Symblepharon

Abstract: Conjunctiva has to be replaced when a large enough area is destroyed so as to cause a high degree of symblepharon or entropion or when the socket is too small to carry a prosthesis. Most common causes of its destruction are chemical and thermic burns and trachoma. Rare causes are malignant tumor, pemphigus, tuberculous ulcer, mechanical injury and amyloid and hyaline degeneration. Conjunctiva can be replaced primarily immediately after its loss. This has to be done after the removal of the necrotic conjunctiva. Denig 1 introduced the method by which necrotic conjunctiva is removed immediately after the chemical burn and the defect is covered with mucous membrane. However, the conjunctiva usually has to be replaced when symblepharon has already developed. Veasey 1a revised the materials which are or have been used to cover the defects of the conjunctiva. These consist of grafts of conjunctiva, of the inner surface of the

Abstract: Transplantation of preserved human amniotic membrane (AM) can be considered one of the major new developments in surgery of the ocular surface Although the first ophthalmological use of AM documented in the international literature took place almost 70 years ago, amniotic membrane transplantation (AMT) has only been performed in larger numbers of patients since 1995, with promising results (1– 3) Various disorders of the ocular surface, including persistent epithelial defects of the cornea, acute chemical burns with long-term loss of integrity of the ocular surface epithelium or conjunctival scarring as a result of the healing of mucous membrane disorders still pose a clinical challenge in ophthalmic surgery Since modern preservation methods were introduced, the innermost layer of the placenta, the AM, procured in sterile conditions following a Cesarean section, has experienced a renaissance as a basement membrane substitute Today it is hard to imagine reconstructive surgery of the ocular surface without it (1– 3) In 2008, a total of 2308 AMTs were performed in Germany (seehttp://wwwdogorg/?cat=121, in German) The many possible applications of AM established since then range from grafts via patches to a culture substrate/carrier for ex vivo cultivation of ocular surface epithelium Each type of application yields histologically different integration patterns for AM in the host corneal tissue (4) The most important indications in reconstructive surgery of the ocular surface are persistent epithelial defects of the cornea with corneal ulceration of varying etiology, covering defects after surgical removal of large conjunctival lesions, acute chemical burns, symblepharon and fornix reconstruction in healing conjunctival disorders, and limbal stem cell deficiency of the cornea with simultaneous stem cell grafting (5– 7) This review article presents information obtained from the authors’ scientific and clinical activities and a selective search of PubMed literature using the search terms “amniotic membrane,” “cornea,” and/or “conjunctiva” ranging from 1994 to 2009 It reports new developments, mechanisms of action, and established indications of AMT