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Mahmoudzadeh R, Oh GJ, Patel N, Patel SN, Tien T, Xu D, Finklea BD, Gupta OP, Ayres BD, Khan MA. Pars plana vitrectomy and scleral-fixated intraocular lenses: comparison of Gore-Tex suture and flanged intrascleral haptic fixation techniques. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00138-8. [PMID: 38815959 DOI: 10.1016/j.jcjo.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/08/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To compare clinical outcomes of combined pars plana vitrectomy (PPV) and secondary scleral fixation of an intraocular lens (IOL) using Gore-Tex suture versus flanged intrascleral haptic fixation (FIHF) using double needles. DESIGN Single-centre retrospective cohort series. PARTICIPANTS Eyes undergoing PPV with simultaneous scleral fixation of an IOL. METHOD Eyes that underwent fixation of a Bausch & Lomb Akreos AO60 or enVista MX60E IOL using Gore-Tex suture or a Tecnis ZA9003 or Zeiss CT LUCIA 602 IOL using FIHF were included. The primary outcome was change from baseline visual acuity to postoperative month 3. Secondary outcomes included deviation from refractive target aim and rates of postoperative complications. RESULTS Seventy-nine eyes of 72 patients were included. Mean (±SD) follow-up was 16 ± 10.5 months (range, 4.5-45.2 months). Fifty-three eyes (67.1%) underwent Gore-Tex suture fixation, and 26 eyes (32.9%) underwent FIHF. Across all eyes, mean visual acuity improved from 1.30 ± 0.74 logMAR (20/399 Snellen equivalent) preoperatively to 0.36 ± 0.36 logMAR (20/45 Snellen equivalent) at 3 months (p < 0.001). No difference in visual acuity at month 3 was noted between the 2 techniques (p = 0.34). Mean deviation from refractive target aim was not significantly different between the Gore-Tex and FIHF groups (+0.14 ± 1.33 D vs -0.16 ± 0.88 D; p = 0.45). Reoperation rates were similar between groups (2 of 53 eyes in the Gore-Tex group vs 3 of 26 eyes in the FIHF group; p = 0.32). CONCLUSION Combined PPV and scleral fixation of IOLs with Gore-Tex suture and FIHF resulted in similar improvements in visual acuity. No significant differences in refractive outcome and postoperative complication profiles were noted.
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Affiliation(s)
| | - Glenn J Oh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Neil Patel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Samir N Patel
- Retina Service, Wills Eye Hospital, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Thomas Tien
- Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - David Xu
- Retina Service, Wills Eye Hospital, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Brenton D Finklea
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - Omesh P Gupta
- Retina Service, Wills Eye Hospital, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Brandon D Ayres
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - M Ali Khan
- Retina Service, Wills Eye Hospital, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
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Aryasit O, Panyavisitkul Y, Damthongsuk P, Singha P, Rattanalert N. Factors affecting anophthalmic socket reconstruction outcomes using autologous oral mucosal graft. BMC Ophthalmol 2024; 24:150. [PMID: 38575898 PMCID: PMC10993518 DOI: 10.1186/s12886-024-03301-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 01/15/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Limited studies have reported surgical outcomes that are defined by strict criteria following grade 2 or 3 socket reconstruction using an oral mucosal graft (OMG). We aimed to determine factors influencing surgical outcomes of anophthalmic socket reconstruction using OMG in patients with grade 2 or 3 socket contractures. METHODS Thirty-seven patients who underwent socket reconstruction with autologous OMG between January 2007 and December 2017 were retrospectively analyzed. The successful outcome was defined as an eye prosthesis wearing without experiencing displacement and the absence of any re-operations or additional surgeries following socket reconstruction. Factors affecting surgical outcomes were identified using multivariate analysis. RESULTS A total of 15 male and 22 female patients (mean age: 40.2 ± 17.2 years) were included. The median duration of socket contracture was 21.5 years. Grade 2 and 3 socket contractures, based on Tawfik's classification, were reported in 20 and 17 patients, respectively. Twenty-eight and eight patients underwent socket reconstruction using OMG alone and OMG combined with a hard palate graft, respectively. The success rates of grades 2 and 3 socket contracture reconstruction were 80.0% and 52.9%, respectively. Multivariate analysis demonstrated that only grade 3 contractures were predictive of worse outcomes. At the final visit (mean follow-up: 6.3 years), 34 patients (91.9%) could wear their eye prostheses. CONCLUSIONS Socket reconstruction using autologous OMG can provide acceptable results in grade 2 and 3 contractures; however, satisfactory results were more significantly reported in grade 2 than in grade 3 contractures.
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Affiliation(s)
- Orapan Aryasit
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15, Kanjanavanich Road, Kohong, Hat Yai, Songkhla, 90110, Thailand.
| | - Yanin Panyavisitkul
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15, Kanjanavanich Road, Kohong, Hat Yai, Songkhla, 90110, Thailand
| | - Parichat Damthongsuk
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15, Kanjanavanich Road, Kohong, Hat Yai, Songkhla, 90110, Thailand
| | - Penny Singha
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15, Kanjanavanich Road, Kohong, Hat Yai, Songkhla, 90110, Thailand
| | - Narisa Rattanalert
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 15, Kanjanavanich Road, Kohong, Hat Yai, Songkhla, 90110, Thailand
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Song P, Liu Y, Du C, Lei Z, Ai J, Li G, Jing K. IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch promotes angiogenesis in transplanted flap and inhibits inflammatory response. BMC Surg 2023; 23:144. [PMID: 37245036 DOI: 10.1186/s12893-023-02024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 05/03/2023] [Indexed: 05/29/2023] Open
Abstract
Skin flap transplantation is one of the most common tissue transplantation methods for wound repair and organ reconstruction in plastic surgery. During the transplantation process, the inflammatory response of transplanted flap and angiogenesis are critical to the successful rate of skin flap transplantation. In recent years, to improve the biocompatibility and cell affinity of biomedical materials, the modified biomaterials have gradually become a popular subject in scientific researches. In our study, the IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch IL4-e-PTFE was prepared, and the rat skin flap transplantation model was constructed. The results of cell experiment prove that IL-4 has potentiation in the angiogenesis of human umbilical vein endothelial cell (HUVEC) induced by monocyte, and IL-4 can also promote angiogenesis by inducing the M2 macrophages. According to the results of in vivo experiment, the apoptosis level of transplanted flap cells of rats in the IL4-e-PTFE group was lower than that in the e-PTFE group, and in the IL4-e-PTFE group, the expression levels of pro-inflammatory cytokines IL-1β, IL-6 and TNF-α showed significantly decline compared to the e-PTFE group, while the expression levels of anti-inflammatory cytokines IL-1Ra, IL-10 and TGF-β presented significant increase compared to the e-PTFE group; the immunofluorescence staining results show that the number of M2 macrophages in transplanted flap area of rats in the IL4-e-PTFE group was significantly higher than that in the e-PTFE group, and the angiogenesis level was remarkably improved. In this study, by preparing IL4-e-PTFE and carrying out the cell and in vivo experiments, a reference method is proposed, which can reduce the inflammatory response during skin transplantation process using e-PTFE and optimize the long-term effects of flap blood vessels, hoping to provide a broader space for the applications of e-PTFE in medicine.
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Affiliation(s)
- Peng Song
- Department of Burns Microsurgery, Henan Province Hospital of TCM, the Second Affiliated Hospital of Henan University of Chinese Medicine, No. 6 Dongfeng Road, Jinshui District, Zhengzhou, Henan Province, 450000, China.
| | - Yizheng Liu
- Department of Burns Microsurgery, Henan Province Hospital of TCM, the Second Affiliated Hospital of Henan University of Chinese Medicine, No. 6 Dongfeng Road, Jinshui District, Zhengzhou, Henan Province, 450000, China
| | - Chenfei Du
- Department of Burns Microsurgery, Henan Province Hospital of TCM, the Second Affiliated Hospital of Henan University of Chinese Medicine, No. 6 Dongfeng Road, Jinshui District, Zhengzhou, Henan Province, 450000, China
| | - Zhen Lei
- The Central Laboratory, Henan Province Hospital of TCM, the Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jinwei Ai
- Department of Burns Microsurgery, Henan Province Hospital of TCM, the Second Affiliated Hospital of Henan University of Chinese Medicine, No. 6 Dongfeng Road, Jinshui District, Zhengzhou, Henan Province, 450000, China
| | - Guanghui Li
- Department of Burns Microsurgery, Henan Province Hospital of TCM, the Second Affiliated Hospital of Henan University of Chinese Medicine, No. 6 Dongfeng Road, Jinshui District, Zhengzhou, Henan Province, 450000, China
| | - Kai Jing
- Department of Burns Microsurgery, Henan Province Hospital of TCM, the Second Affiliated Hospital of Henan University of Chinese Medicine, No. 6 Dongfeng Road, Jinshui District, Zhengzhou, Henan Province, 450000, China
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Mattout HK, Fouda SM, Al-Nashar HY. Evaluation of Topical Mitomycin-C Eye Drops After Reconstructive Surgery for Anophthalmic Contracted Socket. Clin Ophthalmol 2021; 15:4621-4627. [PMID: 34916774 PMCID: PMC8667192 DOI: 10.2147/opth.s343550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the outcomes of using topical mitomycin-C (MMC) after reconstructive surgery for contracted socket and to compare the results with those of the conventional postoperative treatment. Patients and Methods The medical records of patients who underwent reconstructive surgery for contracted anophthalmic socket were retrospectively reviewed. Based on the postoperative treatment protocol, two groups of patients were identified; group I (15 patients) who received topical MMC drops (0.02%) 4 times daily for 6 weeks and group II (15 patients) who received the conventional treatment (topical antibiotic-steroid combination). Preoperative data were extracted for age, gender, cause and timing of anophthalmia, history of previous surgeries, preoperative forniceal depth and socket volume (SV). The main postoperative outcome measures were superior fornix depth (SFD), inferior fornix depth (IFD) and SV at the end of 6th postoperative month. Prosthesis fitting and complications were also considered for analysis. Results The mean preoperative IFD was 1.67±0.04 mm in group I and 1.58±0.37 mm in group II, by the end of the 6th postoperative month it increased to 6.1 ±0.27 mm and 5.12 ±0.25mm, respectively. The mean preoperative SFD in group I was 8.3±0.9 mm and 8.9±1.1 mm in group II, by the end of the 6th postoperative month SFD became 13.4±1.2 mm and 10.2±1.4 mm in groups I and II, respectively. The mean SV measured six months postoperatively was 1.9±0.2 mL and 1.3±0.09 mL in groups I and II, respectively. These differences in the postoperative SFD, IFD and SV between both groups were statistically significant. More cases reported successful fitting in group I than in group II but this difference was not statistically significant. Conclusion Postoperative use of topical MMC is associated with higher forniceal depth and greater SV when compared to the conventional treatment in socket reconstructive surgeries with amniotic membrane graft (AMG).
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Affiliation(s)
- Hala K Mattout
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh M Fouda
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Haitham Y Al-Nashar
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Long-Term Results of Autologous Auricular Cartilage Graft Applied in Anophthalmic Orbits Unable to Wear Prosthesis. J Ophthalmol 2019; 2019:7197063. [PMID: 31093371 PMCID: PMC6481011 DOI: 10.1155/2019/7197063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/24/2019] [Indexed: 11/17/2022] Open
Abstract
In anophthalmic patients, shallow lower fornices make wearing ocular prostheses impossible and maintaining normal social activities difficult. This study retrospectively investigated the long-term surgical outcomes of autologous auricular cartilage grafting for contracted orbits. From 1995 to 2013, 29 anophthalmic contracture sockets with inadequate lower fornices and poor prosthesis retention presented to Chang Gung Memorial Hospital in Linkou, Taiwan, were treated using this surgical method. The success rate, aesthetic outcome, recurrence, and complications were analyzed. Among the 29 patients, 15 were women, 14 were men, their mean age was 45 years, and the mean follow-up time was 52 months (range = 6–159 months). Satisfactory lid position was achieved in 25 cases (86%), and lower fornix retraction recurred in four cases (14%). Neither donor site morbidity nor auricular deformity was noted during the follow-up period. Therefore, an auricular cartilage graft can be used successfully as a compatible spacer for anophthalmic patients with shallow lower fornices and prosthesis-fitting problems in long-term follow-up.
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COMBINED PARS PLANA VITRECTOMY AND SCLERAL FIXATION OF AN INTRAOCULAR LENS USING GORE-TEX SUTURE: One-Year Outcomes. Retina 2018; 38:1377-1384. [PMID: 28492433 DOI: 10.1097/iae.0000000000001692] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the 1-year clinical outcomes of combined pars plana vitrectomy and ab externo scleral fixation of an intraocular lens using Gore-Tex suture. METHODS Retrospective, interventional case series. Outcome measures were change in visual acuity and occurrence of intraoperative and postoperative complications with minimum follow-up of 1 year. RESULTS Eighty-four eyes of 83 patients were identified. The mean best available visual acuity improved from 20/782 preoperatively to 20/65 postoperatively (P < 0.001). The mean follow-up was 598 ± 183 days (median 533 days, range 365-1,323 days). There were no intraoperative complications noted. A Bausch & Lomb Akreos AO60 intraocular lens was implanted in 77 eyes and an Alcon CZ70BD in 7 eyes. Postoperative complications included transient vitreous hemorrhage in six eyes (7.1%), cystoid macular edema in four eyes (4.8%), ocular hypertension in three eyes (3.6%), hyphema in two eyes (2.4%), and transient corneal edema in two eyes (2.4%). There were no cases of postoperative endophthalmitis, suture erosion/breakage, hypotony, retinal detachment, suprachoroidal hemorrhage, choroidal detachment, uveitis-glaucoma-hyphema syndrome, or persistent postoperative inflammation during the follow-up period. CONCLUSION Combined pars plana vitrectomy and ab externo scleral fixation of an intraocular lens with Gore-Tex suture was well tolerated at a minimum of 1-year follow-up. No suture-related complications were encountered.
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Zhao D, Yin HY, Cheng A, Chen R, Sheha H, Tseng SC. Sealing of the gap between the conjunctiva and tenon capsule to improve symblepharon surgery. Am J Ophthalmol 2015; 160:438-446.e1. [PMID: 26093286 DOI: 10.1016/j.ajo.2015.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/07/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the surgical outcome of "sealing the gap" in treating symblepharon caused by various etiologies other than recurrent pterygium. DESIGN Retrospective, interventional case series. METHODS Sixteen eyes of 14 patients with pathogenic symblepharon were consecutively operated by conjunctival recession, sealing the gap between recessed conjunctiva and Tenon capsule with a running 9-0 nylon suture, and covering of the bare sclera with amniotic membrane. For severe symblepharon where there was conjunctival shortening, oral mucosa graft was added. Outcome measures include ocular surface inflammation, fornix reformation, and restoration of ocular motility. RESULTS The underlying causes of symblepharon included Stevens-Johnson syndrome (n = 6), chemical burn (n = 5), ocular cicatricial pemphigoid (n = 1), thermal burn (n = 1), following excision of conjunctival squamous cell carcinoma (n = 1), conjunctival scarring following exposed buckle (n = 1), and immune dysregulation (n = 1). Twelve eyes (75%) had an average of 1.6 ± 0.9 previous surgeries. Before surgery, ocular motility restriction was significantly correlated with the severity of symblepharon. During the follow-up period of 17.1 ± 13.6 months, 13 eyes (81.3%) achieved complete success, 2 eyes (12.5%) achieved partial success, and 1 eye with immune dysregulation had failure (6.3%). There was no correlation between the success rate and the severity of symblepharon. After surgery, the ocular motility and inflammation were significantly improved. Visual acuity had improved in 2 of 15 eyes. CONCLUSIONS Sealing the gap between the conjunctiva and Tenon capsule is an important step in the surgical management of pathogenic symblepharon. This method not only avoids the use of mitomycin C, but also creates a strong barrier to prevent recurrence, restore ocular surface integrity, reform a deep fornix, and regain full ocular motility.
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Wei YH, Liao SL. The reconstruction of a contracted eye socket using a post-auricular full-thickness skin graft. Graefes Arch Clin Exp Ophthalmol 2014; 252:821-7. [PMID: 24599661 DOI: 10.1007/s00417-014-2600-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/03/2014] [Accepted: 02/06/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report the efficacy of a full-thickness skin graft (FTSG) for the reconstruction of a contracted eye socket. DESIGN A retrospective, non-comparative, interventional case series. METHODS This was a retrospective review of patients with a contracted eye socket who underwent socket reconstruction using a post-auricular FTSG from 2001 to 2011 at the National Taiwan University Hospital. The postoperative results including prosthetic fitting, the cosmetic result, and eyelid function were assessed. RESULTS There were 11 male and 15 female patients, with a mean age of 52.3 ± 15.6 years (range 21 to 76). The duration of the socket contracture varied from three months to three years (average 7.4 ± 8.1 months). The severity of the socket contracture ranged from grade 2 to grade 4, based on Tawfik's classification. The mean follow-up time was 35.7 ± 9.6 months. After socket reconstruction, using a post-auricular FTSG, 96% of the cases (25 of 26) demonstrated a successful prosthetic fitting and a satisfactory cosmetic outcome. Both good eyelid function and a stable fornix depth were maintained during the follow-up time. One case received a second socket reconstruction three months after the first operation, using a FTSG, because of an inadequate lateral fornix. The final result was satisfactory. There were no serious complications, but a granuloma formed in one case, and there was prolonged discharge in one case. CONCLUSIONS The reconstruction of a contracted eye socket using a post-auricular FTSG is an effective method with a high success rate, which causes less discomfort to donor sites and results in few complications.
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Affiliation(s)
- Yi Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, 7, Chung Shan South Rd, Taipei, Taiwan
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Serial sub-conjunctival 5-Fluorouracil for early recurrent anophthalmic contracted socket. Graefes Arch Clin Exp Ophthalmol 2013; 251:2797-802. [DOI: 10.1007/s00417-013-2478-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/01/2013] [Accepted: 09/23/2013] [Indexed: 11/26/2022] Open
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Kumar A, McCormick A, Bhargava JS. Temporary Gortex (polytetrafluoroethylene) spacer for the treatment of fornix shortening following severe alkali chemical injury. Orbit 2011; 30:252-254. [PMID: 21957958 DOI: 10.3109/01676830.2011.574772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Gortex is an inert, smooth, flexible material, which is well tolerated in situ. We describe a case of fornix shortening secondary to alkali injury, which was treated successfully with a temporary Gortex patch. METHOD Retrospective case report. RESULTS A patient with Grade IV chemical injury developed significant symblepharon formation 47 days after the initial injury. Following an initial failed mucous membrane graft the patient had a Gortex patch sutured into the upper lid fornix which acted as a spacer to allow epithelisation of the bulbar conjunctiva. The Gortex patch was removed after 25 days, and at 6 months' follow-up, there was no recurrence of symblepharon formation. CONCLUSION Industry-related severe ocular chemical injury is a rare occurrence. It can lead to symblepharon formation and destruction of the conjunctival fornix. In this case a Gortex spacer was successfully used to prevent symblepharon formation and reform the upper eyelid fornix after severe chemical injury.
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Affiliation(s)
- Anupma Kumar
- Countess of Chester, Ophthalmology, Countess of Chester Hospital Health Park, Chester, United Kingdom.
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