Symblepharon Research Articles

The Value of Conjunctival Immunohistochemistry Analysis for the Diagnosis of Ocular Mucous Membrane Pemphigoid

Ocular Mucous Membrane Pemphigoid (OMMP), a subset of Mucous Membrane Pemphigoid (MMP) is an autoimmunemediated progressive cicatrizing conjunctivitis with the potential for corneal blindness. Direct Immunofluorescence (DIF) is considered the gold standard for the diagnostic confirmation of this condition; nevertheless, in many cases, this immunopathological technique is inconclusive. A 54 years old female presented to our service complaining of progressive diminished visual acuity, foreign body sensation, and photophobia in both eyes. The slit-lamp examination showed bulbar and palpebral conjunctival hyperaemia, as well as bilateral corneal scarring. During clinical follow-up, progressive conjunctival scarring with inferior fornix foreshortening, symblepharon formation, and significant corneal opacity dramatically diminished her visual acuity. A conjunctival biopsy was negative for DIF; therefore, Immunohistochemical analysis (IHCA) for IgG, IgA, and C3 immune reactants linear deposition on the conjunctival Basement-membrane zone (BMZ) was necessary for diagnosis confirmation. The present clinical case highlights the utility of paraffin-embedded conjunctival IHCA as an alternative immunohistopathology tool for the diagnosis of OMMP when DIF is non-conclusive.

Analysis on the efficacy of biological amniotic membrane transplantation for complicated ocular surface diseases

Objective To evaluate the clinical efficacy of biological amniotic membrane transplantation in complicated ocular surface disease and ocular surface reconstruction. Methods The data of 74 eyes of 74 patients with complicated ocular surface disease from Jan. 2011 to Dec. 2016 were analyzed retrospectively. They underwent biological amniotic membrane transplantation. Results The most common primary diseases was recurrent pterygium in 25 eyes (33.78%), followed by corneal ulcer in 20 eyes (27.03%), chemical injury in 15 eyes (20.27%), symblepharon in 10 eyes (13.51%), persistent epithelial defects (PED) in 2 eyes (2.70%), eyelid basal cell carcinoma in 1 eye (1.35%) and Stevens-Johnson syndrome (SJS) in 1 eye (1.35%). After 6 - 24 months follow-up, there were 12 eyes (16.22%) reoperated, including pterygium recurrence in 3 eyes (3/25, 12.00%), corneal ulcer in 2 eyes (2/20, 10.00%), chemical injury in 4 eyes (4/15, 26.67%), symblepharon in 2 eyes (2/10, 20.00%), SJS 1 in eye (1/1, 100.00%). No infection, graft rejection or allergic reaction after surgery occurred. Conclusion Amniotic membrane transplantation is an effective method for the treatment of complicated ocular surface diseases. Key words: Transplantation, biological amniotic membrane; Diseases, ocular surface; Pterygium; Ulcer, corneal; Injury, chemical

Conjunctival-limbal autograft in total unilateral limbal stem cell deficiency

Background : Corneal epithelium is renewed by stem cells (SC) that reside at the corneal limbus. Reduced number of SC or their abnormal function lead to the ocular surface disease called limbal stem cell deficiency (LSCD), characterized by corneal conjunctivalization, vascularization, persistent epithelial defects, chronic inflammation, and loss of vision. In a case of total unilateral LSCD, autologous transplantation of limbal epithelial stem cells (LESC) from the healthy eye is needed. We describe the surgical technique of choice for autologous limbal transplantation, called conjunctival limbal autograft (CLAU) that we combined with amniotic membrane (AM) use. We present the results of CLAU in three patients with total unilateral LSCD due to chemical injury. Methods : Autologous limbal transplantation CLAU begins with the removal of fibrovascular pannus from the diseased corneal surface and the harvesting of two conjunctival-limbal grafts from the healthy eye. The grafts are then transplanted on to the limbal area of the recipient eye. AM is used as a patch to cover the denuded cornea and limbal grafts, as well as a barrier preventing the conjunctival epithelium from encroaching on to the temporal and nasal side of the corneal surface. In the donor eye, AM is used to cover the donor sites. CLAU with the use of AM was performed in 3 patients with unilateral LSCD due to chemical eye injury. In one patient limbal transplantation was combined with symblepharon lysis for entropium repair. In all cases AM was removed 3–6 days postoperatively to assess the growth of new epithelium from the limbal grafts. In all patients the ocular surface was covered with another AM until the cornea was completely epithelized and the new epithelium stable. In one patient the corneal regrafting and cataract removal was performed subsequently. Results : CLAU was successful in 2 patients and partially successful in 1 patient during the follow up. In all cases the growth of new epithelium from the limbal grafts was noted on day 3–6 after CLAU. The cornea was completely epithelized within 2 weeks in 2 patients and after 35 days in one patient. In two patients the corneal epithelium remained clear, smooth and stable during the follow up of 3.5 years and 4 months, respectively. In one patient, uneven epithelium probably representing a mosaic of corneal and conjunctival cells was noted in the central corneal region, where a small corneal ulcer developed 5 months after CLAU. In donor eyes no postoperative complications were noted, the donor sites epithelized within few days. Conclusions : Autologous limbal transplantation according to CLAU surgical technique combined with the use of AM is a successful and safe therapy for restoring corneal surface in total unilateral LSCD after chemical injury. It enables further surgical procedures for restoring the vision such as corneal transplantation and cataract surgery.

Efficacy of amniotic membrane transplantaion combined with limbal stem cell autograft transplantation for recurrent pterygium with symblepharon

Objective To evaluate the efficacy of amniotic membrane transplantation combined with limbal stem cell autograft transplantation for recurrent pterygium with symblepharon. Methods The data of 12 eyes of 12 cases with recurrent pterygium and symblepharon from Apr. 2013 to Aug. 2016 were collected and analyzed retrospectively. They underwent amniotic membrane transplantation combined with limbal stem cell autograft transplantation, and the application of mitomycin C during surgery. Results The follow-up period was 8-36 months, pterygium recurred in 1 case after surgery and the recurrent rate was 8.33%. No symblepharon or histolysis complication occurred. Conclusion Amniotic membrane transplantation combined with limbal stem cell autograft transplantation and application of mitomycin C intraoperatively for recurrent pterygium with symblepharon is efficient. Key words: Pterygium, recurrent; Symblepharon; Transplantaion, amniotic membrane; Transplantation, limbal stem cell autograft; Mitomycin C

Clinical analysis of 15 cases of paraquat-induced ocular chemical injury

Objective To investigate the clinical manifestation and therapeutic method of paraquat-induced ocular chemical injury. Methods A retrospective analysis was conducted on the clinical data of 21 eyes from 15 patients with paraquat-induced ocular chemical injury from July 2012 to June 2014. Results Specific pseudomembranous conjunctivitis was manifested on all patients. The treatment with rinsing conjunctival sac, antibiotic eye drops and autologous serum eye drops, as well as systematically injection with glucocorticoid were used combined with pseudomembrane removal. All patients were recovered well except symblepharon occurred on the zone of the fornix in one patient. Conclusion The specific clinical manifestation of paraquat-induced ocular chemical injury is conjunctival pseudomembrane. Those patients should to be rescued timely with the methods given above and they will recover well. Key words: Paraquat; Injury, chemical, ocular; Pseudomembrane, conjunctival

Treatment of ammonia Eye burn

Objective To observe the clinical efficacy of first aid and treatment of ocular ammonia burn. Methods Thirty-seven cases of ocular ammonia burn from January 2010 to December 2013 in our hospital were collected and randomly divided into two groups: the observation group with 23 eyes of 20 cases and the control group with 22 eyes of 17 cases. Patients in control group received first aid treatment and patients in observation group received first aid combined with systemic treatment. The therapeutic effect and the complications of two groups were all observed. Results In observation group the patients whose inflammation was significantly relieved accounted for 60.87% which was higher than 27.27% in control group (P=0.023); In observation group the corneal perforation rate was 13.04% which was lower than that in control group 40.91% (P=0.035). In observation group the incidence of conjunctivalization and extensive symblepharon were lower than that in control group (P=0.004, P=0.016). The ocular surface epithelization time in observation group was shorter than that in control group (P=0.035). Conclusion The clinical efficacy of proper first aid and systemic treatment of ocular ammonia burn is significant. Key words: Eye burn, ammonia; First aid; Treatment, systemic

A clinical investigation on amniotic membrane transplantation for ocular surface chemical burns in early stage

Objective To investigate the clinical effect of amniotic membrane transplantation for ocular surface chemical burns in early stage.Methods 24 eyes of 18 cases with ocular surface chemical burns in early stage were treated with amniotic membrane transplantation and were followed up for 3-12 months.The postoperative corrected visual acuity,the condition of amniotic membrane,renovation of cornea,and complication were observed.Results Postoperative corrected visual acuities were at ≤ 0.04 in 1 eye,0.05-0.1 in 2 eyes,0.12-0.25 in 5 eyes,≥0.3 in 16 eyes.95.8％ of eyes (23/24) avoided blindness and 66.7％ of eyes (16/24) avoided disability.The amniotic membrane survived in 24 eyes and the survival rate was 91.7％.The cornea of 8 eyes recovered to transparent eventually.The corneal nebula emerged in 14 eyes.The corneal macula emerged in 2 eyes and 1 eye ended up with corneal leucoma.Corneal neovascularization appeared in 6 eyes,18 eyes had stable ocular surface.The complications were pseudopterygium in 4 eyes and mild symblepharon in 2 eyes.Conclusion Amniotic membrane transplantation can be used to reconstruct ocular surface in the eyeballs with ocular surface chemical burns in early stage,which can effectively reduce inflammation,neovascularization and fibrous proliferation. Key words: Transplantation, amniotic membrane ; Surface, ocular; Burns, chemical

Evaluation of biological amniotic membrane transplantation for recurrent pterygium

Objective To evaluate the efficacy and safety of biological amniotic membrane transplantation for recurrent pterygium.Methods 12 cases(12 eyes) with recurrent pterygium were treated by pterygium resection + amniotic membrane transplantation.The post operative follow-up period was 1 year.Results 4 cases(4eyes) were recurrent.The recurrent rate was 33.3％.Visual acuity all improved postoperatively with no symblepharon or infection.Conclusion Amniotic membrane transplantation is a safe and effective method for recurrent pterygium surgery. Key words: Biological amniotic membrane; Pterygium, recurrent ; Surgical operation

Microsurgicai techniques in amniotic membrane patching for mild to moderate ocular surface burns

Objective To evaluate the use of amniotic membrane patches for mild or moderate eye burns at the stage of acute burns and the involved microsurgical techniques.Methods Thirty-four eyes with corneal burns of Ⅱ to Ⅲ degree in which may have partial limbal necrosis were accepted amniotic membrane patching (21 eyes) or pharmaceutical treatment (13 eyes).Four amniotic patches were procured and examined by transmitting electronic microscope when the exposed corneal surface became re-epithelialization after amniotic membrane inching.Results Amniotic patches became partially melting or prolapsed 5-10 (11± 2) days after surgery.The uncovered corneal surface showed quickly re-epithehalized.There were a few thin fibrovascular membrane invaded onto corneal surface in the patients with more than a half limbal necrosis.Postoperative visual acuity increased 1 to 6 (3.3 ± 1.2) lines.The electronic findings showed that most of the infiltrated polymorphonuclear neutrophils in the anmiotic patches became apoptosis.Corneal melting presented in four of 13 eyes who received only drug treatment and lamellar keratoplasty was then performed.The other eyes manifested pseudo-pterygium or symblepharon at different extent.Conclusion Amniotic,patches may reduce the inflammation of burned cornea and corneal neovascularization,accelerate re-epithelialization of corneal surface,even improve the rehabilitation of burned limbal stem cells. Key words: Amniotic membrane patching; Ocular surface reconstruction; Eye burns; Microsurgical technique

Combined implantation of auto-limbal epithelium and amniotic membrance for treatment of symblepharon

Objective To observe the auto-limbal epithelium and amniotic membrance transplantation in treatment of Symblepharon.Methods Transplant with auto-limbal epithelium and aminiotie membrance including 23 patients (31eyes) some of them are recurrentcd pterygium,most of them are symblepharons.[ Result ] In the followup period for 3～12 months,Ocular surface reconstruction was successful in 26 of 31 eyes with symb|epharon,but five of them recurrented three months later with lees than pre-transplantation in degree.Conclusion The transplantation with auto-limbal epithelium and membrance transplantation is an effective method for the symblepharon. Key words: Corneal transplantation; Amnion; Eyelids

Sarcoid-induced symblepharon

Sarcoid-induced symblepharon

Experimental study on the effects of chitosan on the conjunctiva scar formation and symblepharon

To study the effects of chitosan on preventing symblepharon, reducing conjunctiva scar formation and promoting epithelial healing in the treatment of keratoconjunctival alkali burn. Keratoconjunctival alkali burn model of New Zealand rabbits was induced in the present study. Twenty-one rabbits were randomly selected from 26 rabbits to induce the alkali burn. Right eyes were treated with chitosan (treatment group), left eyes were non-treated (experimental control group). Five rabbits were used as normal control group. The symblepharon, conjunctiva scar formation and the inflammatory reaction of cornea and conjunctiva were observed by slit lamp. Histopathologic studies were performed 20 and 30 d after alkali burn. The amount of collagen in the conjunctiva and the scar formation process was evaluated by sirius red staining 30 d after alkali burn. The degrees of the symblepharon and conjunctiva scar formation in the treatment group were less than those in the experimental control group (u = 2.1159, P < 0.05). The amount of collagen in the conjunctiva was increased and the conjunctiva scar was formed after alkali burn, but the amount of collagen, which was evaluated by the area (Q = 32.1450, P < 0.01) and integral spectra (Q = 22.4767, P < 0.01) of sirius red staining in the treatment group was much lower than that of the experimental control group. Chitosan is effective in preventing symblepharon and reducing scar formation in the treatment of keratoconjunctival alkali burn.

Long-term results of amniotic membrane transplantation for conjunctival surface reconstruction

To investigate the long-term results of amniotic membrane transplantation (AMT) for conjunctival surface reconstruction after symblepharon resection and analysis the related factors. Fifty-one cases (55 eyes) with symblepharon due to eye burns (chemical or heat) or Stevens-Johnson syndrome were selected for symblepharon resection and AMT. Ten eyes were performed within 1 year and twenty-three eyes in 1.0 to 8.0 years after chemical eye burns. Observation time varied from 26.0 to 30.0 months [mean value (27.4 +/- 2.6) months]. No necrosis and ulceration were found in all amnion grafts at the early stage after transplantation. Deep conjunctival fornix and free of eye movement were obtained in 56.4% (31/55) of those eyes received surgery. Slight symblepharon recurrence and limited eye movement restrict were revealed in 16.4% of them (9/55), Fifteen eyes of them (27.3%) shown moderate recurrence of symblepharon. The effects of AMT for those patients with different degree of symblepharon had significant difference statistically (Pearson Chi-Square, P = 0.000). The same results were observed between those patients who were performed in different time after chemical eye burns (Likelihood Ratio, P = 0.039) and with different severity of dry eye (Pearson Chi-Square, P = 0.000). Amniotic membrane can be used to reconstruct ocular surface effectively, but multiple surgeries may be needed. These microenvironments such as symblepharon severity, dry eye, and whether remained partial healthy conjunctiva in the affected eyes before surgery will influence the long-term results of AMT for conjunctival surface reconstruction.

A Case of Complete Symblepharon Successfully Treated by Operation

A Case of Complete Symblepharon Successfully Treated by Operation

52. Symblepharon treated successfully by Blandin??s Method

52. Symblepharon treated successfully by Blandin??s Method