Symblepharon Release and Fornix Reconstruction after Ocular Chemical Injury: Outcomes from a Decade-Long Clinical...

To evaluate anatomical, visual and cosmetic rehabilitation outcomes of symblepharon release with fornix reconstruction (SR-FR) in eyes with chronic chemical injury and identify factors influencing surgical success.

Retrospective observational study of patients undergoing SR-FR for chemical injury-related symblepharon over 10 years at a tertiary eye care centre. Symblepharon severity, surgical techniques, epithelial healing and demographics were recorded. Anatomical (success, partial success and failure), visual rehabilitation and cosmetic rehabilitation outcomes were analysed. Multivariate ordinal logistic regression identified factors associated with anatomical outcome.

The study involved 125 fornices in 118 patients. Median age at injury was 7 years (IQR 4-19) and at SR-FR 12 years (IQR 5-24), with a median follow-up of 15 months (IQR 8-36). Successful anatomical outcome was achieved in 61.6% after the first procedure, increasing to 84.8% after final reconstruction. Severe symblepharon was associated with lower success rates and greater need for repeat attempts (p=0.027). On multivariate analysis, symblepharon grade was an independent predictor of anatomical outcome (p=0.005), while epithelial healing was associated with improved outcome (p=0.046); delayed epithelial healing was independently associated with poorer outcome (p=0.011); age, gender, chemical type, mitomycin-C use and fornix-forming sutures were not significant. Visual improvement was independent of anatomical success and primarily limited by ocular comorbidities.

SR-FR is an effective approach for anatomical restoration. Symblepharon severity is an independent predictor of outcome, while delayed epithelialisation is a clinically relevant early postoperative indicator of poorer outcomes. Visual recovery is largely determined by associated ocular comorbidities.