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Published on: September 12, 2014
Amniotic membrane transplantation in children with symblepharon and massive pannus
Raina Goyal1, Sophie M Jones, Marcela Espinosa
1Department of Ophthalmology and VCB Theatres, Great Ormond Street Hospital for Children, and Visual Sciences Unit, Institute of Child Health, London, England.
Insights
Amniotic membrane transplantation effectively reconstructs ocular surfaces in children with severe conditions like epidermolysis bullosa. This procedure improves vision and comfort, offering lasting results for ocular surface disease.
Area of Science:
- Ophthalmology
- Regenerative Medicine
- Pediatric Surgery
Background:
- Severe ocular surface disease in children, including conditions like epidermolysis bullosa, often requires complex surgical interventions.
- Forniceal and ocular surface reconstruction are critical for restoring function and preventing further visual impairment in pediatric patients.
- Amniotic membrane transplantation (AMT) is a recognized therapeutic option for various ocular surface pathologies.
Observation:
- A retrospective review of four pediatric patients (five eyes) undergoing AMT for ocular surface and forniceal reconstruction was conducted.
- Diagnoses included epidermolysis bullosa, laryngo-onychocutaneous syndrome, and measles-related keratitis with HIV.
- Patients experienced improved ocular comfort and anatomical restoration of ocular surfaces post-surgery.
Findings:
- Mean visual acuity improved from 1.1 logMAR preoperatively to 0.7 logMAR postoperatively.
- Three out of five eyes showed improved visual acuity.
- Amniotic membrane transplantation demonstrated effectiveness in managing symblepharon and corneal scarring in pediatric cases, with better outcomes observed in patients with epidermolysis bullosa.
Implications:
- Amniotic membrane transplantation is a viable and effective surgical strategy for pediatric ocular surface and forniceal reconstruction.
- The procedure offers significant benefits in terms of visual acuity improvement and patient comfort for children suffering from severe ocular surface conditions.
- Further research with larger cohorts is warranted to confirm long-term efficacy and compare outcomes across different pediatric ocular surface pathologies.
Objective:
To report our pediatric experience with amniotic membrane transplantation for ocular surface and forniceal reconstruction.
Methods:
Retrospective case review of children who underwent superficial keratectomy, symblepharon lysis, and forniceal reconstruction using amniotic membrane transplantation. The underlying diagnosis, visual acuity, level of discomfort at first and last visits, and surgical details were noted.
Results:
Four patients (5 eyes) were included. Two patients had epidermolysis bullosa (1 recessive dystrophic and 1 junctional), 1 had laryngo-onychocutaneous syndrome, and 1 had measles-related keratitis and was positive for human immunodeficiency virus. Their mean age when initially seen was 8.7 years (age range, 4-16 years), and mean follow-up was 18.25 months (range, 12-29 months). The mean visual acuity preoperatively was 1.1 logMAR (logarithm of the minimum angle of resolution) (range, 1-1.3), and postoperatively was 0.7 (range, 0.2-1.2). All patients experienced increased ocular comfort with anatomical restoration of corneal and conjunctival surfaces. Visual acuity improved in 3 eyes. Only the patient with laryngo-onychocutaneous syndrome had recurrence of granuloma, at 9 months after surgery.
Conclusion:
Amniotic membrane transplantation with symblepharon lysis is effective for ocular surface reconstruction in the management of epidermolysis bullosa and other conditions that cause corneal scarring and symblepharon in children. In this small series, children with epidermolysis bullosa fared better and the effects of surgery lasted longer compared with patients with other causes of symblepharon and massive pannus.
