Intraoperative Mitomycin C and Amniotic Membrane Transplantation for Fornix Reconstruction

Abstract

Abstract: : Purpose: In cicatricial ocular surface diseases such as Stevens Johnson Syndrome (SJS), ocular cicatricial pemphigoid (OCP) and chemical/thermal burns, symblepharon, foreshortening of fornix and chronic inflammation are difficult to manage and continue to threaten the success of ocular surface reconstruction. We investigated whether intraoperative application of MMC may enhance the success of amniotic membrane transplantation in symblepharon lysis and fornix reconstruction. Methods: Fifteen (8 female and 8 male) patients with mean ages of 41±23.4 years old including 7 eyes with severe chemical/thermal burns, 5 eyes with multiple recurrent pterygium, 4 eyes with SJS and 2 eyes with OCP were consecutively enrolled. All eyes had symblepharon and persistent ocular inflammation, and six eyes still had obliterated fornix and meniscus despite prior mucous membrane grafts for fornix reconstruction. After excision of subconjunctival fibrovascular tissues, 0.04% MMC was applied for five minutes in the deep fornix before amniotic membrane transplantation. Results: The mean epithelial healing time was 3.7±1.9 weeks. During the followed up of 7.2±5.3 months, all eyes were successfully reconstructed with a deep fornix and a continuous tear meniscus, with one eye with multiple recurrent pterygium and one with severe thermal burn, partial motility restriction recurred two months after surgery. Most notable finding was marked reduction of conjunctival inflammation in all eyes. Seven eyes were then successfully operated by additional surgeries to restore vision including KLAL with PKP (2 eyes) or without PKP (5 eyes). Conclusions: Intraoperative application of MMC is an effective means to reduce deep–seated conjunctival inflammation, and helps restore a deep fornix after symblepharon lysis even in eyes that had a failed mucous membrane graft. Restoration of deep fornix and tear meniscus is an important step to improve the outcome of subsequent limbal stem cell transplantation.

Keywords: conjunctiva • cornea: clinical science • clinical (human) or epidemiologic studies: outcomes/complications