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  • Amniotic membrane transplant shows promise for postsurgical restrictive strabismus

    Pediatric Ophth/Strabismus

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    This retrospective case series reports on the use of amniotic membrane transplant to repair restrictive strabismus that occurred after anterior segment, oculoplastic or retinal surgery. Six of seven patients included in the study experienced improved ocular motility, relief of pain and elimination of diplopia, with no recurrence of scarring during follow-up of five to 13 months.

    The authors reviewed the charts of seven consecutive patients (eight eyes) who developed restrictive strabismus after periocular surgery. The procedure types that lead to these cases of restrictive strabismus were transconjunctival blepharoplasty, pterygium surgery with mitomycin C, orbital dermoid removal, orbital floor fracture repair and retinal detachment surgery with a scleral buckle.

    Restrictive strabismus was due to a combination of conjunctival contracture with significant symblepharon in three patients, fat adherence in six patients and tight rectus muscles in four patients. All patients developed postoperative scarring and had failed additional standard surgery to remove the adhesions.

    In the one unsuccessful case, despite two reconstructive surgeries using amniotic membrane transplant by two experienced surgeons, restrictive strabismus and scarring with persistent diplopia recurred.

    The authors conclude that amniotic membrane transplant should be considered as a treatment option for difficult cases of restrictive strabismus. They say that the procedure can be used to replace missing or contracted conjunctiva and reconstruct a tissue barrier that separates orbital fat and adhesions from sclera. Because amniotic membrane has anti-inflammatory and anti-fibrosis characteristics, they say that it may reduce secondary scarring and help prevent recurrence of restrictive strabismus and the diplopia and pain that often accompany it.

    However, they caution that amniotic membrane transplant is not a panacea. Theu say that prevention of conjunctival scarring and fat adherence during primary surgery remains the best option.