[Ocular surface reconstruction for severe symblepharon resulting from eye burns].

OBJECTIVE

To evaluate the efficacy of lamellar keratoplasty (LKP) using fresh graft with limbus, combined with conjunctival limbal autograft transplantation (CLAT) and amniotic membrane transplantation (AMT), in treating severe symblepharon resulting from eye burns.

METHODS

Patients with severe symblepharon visited our hospital between February 1998 and February 2003 were divided into 4 degrees based on impairment of visual function. Pseudopterygium was partially dissected after separation of conjunctival adhesion, the corneal lesion was covered with partial (17 eyes) or total (9 eyes) lamellar corneal graft. Autologous limbal graft was placed onto the most seriously damaged limbus. Then the preserved pseudopterygium was receded with AMT to reconstruct fornix. All cases were followed up for 8 months to 3 years. Eye movement, diplopia, development of corneal grafts, preserved pseudopterygium and transplanted amniotic membrane were observed.

RESULTS

25 eyes, except that 1 eye because of irreformable lagophthalmos, got considerable improvement. Conjunctival adhesion was completely relieved and diplopia disappeared in 17 eyes. Adhesion recurred in the area covered only with amniotic membrane in 8 eyes, and 5 of them were completely relieved after one or two adhesion excisions combined with autologous conjunctival transplantation. Mild adhesion still remained in 3 eyes. Amniotic membrane began autolyzing at 1 week and completely disappeared 3 months after operation. Pseudopterygium began thinning at 1 to 3 months. Immune rejection occurred in 6 eyes, and 2 of them had second LKP.

CONCLUSIONS

LKP using fresh graft with limbus, combined with CLAT and AMT, is an ideal treatment for severe symblepharon resulting from eye burns. Pseudopterygium can partly substitute conjunctiva to reconstruct fornix. Amniotic membrane facilitates ocular surface reconstruction by temporary protection of lesions.