Issues of rehabilitation of the patients with symblepharon using oral mucosal autografts
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OCULOPLASTICS AND ORBIT
Issues of rehabilitation of the patients with symblepharon using oral mucosal autografts Marina B. Gushchina 1,2
&
Alexander V. Gushchin 1,3 & Daria S. Afanasyeva 2,4
Received: 14 June 2020 / Revised: 9 September 2020 / Accepted: 5 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To systematize clinical variants of symblepharon and to analyze rehabilitation availability boundaries in patients with different forms of symblepharons. Methods Retrospective analysis of clinical cases included 26 patients with local, subtotal, and total symblepharon (ankyloblepharon) with a normal or anophthalmic orbit. In all patients, symblepharon was operated using split- or full-thickness oral mucosal autografts and their fixation with U-shaped stitches and compression plates. Preoperatively and postoperatively, best-corrected visual acuity, IOP, extraocular motility, results of Schirmer I test, and tear break-up time with slit-lamp biomicroscopy were analyzed, as well as additional ultrasound and electrophysiological studies were performed in some cases. Follow-up period lasted from 1.5 to 6 years. Results The proposed surgical technique using mucosal autografts in all patients allowed complete anatomical restoration of conjunctival fornices and cavity. It resulted in improvement of visual function in patients with local symblepharon, full restoration of ocular motility in patients with a presence of the eye and provided an opportunity to wear artificial eye in patients with anophthalmia. Nonetheless, loss of conjunctival Krause’s and Wolfring lacrimal glands, goblet cells, meibomian glands, and limbal stem cells prevents from further optic keratoplasty in patients with total or subtotal symblepharon on potentially sighted eye. Conclusion The most difficult patients for visual rehabilitation were the ones with subtotal or total symblepharon (ankyloblepharon) on potentially sighted eye due to the loss of conjunctival goblet cells, meibomian glands, and limbal stem cells. Key Messages Intraoral area is one of the best to harvest autografts due to the opportunity it gives in obtaining large-scale multipurpose grafts (split-and full-thickness ones) for both palpebral and bulbar reconstruction. The most relevant anatomical and functional results can be observed in subtotal/total symblepharon and especially ankyloblepharon depending on traumatic agent and presence or absence of the eye on the affected side. Presence of DED in patients with total/subtotal symblepharon with normal orbit complicated with vascularized corneal leucoma has not allowed recommending optical keratoplasty. Although, for patients with the only sighted eye, keratoprosthesis is mandatory.
This article received support from the mentorship team. Further information can be found in the editorial https://urldefense.proofpoint. com/v2/url?u=https-3A__bit.ly_3a7ltPx&d=DwIGaQ&c= vh6FgFnduejNhPPD0fl_yRaSfZy8CWbWnIf4XJhSqx8&r= pEPMh1MRQKL_64LZtumS_uYOgrUgOE2TKlQWl0iNTvc&m= qst2NhCmNVPjO7WLN3jCOkWNvQeMmyPpJ
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