97th DOG Annual Meeting 1999



S. Walter, H. Mittelviefhaus

We report our experiences on the transplantation of preserved human amniotic membrane in reconstruction of the eye surface in a case of complete symblepharon.

Patient: A 10 year old patient with a combined T- and B-lymphocyte immune defect developed progressive scarring of the mucous membranes of his nose and eyes after varicella-zoster infection. The severe scarring of the nasal mucosa caused complete bilateral obstruction of the nasal airways. The bilateral entropion could be improved by anterior lamellar repositioning and by transplantation of oral mucosa. Treatment was complicated by scarring and contraction of the donor side of the mucosal graft. After initial improvement the conjunctival and corneal epithelium of the right eye was destroyed and vision was lost completely due to symblepharon. As destructive scarring of the left eye progressed, bilateral transplantation of amniotic membrane was performed before complete symblepharon of the left eye occurred.

Method: Scar tissue was excised on the right eye and the entire eye surface including the conjunctival side of the lids was covered with amniotic membrane. On the left eye amniotic membrane was transplanted only on to the conjunctival side of the upper lid, in the upper fornix, on the cornea and partially on the lower conjunctiva sparing the lower fornix and the lower lid. The transplanted amniotic membrane was then sutured underneath the residual conjunctiva, which seemed macroscopically normal. Amniotic membranes were donated by the cornea bank of the Universit├Ąts-Augenklinik Heidelberg.

Results: Three months after transplantation of amniotic membrane recurrent symblepharon and entropion developed, but surprisingly only on the initially better left eye at the lower fornix where the conjunctiva had not been replaced by amniotic membrane. In the fornices of the right eye and in the upper fornix of the left eye, which had been completely covered with amniotic membrane, no additional scarring was observed.

Conclusion: In our patient with symblepharon and completely destroyed conjunctiva the transplantation of amniotic membrane was able to prevent the development of new symblepharon and helped to preserve vision. In contrast to current therapy concepts it might be necessary to remove the entire pathological conjunctiva before transplantation of amniotic membrane in order to prevent recurrent contraction and progression of symblepharon.

Universit├Ąts-Augenklinik, Killianstr. 5, D-79106 Freiburg