Amniotic membrane transplantation in entropion surgery

Purpose: To evaluate the role of amniotic membrane transplantation in the m anagement of cicatricial eyelid entropion. Design: Prospective, noncomparative interventional case series. Participants: Eighteen consecutive patients with cicatricial entropion. Methods: A gray line lid split procedure with vertical anterior lamella rep ositioning was performed on 25 eyelids (upper or lower) of 18 patients with moderate to severe cicatricial entropion. Preserved human amniotic membran e (AM) was used to cover the bare tarsus up to the lid margin and secured w ith running 7-0 Vicryl. Impression cytology of the AM was performed at vari ous stages postoperatively to study the epithelialization process. Main Outcome Measures: (1) Reepithelialization of bare tarsus, (2) extent o f tarsal shrinkage, (3) recurrence of entropion. Results: Ail the AM grafts took well. The most common complication was hemo rrhage below the graft, which occurred in six cases. Complete success with no lashes touching the globe was achieved in 22 of 25 (88%) lids after a mi nimum follow-up of 12.0 months. The mean follow-up was 17.8 months. Two cas es (qualified success) had recurrent trichiasis treated successfully with e lectrolysis. One case with severe trachomatous upper lid entropion recurred 14 months after surgery. The AM accelerated the epithelialization of bare tarsus; this was demonstrated by lack of fluorescein staining and reversion to skin color within 2 to 3 weeks. However, AM could not prevent tarsal sh rinkage. Impression cytology demonstrated that features of conjunctival epi thelium were present for the first postoperative month, but this was gradua lly replaced by squamous metaplasia, with keratinization appearing as early as 3 weeks postoperatively. Conclusions: The use of AM in a lid split procedure for correction of cicat ricial entropion helps the bare tarsus epithelialize rapidly and improves t he initial cosmetic result of surgery. Ophthalmology 2001;108: 1209-1217 (C ) 2001 by the American Academy of Ophthalmology.