Sealing of the gap between the conjunctiva and tenon capsule to improve symblepharon surgery

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.