Abstract
Objective: To describe the use of amniotic membrane (AM) in reoperations to decrease scar formation and to improve ductions. Design: Prospective interventional case series. Participants: Four previously operated cases with restrictive strabismus. Methods: Objective clinical findings were recorded during both pre and post-operative periods. Excision of adhesions and scar tissue, repositioning of extraocular muscles and placement of AM between muscle, sclera and tenon tissue were performed. Results: Orthophoria with no duction deficits was achieved in 2 patients. One patient with fat adherence syndrome had orthophoria with -1 adduction deficit. Only one patient with congenital fibrosis syndrome had 25 PD of esotropia with abduction deficit (-2). Conclusions: We believe that AM placement between the extra ocular muscle, sclera and tenon tissue improves the ductions by inhibiting post-operative scar formation.
Highlights
Reoperation may be expected in at least 5-10% of patients who undergo strabismus surgery, despite the most meticulous efforts to perform a careful preoperative evaluation and determine appropriate surgical strategy [1]
We believe that amniotic membrane (AM) placement between the extra ocular muscle, sclera and tenon tissue improves the ductions by inhibiting post-operative scar formation
Yamada et al published a case report on the successful treatment of restrictive strabismus occurring after retinal detachment surgery, Sheha et al [4] described wrapping the extraocular muscles with amniotic membrane in a case of consecutive exotropia, and Kersey and Vivian used amniotic membrane in conjunction with mitomycin C in 2 patients with complex strabismus surgery [3,4,5]
Summary
Reoperation may be expected in at least 5-10% of patients who undergo strabismus surgery, despite the most meticulous efforts to perform a careful preoperative evaluation and determine appropriate surgical strategy [1]. There are only a few reports in the literature on the use of amniotic membrane transplantation to treat restrictive strabismus. Yamada et al published a case report on the successful treatment of restrictive strabismus occurring after retinal detachment surgery, Sheha et al [4] described wrapping the extraocular muscles with amniotic membrane in a case of consecutive exotropia, and Kersey and Vivian used amniotic membrane in conjunction with mitomycin C in 2 patients with complex strabismus surgery [3,4,5]. Strube et al [6] reported a case series describing the use of amniotic membrane transplant to repair restrictive strabismus occurring after a variety of anterior segment, oculo plastic and retinal surgeries [6]
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