Clinical effect of amniotic membrane transplantation for reconstruction of conjunctival sac combined with orbital implantation

Objective To observe the clinical effect of amniotic membrane transplantation for reconstruction of conjunctival sac combined with orbital implantation. Methods Twenty three cases suffered of conjunctival constriction were treated with amniotic membrane transplantation for reconstruction of conjunctival sac and combined with orbital implantation simultaneously. Buried suture of inferior conjunctival fornix via skin next to the inferior orbital margin was performed. The preserved amniotic membrane was flattened onto the conjunctival defect area and the superior and lower eyelid were closed with mattress suture. The eyelids were opened and stained with fluorescein test paper every week in order to observe the growth of conjunctival epithelium. Stitches were removed two months after surgery and the suitable prosthesis was made.Results Conjunctival epithelium migrated to the surface of the amniotic membrane and covered it completely in 20 cases four weeks after surgery. Amniotic membrane was dissolved and conjunctival epithelium could not cover the defect areas in the rest 3 cases. Two months after surgery, 4 eyes of degree Ⅰ conjunctival sac constriction were all cured. In degree Ⅱ conjunctival sac constriction, 8 eyes were cured and 2 eyes were improved. In degree Ⅲ conjunctival sac constriction, 3 eyes were cured, 3 eyes improved, and 3 eyes failed. Among the failed eyes, one eye was underwent reconstruction of conjunctival sac again in six months. No exposure, secondary infection or symblepharon were occurred in 21 eyes with completed treatment, and these patients were satisfied with the good motility and the cosmetic results.Conclusion Preserved amniotic membrane transplantation for reconstruction of conjunctival sac combined with orbital implantation is safe and effective in degree Ⅰ and degree Ⅱ conjunctival sac constriction, but less than perfect in degree Ⅲ conjunctival sac constriction. (Chin J Ophthalmol,2005,41:1005-1008)