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Raina Goyal, FRCS; Sophie M. Jones, MRCSEd, MRCOphth; Marcela Espinosa, FRCS; Vanessa Green, RGN; Ken K. Nischal, FRCOphth

Arch Ophthalmol. 2006;124:1435-1440.

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.

Author Affiliations: Department of Ophthalmology (Drs Goyal, Jones, Espinosa, and Nischal) and VCB Theatres (Ms Green), Great Ormond Street Hospital for Children, and Visual Sciences Unit, Institute of Child Health (Drs Goyal, Jones, Espinosa, and Nischal), London, England; and Dystrophic Epidermolysis Bullosa Research Association, Berkshire, England (Dr Jones).