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. 1998 Mar;82(3):235–240. doi: 10.1136/bjo.82.3.235

Transplantation of amniotic membrane and limbal autograft for patients with recurrent pterygium associated with symblepharon

J Shimazaki 1, N Shinozaki 1, K Tsubota 1
PMCID: PMC1722509  PMID: 9602618

Abstract

AIM—Treatment of recurrent pterygium associated with symblepharon requires both suppression of fibrosis and reconstruction of limbal barrier. To achieve this, human amniotic membrane was transplanted and limbal autografts performed.
METHODS—Four patients with severe symblepharon resulting from multiple surgeries for pterygium were treated. Human amniotic membrane was obtained at caesarean section and preserved until surgery. After excision of the fibrous tissues, the amniotic membrane was placed on the sclera, and a limbal autograft transplantation was performed using limbal tissues taken from the affected eye.
RESULTS—Recurrence of symblepharon was not observed in any of the patients and significant suppression of the subconjunctival fibrosis was achieved. Ocular movement improved in all cases. Complete remission of pterygium regrowth occurred in three cases, and a slight (about 1 mm) recurrence occurred in one case. The limbal donor site showed the presence of mild depressions without the formation of pseudopterygium.
CONCLUSION—Transplantation of human amniotic membrane with a limbal autograft appears to be a promising surgical treatment for reconstructing the ocular surface in patients with recurrent pterygium associated with symblepharon.

 Keywords: pterygium; limbal transplantation; amniotic membrane; symblepharon

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Figure 1  .

Figure 1  

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Surgical steps of amniotic membrane and limbal autograft transplantation.(A) Subconjunctival fibrosis tissue is excised and sclera is exposed. (B) Amniotic membrane is placed on the sclera and secured with 9-0 silk sutures. Arrows indicate the margin of amniotic membrane. (C) A limbal autograft with bulbar conjunctiva is dissected from the superior limbal region of the operated eye. (D) The limbal graft (arrows) is transferred and secured to the nasal limbal region. (E) Surgical schema. Note limbal autograft placed on the amniotic membrane.

Figure 2  .

Figure 2  

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(A) Preoperative appearance of case 1. Severe symblepharon is formed. Inferior punctum is dislocated (arrow). (B) Postoperatively, symblepharon is lysed almost completely, and the central cornea is clear. (C) Case 2. A stalk-shaped symblepharon is seen preoperatively. (D) Symblepharon is lysed, and no recurrence of pterygium is noted. (E) Case 3. Severe subconjunctival fibrosis at the nasal region is recognised. (F) Postoperatively, the nasal conjunctiva is flat without fibrous tissue regrowth. (G) Case 4. Massive fibrosis is formed around the medial muscle. (H) Adhesion between medial muscle and canthus is lysed after the surgery. Note persistence of slight subconjunctival fibrosis at the 10 o'clock position.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adinolfi M., Akle C. A., McColl I., Fensom A. H., Tansley L., Connolly P., Hsi B. L., Faulk W. P., Travers P., Bodmer W. F. Expression of HLA antigens, beta 2-microglobulin and enzymes by human amniotic epithelial cells. Nature. 1982 Jan 28;295(5847):325–327. doi: 10.1038/295325a0. [DOI] [PubMed] [Google Scholar]
  2. Akle C. A., Adinolfi M., Welsh K. I., Leibowitz S., McColl I. Immunogenicity of human amniotic epithelial cells after transplantation into volunteers. Lancet. 1981 Nov 7;2(8254):1003–1005. doi: 10.1016/s0140-6736(81)91212-5. [DOI] [PubMed] [Google Scholar]
  3. Cardillo J. A., Alves M. R., Ambrosio L. E., Poterio M. B., Jose N. K. Single intraoperative application versus postoperative mitomycin C eye drops in pterygium surgery. Ophthalmology. 1995 Dec;102(12):1949–1952. doi: 10.1016/s0161-6420(95)30770-1. [DOI] [PubMed] [Google Scholar]
  4. Colocho G., Graham W. P., 3rd, Greene A. E., Matheson D. W., Lynch D. Human amniotic membrane as a physiologic wound dressing. Arch Surg. 1974 Sep;109(3):370–373. doi: 10.1001/archsurg.1974.01360030022006. [DOI] [PubMed] [Google Scholar]
  5. Copeland R. A., Jr, Char D. H. Limbal autograft reconstruction after conjunctival squamous cell carcinoma. Am J Ophthalmol. 1990 Oct 15;110(4):412–415. doi: 10.1016/s0002-9394(14)77023-0. [DOI] [PubMed] [Google Scholar]
  6. Dunn J. P., Seamone C. D., Ostler H. B., Nickel B. L., Beallo A. Development of scleral ulceration and calcification after pterygium excision and mitomycin therapy. Am J Ophthalmol. 1991 Sep 15;112(3):343–344. doi: 10.1016/s0002-9394(14)76738-8. [DOI] [PubMed] [Google Scholar]
  7. Frucht-Pery J., Ilsar M., Hemo I. Single dosage of mitomycin C for prevention of recurrent pterygium: preliminary report. Cornea. 1994 Sep;13(5):411–413. doi: 10.1097/00003226-199409000-00006. [DOI] [PubMed] [Google Scholar]
  8. Frucht-Pery J., Ilsar M. The use of low-dose mitomycin C for prevention of recurrent pterygium. Ophthalmology. 1994 Apr;101(4):759–762. doi: 10.1016/s0161-6420(94)31269-3. [DOI] [PubMed] [Google Scholar]
  9. Hayasaka S., Noda S., Yamamoto Y., Setogawa T. Postoperative instillation of low-dose mitomycin C in the treatment of primary pterygium. Am J Ophthalmol. 1988 Dec 15;106(6):715–718. doi: 10.1016/0002-9394(88)90706-4. [DOI] [PubMed] [Google Scholar]
  10. Houlihan J. M., Biro P. A., Harper H. M., Jenkinson H. J., Holmes C. H. The human amnion is a site of MHC class Ib expression: evidence for the expression of HLA-E and HLA-G. J Immunol. 1995 Jun 1;154(11):5665–5674. [PubMed] [Google Scholar]
  11. Kenyon K. R., Tseng S. C. Limbal autograft transplantation for ocular surface disorders. Ophthalmology. 1989 May;96(5):709–723. doi: 10.1016/s0161-6420(89)32833-8. [DOI] [PubMed] [Google Scholar]
  12. Kenyon K. R., Wagoner M. D., Hettinger M. E. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 1985 Nov;92(11):1461–1470. doi: 10.1016/s0161-6420(85)33831-9. [DOI] [PubMed] [Google Scholar]
  13. Lee S. H., Tseng S. C. Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol. 1997 Mar;123(3):303–312. doi: 10.1016/s0002-9394(14)70125-4. [DOI] [PubMed] [Google Scholar]
  14. Li D. Q., Tseng S. C. Three patterns of cytokine expression potentially involved in epithelial-fibroblast interactions of human ocular surface. J Cell Physiol. 1995 Apr;163(1):61–79. doi: 10.1002/jcp.1041630108. [DOI] [PubMed] [Google Scholar]
  15. Mastropasqua L., Carpineto P., Ciancaglini M., Enrico Gallenga P. Long term results of intraoperative mitomycin C in the treatment of recurrent pterygium. Br J Ophthalmol. 1996 Apr;80(4):288–291. doi: 10.1136/bjo.80.4.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Naumann G. O., Lang G. K., Rummelt V., Wigand M. E. Autologous nasal mucosa transplantation in severe bilateral conjunctival mucus deficiency syndrome. Ophthalmology. 1990 Aug;97(8):1011–1017. doi: 10.1016/s0161-6420(90)32471-5. [DOI] [PubMed] [Google Scholar]
  17. Pfister R. R. Corneal stem cell disease: concepts, categorization, and treatment by auto- and homotransplantation of limbal stem cells. CLAO J. 1994 Jan;20(1):64–72. [PubMed] [Google Scholar]
  18. Prabhasawat P., Barton K., Burkett G., Tseng S. C. Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology. 1997 Jun;104(6):974–985. doi: 10.1016/s0161-6420(97)30197-3. [DOI] [PubMed] [Google Scholar]
  19. Prasad J. K., Feller I., Thomson P. D. Use of amnion for the treatment of Stevens-Johnson syndrome. J Trauma. 1986 Oct;26(10):945–946. doi: 10.1097/00005373-198610000-00016. [DOI] [PubMed] [Google Scholar]
  20. Rennekampff H. O., Dohrmann P., Föry R., Fändrich F. Evaluation of amniotic membrane as adhesion prophylaxis in a novel surgical gastroschisis model. J Invest Surg. 1994 May-Jun;7(3):187–193. doi: 10.3109/08941939409018285. [DOI] [PubMed] [Google Scholar]
  21. Riordan-Eva P., Kielhorn I., Ficker L. A., Steele A. D., Kirkness C. M. Conjunctival autografting in the surgical management of pterygium. Eye (Lond) 1993;7(Pt 5):634–638. doi: 10.1038/eye.1993.146. [DOI] [PubMed] [Google Scholar]
  22. Rubinfeld R. S., Pfister R. R., Stein R. M., Foster C. S., Martin N. F., Stoleru S., Talley A. R., Speaker M. G. Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology. 1992 Nov;99(11):1647–1654. doi: 10.1016/s0161-6420(92)31749-x. [DOI] [PubMed] [Google Scholar]
  23. Shimazaki J., Yang H. Y., Tsubota K. Limbal autograft transplantation for recurrent and advanced pterygia. Ophthalmic Surg Lasers. 1996 Nov;27(11):917–923. [PubMed] [Google Scholar]
  24. Subrahmanyam M. Amniotic membrane as a cover for microskin grafts. Br J Plast Surg. 1995 Oct;48(7):477–478. doi: 10.1016/0007-1226(95)90123-x. [DOI] [PubMed] [Google Scholar]
  25. Tayyar M., Turan R., Ayata D. The use of amniotic membrane plus heparin to prevent postoperative adhesions in the rabbit. Tokai J Exp Clin Med. 1993 Jun;18(1-2):57–60. [PubMed] [Google Scholar]
  26. Thoft R. A. Keratoepithelioplasty. Am J Ophthalmol. 1984 Jan;97(1):1–6. doi: 10.1016/0002-9394(84)90438-0. [DOI] [PubMed] [Google Scholar]
  27. Trelford J. D., Trelford-Sauder M. The amnion in surgery, past and present. Am J Obstet Gynecol. 1979 Aug 1;134(7):833–845. doi: 10.1016/0002-9378(79)90957-8. [DOI] [PubMed] [Google Scholar]
  28. Tsubota K., Satake Y., Ohyama M., Toda I., Takano Y., Ono M., Shinozaki N., Shimazaki J. Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens-Johnson syndrome. Am J Ophthalmol. 1996 Jul;122(1):38–52. doi: 10.1016/s0002-9394(14)71962-2. [DOI] [PubMed] [Google Scholar]
  29. Vrabec M. P., Weisenthal R. W., Elsing S. H. Subconjunctival fibrosis after conjunctival autograft. Cornea. 1993 Mar;12(2):181–183. doi: 10.1097/00003226-199303000-00016. [DOI] [PubMed] [Google Scholar]
  30. Zohar Y., Talmi Y. P., Finkelstein Y., Shvili Y., Sadov R., Laurian N. Use of human amniotic membrane in otolaryngologic practice. Laryngoscope. 1987 Aug;97(8 Pt 1):978–980. [PubMed] [Google Scholar]
  31. van Herendael B. J., Oberti C., Brosens I. Microanatomy of the human amniotic membranes. A light microscopic, transmission, and scanning electron microscopic study. Am J Obstet Gynecol. 1978 Aug 15;131(8):872–880. doi: 10.1016/s0002-9378(16)33135-0. [DOI] [PubMed] [Google Scholar]
  32. van der Linden P. J., de Goeij A. F., Dunselman G. A., Erkens H. W., Evers J. L. Endometrial cell adhesion in an in vitro model using intact amniotic membranes. Fertil Steril. 1996 Jan;65(1):76–80. [PubMed] [Google Scholar]

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