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       Journal List > Yonsei Med J > v.48(6); Dec 2007
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Yonsei Med J. 2007 Dec;48(6):955-962.
Published online 2007 December 31.  doi: 10.3349/ymj.2007.48.6.955.
Copyright © 2007 The Yonsei University College of Medicine
Conjunctival Expansion Using a Subtenon's Silicone Implant in New Zealand White Rabbits
Ie-na Yoon, Dong-hoon Lee and Sang-hoon Rah
Department of Ophthalmology, Wonju Christian Hospital, Yonsei University, Wonju College of Medicine, Wonju, Korea.

Reprint address: requests to Dr. Sang-hoon Rah, Department of Ophthalmology, Wonju Christian Hospital, Yonsei University, Wonju College of Medicine, 162 Ilsan-dong, Wonju 220-701, Korea. Tel: 82-33-741-1390, Fax: 82-33-745-2965, Email: shrah@wonju.yonsei.ac.kr
Received March 20, 2007; Accepted July 06, 2007.

Abstract

Purpose

In the field of ophthalmology, the conjunctival autograft is a useful therapeutic material in many cases, but the small size of the autograft is a disadvantage. Therefore, we evaluated the feasibility of taking an expanded sample of conjunctival tissue using a subtenon's silicone implant.

Materials and Methods

We included a total of nine rabbits; eight rabbits were operative cases, and one was a control. A portion of conjunctival tissue from the control rabbit, which did not undergo surgery, was dissected and examined to determine whether it was histologically different from the experimental group. The surgical procedure was performed on eight rabbits via a subtenon's insertion of a silicone sponge in the left superior-temporal portion; after surgery, we dropped antibiotics into the eyes. We sacrificed a pair of rabbits every three days (on days 3, 6, 9, and 12) after surgery, removed the expanded conjunctival tissues with the silicone sponge implants, and measured their sizes.

Results

The mean size of the expanded conjunctival tissues was 194.4 mm2. On the third day, we were able to harvest a 223.56 mm2 section of conjunctival tissue, which was the most expanded sample of tissue in the study. On the twelfth day, we removed a 160.38 mm2 section of conjunctival tissue, which was the least expanded sample of tissue. Statistically, there were no significant differences in the mean dimensions of the expanded conjunctival tissues for each time period. Microscopic examinations showed no histological differences between the expanded conjunctival tissues and the normal conjunctival tissues.

Conclusion

The results reveal that this procedure is a useful method to expand the conjunctiva for grafting and transplantation.

Keywords: Conjunctival expansion, subtenon's silicone implant.
References
1. Lee SB,Cho YJ,Hahn DK. Clinical experience of conjunctival flaps for persistent ulcerative keratitis. J Korean Ophthalmol Soc 1996;37:36–44.
2. Brown DD,McCulley JP,Bowman RW,Halsted MA. The use of conjunctival flaps in the treatment of herpes keratouveitis. Cornea 1992;11:44–46.
3. Lugo M,Arentsen JJ. Treatment of neurotrophic ulcers with conjunctival flaps. Am J Ophthalmol 1987;103:711–712.
4. Lukáts O. Contracted anophthalmic socket repair. Orbit 2002;21:125–130.
5. Suh IS,Yang YM,Oh SJ. Conjunctival cul-de-sac reconstruction with radial forearm free flap in anophthalmic orbit syndrome. Plast Reconstr Surg 2001;107:914–919.
6. Shore JW,McCord CD Jr,Bergin DJ,Dittmar SJ,Maiorca JP,Burks WR. Management of complications following dermis-fat grafting for anophthalmic socket reconstruction. Ophthalmology 1985;92:1342–1350.
7. Wiese KG,Vogel M,Guthoff R,Gundlach KK. Treatment of congenital anophthalmos with self-inflating polymer expanders: a new method. J Craniomaxillofac Surg 1999;27:72–76.
8. Mazzoli RA,Raymond WR 4th,Ainbinder DJ,Hansen EA. Use of self-expanding, hydrophilic osmotic expanders (hydrogel) in the reconstruction of congenital cilinical anophthalmos. Curr Opin Ophthalmol 2004;15:426–431.
9. Eppley BL,Holley S,Sadove AM. Experimental effects of intraorbital tissue expansion on orbitomaxillary growth in anophthalmos. Ann Plast Surg 1993;31:19–27.
10. Dunaway DJ,David DJ. Intraorbital tissue expansion in the management of congenital anophthalmos. Br J Plast Surg 1996;49:529–535.
11. Lee YH,Kim HC,Lee JS,Park WJ. Surgical reconstruction of the contracted orbit. Plast Reconstr Surg 1999;103:1129–1138.
12. Wieslander JB,Wieslander M. Prefabricated (expander) capsule-lined transposition and advancement flaps in reconstruction of lower eyelid and oral defects: an experimental study. Plast Reconstr Surg 2000;105:1399–1407.
13. Ang LP,Tan DT,Cajucom-Uy H,Beuerman RW. Autologous cultivated conjunctival transplantation for pterygium surgery. Am J Ophthalmol 2005;139:611–619.
14. Zemba M,Bobeico V,Brătulescu M,Ciucă C,Andrei S,Anton O. Conjunctival autoplasty in pterygium treatment. Oftalmologia 2005;49:41–45.
15. Uy HS,Reyes JM,Flores JD,Lim-Bon-Siong R. Comparison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision. Ophthalmology 2005;112:667–671.
16. Oh TH,Choi KY,Yoon BJ. The effect of conjunctival autograft for recurrent pterygium. J Korean Ophthalmol Soc 1994;35:1335–1339.
17. Lee CO,Jong SH,Lee JJ. Autologous simple conjunctival graft and conjunctiva/Tenon graft of focal scleromalacia. J Korean Ophthalmol Soc 1997;38:1737–1741.
18. Kim MJ,Tchah HW. Treatment of pterygium with amniotic membrane transplantation. J Korean Ophthalmol Soc 1998;39:59–64.
19. Youngson RM. Recurrence of pterygium after excision. Br J Ophthalmol 1972;56:120–125.
20. Jaros PA,DeLuise VP. Pingueculae and pterygia. Surv Ophthalmol 1988;32:41–49.
21. Kenyon KR,Wagoner MD,Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 1985;92:1461–1470.
22. Riordan-Eva P,Kielhorn I,Ficker LA,Steele AD,Kirkness CM. Conjunctival autografting in the surgical management of pterygium. Eye 1993;7:634–638.
23. Allan BD,Short P,Crawford GJ,Barrett GD,Constable IJ. Pterygium excision with conjunctival autografting: an effective and safe technique. Br J Ophthalmol 1993;77:698–701.
24. McCoombes J,Hirst LW,Isbell GPRecurrence rate following simple excision and sliding conjunctival flap for primary pterygium; 1992 Nov; Sydney, Australia. 1992.
Presented at the Annual Scientific Congress of the Royal Australian College of Ophthalmologists
25. Huang Y,Li H,Huang Z,Lin J,Chen J,Li H. Application of amnion membrane transplantation combine with mitomycin C in the treatment of pterygium. Yan Ke Xue Bao 2004;20:74–76.
26. Fournier JH,McLachlan DL. Ocular surface reconstruction using amniotic membrane allograft for severe surface disorders in chemical burns: case report and review of the literature. Int Surg 2005;90:45–47.
27. Gündüz K,Uçakhan OO,Kanpolat A,Günalp I. Nonpreserved human amniotic membrane transplantation for conjunctival reconstruction after excision of extensive ocular surface neoplasia. Eye 2006;20:351–357.
28. Hick S,Demers PE,Brunette I,La C,Mabon M,Duchesne B. Amniotic membrane transplatation and fibrin glue in the management of corneal ulcers and perforations: a review of 33 cases. Cornea 2005;24:369–377.
29. Lambiase A,Sacchetti M,Sgrulletta R,Coassin M,Bonini S. Amniotic membrane transplantation associated with conjunctival peritomy in the management of Mooren's ulcer: a case report. Eur J Ophthalmol 2005;15:274–276.
30. Tosi GM,Traversi C,Schuerfeld K,Mittica V,Massaro-Giordano M,Tilanus MA,et al. Amniotic membrane graft: histopathological findings in five cases. J Cell Physiol 2005;202:852–857.
31. Takano Y,Fukagawa K,Miyake-Kashima M,Tanaka M,Asano-Kato N,Dogru M,et al. Dramatic healing of an allergic corneal ulcer persistent for 6 months by amniotic membrane patching in a patient with atopic keratoconjunctivitis: a case report. Cornea 2004;23:723–725.
32. Rodríguez-Ares MT,Touriño R,López-Valladares MJ,Gude F. Multilayer amniotic membrane transplantation in the treatment of corneal perforations. Cornea 2004;23:577–583.
33. Chen KH,Hsu WM,Liang CK. Relapsing Mooren's ulcer after amniotic membrane transplantation combined with conjunctival autografting. Ophthalmology 2004;111:792–795.
34. Barros PS,Safatle AM,Godoy CA,Souza MS,Barros LF,Brooks DE. Amniotic membrane transplantation for the reconstruction of the ocular surface in three cases. Vet Ophthalmol 2005;8:189–192.
35. Arora R,Mehta D,Jain V. Amniotic membrane transplantation in acute chemical burns. Eye 2005;19:273–278.
36. Prabhasawat P,Tesavibul N. Preserved amniotic membrane transplantation for conjunctival surface reconstruction. Cell Tissue Bank 2001;2:31–39.
37. Jain S,Rastogi A. Evaluation of the outcome of amniotic membrane transplantation for ocular surface reconstruction in symblepharon. Eye 2004;18:1251–1257.
38. Barabino S,Rolando M. Amniotic membrane transplantation in a case of ligneous conjunctivitis. Am J Ophthalmol 2004;137:752–753.
39. Dua HS,Gomes JA,King AJ,Maharajan VS. The amniotic membrane in ophthalmology. Surv Ophthalmol 2004;49:51–77.
40. Kim JC,Kim JH,Cheong TB. Amniotic membrane transplantation in perforation or impending perforation of cornea. J Korean Ophthalmol Soc 1999;40:1487–1495.
41. Schechter BA,Rand WJ,Nagler RS,Estrin I,Arnold SS,Villate N,et al. Corneal melt after amniotic membrane transplant. Cornea 2005;24:106–107.
42. Jacob JT,Burgoyne CF,McKinnon SJ,Tanji TM,LaFleur PK,Duzman E. Biocompatibility response to modified Baerveldt glaucoma drains. J Biomed Mater Res 1998;43:99–107.