METHODS: This non-comparative interventional case study was conducted from January 2013 to December 2015 and included a consecutive series of 14 eyes of 12 patients. Patients were selected for permanent AMT. The amniotic patches were grafted for the treatment of symblepharon. Cryo-preserved or freeze-dried amniotic membrane(AM)was used. Regarded to the 14 eyes(12 patients), their age was ranged from 26-62y, with the mean age of 43.38±11.25, 10 eyes of 8 patients(4 males/4 females)were presented with symblepharon secondary to previous pterygium surgery, and 4 eyes of 4 patients(1 male/3 females)were presented with symblepharon secondary to previous strabismus surgery, at least 6mo after the last surgery. The outcome of success was defined as restoration of a stable-depth fornix and being free of scar or inflammation, and no motility restriction during the follow up of 6mo.

RESULTS: The mean follow-up period was 7±4.2mo(range 6-9mo). In all 14 eyes, complete epithelialization of AM was observed 3wk after surgery, resulting in a non-inflamed appearance of the surgical site. Eight eyes out of total 14 eyes showed successful fornix reconstruction with success rate(57%), the fornix was deep, and no recurrence was observed. Four eyes(29%)showed partial success with moderate depth of the fornix and moderate scar. Two eyes(14%)showed failure of reconstruction of the fornix with complete fornix obliteration. The visual acuity improved after surgery in 7 eyes while remained stable in 7 eyes. Post-operative complications from the AMT was very limited as severe conjunctival reaction and motility restriction was occurred only in one eye out of 14 eyes(7%)and pyogenic granuloma occurred in 2 eyes out of 14 eyes(14%)in the first 3mo after surgery and was managed with surgical excision, with local corticosteroid injection.

CONCLUSION: AMT alone is a safe and effective method for symblepharon. Considering the potential adverse effects associated with limbal excision, also, AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders.