Processed amniotic membrane for conjunctival reconstruction in complex strabismus surgery

In ophthalmology amniotic membrane is usually used for the treatment of corneal ulcerations and chemical burns of the ocular surface. Also, it is useful in the treatment of conjunctival defects. There are few publications on the long-term outcomes with the use of amniotic membrane to replace the conjunctiva. In our cases, we used it in patients with restrictive strabismus or conjunctival problems during or following complex eye muscle surgery.

In this retrospective case study, we reviewed the charts of the patients who had been treated with Ambio5® (IOP Inc. USA) for the replacement of conjunctiva in the treatment of conjunctival problems during or following complex eye muscle surgeries in our ophthalmology department between 2009 and 2015. Ambio5® is a processed dry, multi-layered amniotic membrane of 110-micron thickness. Inclusion criteria were the use of it in the treatment of conjunctival problems during or following complex eye muscle surgery.

Thirty-two patients were identified. Among the 32 identified patients, 7 patients (6 female, 1 male) had restrictive conjunctiva following complex strabismus surgery with functional problems or aesthetic conjunctival scarring requiring transplantation. The mean age of these patients was 47 years (range: 22-60 years). Mean follow-up time was 32 months (range 18-55 months). Only one of these seven patients suffered a discomfort related to conjunctival scarring. The other six patients had restrictive strabismus, four of them suffered from Graves' ophthalmopathy. All patients improved although three patients developed symblepharon. One of these patients needed revision because of a symblepharon.

The result of our study indicates that commercially prepared amniotic membrane is a good alternative graft to replace conjunctiva. It helps to prevent or cure restrictive strabismus, scarring of the conjunctiva with discomfort, and lack of conjunctiva. It is possible that commercially storable products may increase the risk of symblepharon, the reason is unknown.