Journal List > J Korean Ophthalmol Soc > v.57(4) > 1010573

Park, Kim, and Lee: Double-Layered Conjunctival Autograft and Amniotic Membrane Transplantation to Treat Restrictive Esotropia and Hypotropia

Abstract

Purpose

To report a case of double-layered conjunctival autograft and amniotic membrane transplantation for the effective treatment of esotropia and hypotropia after removal of the recurrent pterygium.

Case summary

A 58-year-old male who had pterygium surgery of the right eye twice presented with diplopia on right gaze for 3 months. At the first visit, he had orthotropia in the primary position and right esotropia of 12 prism diopters (PD) on right gaze with limited abduction of −1 in the right eye. Fourteen months later, deviation was aggravated by esotropia of 30 PD and 12 PD of right hypotropia in the primary position at distance, and esotropia of 35 PD and 12 PD of right hypotropia at near with limited abduction of −2 and supraduction of −3 in the right eye. The patient complained of diplopia at all gazes and demonstrated chin-up posture. The conjunctival edge was recessed near the medial canthus and fornix, preventing conjunctival autograft after removal of subconjunctival scar tissue. Thus, 5 mm right medial rectus recession and additional half-sized conjunctival autograft were performed after amniotic membrane transplantation. The patient than showed no diplopia and orthotropia at both distance and near, with limited adduction of −1 in the right eye. He experienced no recurrence during 7 months of follow-up.

Conclusions

To prevent poor epithelial regeneration and dehiscence of graft in the patients with severe restrictive strabismus and very extensive conjunctival defect, double-layered conjunctival autograft and amniotic membrane transplantation may be effective for the treatment of severe esotropia and hypotropia.

References

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Figure 1.
9 cardinals photo of the patient at first visit. The patient showed 30 PD esotropia and 12 PD hypotropia at distance and limited abduction (-2) and supraduction (-3) in the right eye.
jkos-57-686f1.tif
Figure 2.
Right after double-layered conjunctival autograft and amniotic membrane transplantation. A 1.7×1.5 cm-sized defect was reconstructed by amniotic membrane transplantation with medial half conjunctival autograft after medial rectus recession of 5.0 mm in the right eye.
jkos-57-686f2.tif
Figure 3.
One month after double-layered conjunctival autograft and amniotic membrane transplantation. One month after surgery, the graft is located in its place and very clear.
jkos-57-686f3.tif
Figure 4.
9 cardinals photo of the patient 7 months after surgery. Orthotropia at distance and near with only slight adduction limitation (-1) is noted in the right eye. Diplopia at all gaze positions, dehiscence of the graft, and recurrence were not observed over 7 months of follow-up after surgery.
jkos-57-686f4.tif
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