Reconstruction of Contracted Conjunctival Fornices Using Artificial Dermis and Oral Mucosa in Anophthalmic Patients with Symblepharon

1. Yukiko Terada
2. Narumichi Yamamoto
3. Hideaki Tobita
4. Noriko Ozaki
5. Kimio Murakami

Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan

Purpose: To report the usefulness of artificial dermis combined with oral mucosa to correct obliteration of conjunctival fornices by scar tissue resulting from symblepharon in anophthalmic patients.

Methods: Two eyes in two patients with symblepharon underwent reconstruction of fornices. One eye had exposed and extruded orbital implants and the other eye had refractory panopthalmitis caused by lagophthalmos after three surgeries for ptosis due to the third cranial nerve palsy. Surgical procedure to correct the symblepharon involved cicatrix lysis and relaxing incisions of the contracted conjunctiva followed by dissecting it from the underlying scar tissue up to the upper and lower fornices. Anterior borders of artificial dermis were attached to the recessed conjunctiva, and anchoring sutures were used to secure the released conjunctiva deep into the fornices on posterior parts. A buccal oral mucosa trimmed to fit the entire conjunctival defect was grafted partially over the artificial dermis. A temporal prosthesis was inserted until permanent prosthesis may be ready.

Results: Grafted oral mucosa membrane in one patient shrank, repeat artificial dermis grafting was required 4 weeks later. Delayed pale ischemic thinning grafts appeared in two patients but vascularization was well developed at the artificial dermis site of oral mucosa at 3 months without additional treatment. Both patients' prosthesises were cosmetically acceptable.

Conclusion: Artificial dermis can facilitate penetration of host capillary and epithelialization, shrinkage in minimal as well. Artificial dermis with buccal oral mucosa is a successful procedure for re-forming contracted conjunctival fornices.