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A. Nava–Castaneda, J.–L. Tovilla–Canales, J.–L. Tovilla–y–Pomar, M.–H. Monroy–Serrano, V. Tapia–Guerra, L. Garnica; A combined approach for reconstruction of severe contraction of the conjunctival fornix using amniotic membrane transplantation and adjunctive Mitomicin C. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1482.
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Purpose: To evaluate the clinical outcome of patients with severe contraction of the conjunctival fornix secondary to different ocular surface diseases, who were treated with amniotic membrane transplantation and adjunctive application of Mitomicyn C (MMC) at 0.02% . Methods: After a complete ophthalmological evaluation, patients with symblepharon who accepted the treatment and had a signed consent were included. Evaluated parameters were depth of fornix formation, ocular motility and the final integrity of the amniotic membrane graft. Technique: Once the scarred tissue is removed from the affected conjunctiva, MMC–0.02% is applied over the surgical bed using a soaked microsponge for 60 seconds. Intensive irrigation with balanced salt solution is performed to wash out the MMC. The amniotic membrane graft is then sutured with 8–0 Vicryl suture to cover the conjunctival defect, and anchored to episclera as deep as possible in the fornix. Results: Twelve eyes were treated using this technique with a mean follow–up of 8.5 months. In 9 eyes a complete resolution of the symblepharon was obtained, achieving a deep fornix formation and full globe motility. Three patients with Stevens–Johnson syndrome had recurrence of symblepharon and recquired additional procedures. No graft necrosis or scleral melting were reported. Conclusions: In this study we demonstrated that rapid epithelization due to amniotic membrane transplantation associated with the antimetabolite properties of the topical application of MMC–0.02% increases the success rate in the management of severe symblepharon. Worst results were seen in patients with autoimmune disorders. We believe our results should encourage others to use the combined technique in the reconstruction of scarred fornices. Possible secondary effects associated to MMC should also be monitored with a longer follow–up.
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