amniotic membrane graft and limbal conjunctival autograft are successful approaches for treating multirecurrent pterygia with severe symblepharon to restore the ocular surface integrity and prevent recurrence.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Background: Treatment of eyes with multirecurrent pterygia associated with severe symblepharon and motility restriction is challenging. A combined surgical procedure of intraoperative mitomycin C, amniotic membrane transplantation and conjunctival limbal autograft was applied for treating such eyes. Methods: Seven eyes of seven patients who had previously undergone an average of four operations for pterygial removal and who manifested recurrent pterygia associated with severe symblepharon and motility restriction were involved in this retrospective study. The surgical procedures involved clearing fibrovascular membrane over the cornea, extensive excision of epibulbar fibrovascular tissue to the bare sclera, application of 0.02% mytomycin C onto the bare sclera for 5 min and transplantation of preserved human amniotic membrane and conjunctival limbal autograft. Results: Postoperatively, all seven eyes showed rapid epithelialization on the corneal surface in 3- 5 days and, on the conjunctival surface, in 10- 18 days. For a mean follow-up period of 22.46.± 1 months, six eyes recovered deep fornices, smooth and stable ocular surface and full ocular motility without recurrence. One eye showed regrowth of fibrovascular tissue and motility restriction but less severe than before surgery. No complication was noted due to mitomycin C. Conclusions: Combined intraoperative mitomycin C, amniotic membrane graft and limbal conjunctival autograft are successful approaches for treating multirecurrent pterygia with severe symblepharon to restore the ocular surface integrity and prevent recurrence.
