Amniotic Membrane-Covered Conformer And Fibrin Glue For Severe Chemical Eye Injury

Severe chemical eye injury can cause significant morbidity and sight loss. The use of an amniotic membrane transplant works well for ocular surface reconstruction by decreasing inflammation, scarring and vascularisation and provides a new basement membrane for the expansion of surviving epithelial stem cells. This technique is time efficient and minimally invasive but still allows for extensive coverage of the ocular mucosal surfaces to prevent and lessen the severity of the complications from ocular surface sequelae following chemical eye injury. 

Birmingham and Midland Eye Centre, Birmingham, United Kingdom.

A 52-year-old gentleman presented after a 6-day delay following an ocular chemical eye injury of an unknown substance following an assault. Ocular irrigation was carried out by double eversion of the eyelids. A subtarsal triamcinolone injection was administered. One layer of amniotic membrane was secured to the cornea with fibrin glue and interrupted vicryl sutures.  A free amniotic membrane was then draped into the fornices and a conformer shell wrapped within. The free edges were sutured together with a continuous vicryl suture.

Visual acuity at presentation in the left eye was 1.3 logMAR with a pH of 9.0. There was a total corneal epithelial defect with limbal involvement – Dua classification 12/80. The patient underwent 2 separate procedures 4 days apart. 5 weeks post injury, visual acuity is at 1.0 logMar with a healing of the ocular surface epithelium and no symblepharon.

This novel technique, using an amniotic membrane-covered conformer allows for the coverage of the entire ocular surface and protection of the lid margins while requiring minimal preparation and surgical time. It provides an optimal environment to protect the integrity of the ocular surface, facilitate healing, switch off the acute ocular surface inflammatory response before it develops into persistent or chronic disease and to minimise and/or prevent symblepharon formation, progressive conjunctival scarring, and chronic ocular surface failure.