Use of Amniotic Membrane in Restrictive Strabismus

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Use of Amniotic Membrane in Restrictive Strabismus

• Kenneth W. Wright, MD
• Tinny Dinh, MD
• Francisco Conte, MD
• Claudia Faria, MD
• Director Wright Foundation Pediatric
  Ophthalmology
• Director, Pediatric Ophthalmology Cedars-Sinai
  Medical Center
• Clinical Professor of Ophthalmology,
• USC Keck School of Medicine

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68 yr old post lower lid bleph OU
Surgery Explore IR and LR RE Remove scar and
recess conjunctiva RE. Post op For 2 weeks -
Full ductions - No diplopia!
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Post Op 3 weeks after successful surgery and
removal of scar
Recurrence of scar
What to do?
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Re-OperationContracted and scared
conjunctiva-Positive force ductions -
restriction to elevation and adduction
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Peri-ocular scaring and fat adherence in inferior
temporal quadrant
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Scar and fat adherence removed and conjunctiva
recessed-Bare sclera is seen in inferior
temporal quadrant
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Amniotic membrane is thin sheet comes on a paper-
Fine forecepts peal the membrane off the paper
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Amniotic membrane graft placed over bare sclera
sticky side down and epithelial side up.Tissue
glue is placed under the edges of the graft to
secure the graft in place. Small hook smoothes
the graft in place
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Post op amniotic membrane graft
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Post amniotic membrane graft and removal of scar
RESingle vision!
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Case 240 year old surfer with diplopia after
Pterygium surgery

• Two pterygium surgeries last with mitomyocin C
  and postoperative uncrossed diplopia
• Limited abduction

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Bilateral amniotic membrane grafts and MR
recessions

• Postoperative No diplopia
• Stereopsis 100 sec

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Summary

• Amniotic membrane transplant is useful in
  restrictive strabismus
• Reference
• Fat Adherence Syndrome after Retinal Surgery
  Treated with Amniotic Membrane Transplatation
• Yamada et al AJO 8/01