The Use of Amniotic Membrane for the Management of Fibrosis in Complex Strabismus Surgery

Postoperative adhesion formation following complex strabismus surgery limits surgical outcomes. The benefits of amniotic membrane transplant (AMT) are widely recognized in ophthalmology. There are only published isolated case reports regarding its use in strabismus surgery. The limitation of these reports is that they describe use of AMT in cases of restrictive strabismus resulting from periocular surgery and indirect involvement of the extraocular muscles. In our series, the amniotic membrane was used to manage complex strabismus surgery. In this retrospective case series we describe surgical management with AMTin 8 strabismus cases between 2007 and 2010 in a tertiary referral center. Of these, 6 cases resulted from complex and repeat strabismus procedures to the extraocular muscles and 2 cases were a result of periocular surgery. Descriptive methodology was used. Outcomes examined were postoperative objective improvement in angle of deviation, subjective improvement in patient symptoms, and need for further interventions. Mean follow-up period was 15 months. All patients had multiple strabismus surgery in the past with a mean number of 3.2 +/- 1.5 procedures (range 1-5). The indication for surgery using amniotic membrane graft was in 7 cases a large hypotropia with inferior conjunctival fibrosis and in one case a large consecutive horizontal deviation. The mean angle of vertical deviation was reduced from 32.1 +/- 13 prism diopters (PD) preoperatively to 19.75 +/- 11.4 PD postoperatively, with better outcomes in cases where AMT was used early in the surgical plan. Six out of the eight cases had objective improvement also consistent with improvement in the binocular field of vision. This is the largest reported case series on amniotic membrane grafts for strabismus surgery complicated by fibrosis and especially cases of consecutive hypotropia. Our outcomes indicate that AMT is beneficial, but we suggest it be used in the early stages of the surgical management of these cases.