Surgical strategies for fornix reconstruction based on symblepharon severity
| Autor: | Victoria Casas, Gabriela Blanco, Scheffer C.G. Tseng, Ahmad Kheirkhah, Vadrevu K. Raju, Yasutaka Hayashida |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Alkylating Agents Visual acuity genetic structures Adolescent Eye disease Mitomycin Fibrin Tissue Adhesive Ophthalmologic Surgical Procedures Transplantation Autologous Conjunctival Diseases medicine Humans Amnion Oral mucosa Fibrin glue Child Aged Retrospective Studies Aged 80 and over Mucous Membrane business.industry Symblepharon Fornix Suture Techniques Middle Aged Plastic Surgery Procedures medicine.disease Combined Modality Therapy eye diseases Surgery Contact lens Transplantation Ophthalmology medicine.anatomical_structure Treatment Outcome Child Preschool Eyelid Diseases Female sense organs medicine.symptom business |
| Zdroj: | American journal of ophthalmology. 146(2) |
| ISSN: | 0002-9394 |
| Popis: | Purpose To identify surgical strategies of fornix reconstruction for symblepharon graded according to the length from the limbus to the lid margin, to the width, and to associated inflammation. Design Retrospective, comparative, interventional case series. Methods In 61 eyes with symblepharon, cicatrix lysis and amniotic membrane transplantation (AMT) were performed with sutures (n = 34) or fibrin glue (n = 27) together with (n = 47) or without (n = 14) intraoperative mitomycin C (MMC), plus fornix reconstruction using anchoring sutures without (n = 30) or with (n = 7) oral mucosal graft or with conjunctival autograft (n = 4). Overall, success was defined as an outcome of complete success (restoration of an anatomically deep fornix) or partial success (focal recurrence of scar), and failure was defined as the return of symblepharon. Results For a follow-up of 25 ± 10.8 months, the overall success was achieved by the first attempt in 52 eyes (85.2%) and failure resulted in nine eyes (14.8%); however, the success rate improved to 59 eyes (96.7%) with additional attempts. At the first attempt, AMT alone achieved overall successes in 92.8% of grade I eyes and in 100% of grade II eyes. Additional anchoring sutures achieved successes in 100% of grade I eyes, 70% of grade II eyes, and 71.4% of grade III/IV eyes. Additional oral mucosa or conjunctival autograft achieved successes in 100% of grade III/IV eyes. The complete success was correlated positively with lower grades of symblepharon or intraoperative use of MMC, but negatively correlated with younger ages, canthal involvement, or use of anchoring sutures. Anatomic improvement was accompanied by reduction of preoperative conjunctival inflammation (n = 40), improved visual acuity (n = 14), improved ocular motility (n = 18), improved eyelid closure (n = 3), and feasibility of contact lens wear (n = 10). Conclusions Successful outcome can be achieved by selectively deploying cicatrix lysis and AMT, intraoperative MMC, anchoring sutures, and oral mucosal or conjunctival autograft based on the severity of pathogenic symblepharon. |
| Databáze: | OpenAIRE |
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