Amniotic membrane transplantation for conjunctival surface reconstruction

PURPOSE: To determine whether preserved hu man amniotic membrane can be used to reconstruct the conjunctival defect created during surgical removal of a large lesion or during symblepharon lysis. METHODS: Amniotic membrane transplantation was performed in six consecutive patients (seven eyes) during removal of large conjunctival lesions and in nine patients (nine eyes) during removal of conjunctival scars or symblepharon. RESULTS: During a mean follow up period +/- SD of 10.9 +/- 9.1 months (range, 2.2 to 34.0 months), 10 patients (11 eyes) showed successful surface reconstruction without recurrence, five patients (five eyes) showed improved visual acuity, and one patient (one eye) showed epithelialization within 3 weeks and resolution of motility restriction. Two patients (two eyes) showed partial success, with surrounding conjunctival inflammation. Three cases (three eyes) failed and exhibited recurrent scarring: one patient had received mitomycin treatment and beta radiation, whereas the transplanted amniotic membrane of the second patient was partially, and of the third patient was completely, dissolved or replaced by the inflamed pseudopterygial tissue. Two patients (two eyes) had epithelial cyst formation. CONCLUSION: Amniotic membrane transplantation can be considered an alternative substrate for conjunctival surface reconstruction during removal for large tumors, disfiguring scars, or symblepharon, especially for those whose surrounding conjunctival tissue remains relatively normal.