Amniotic membrane transplant a viable treatment option for restrictive strabismus

Ophthalmology. 2011;118(6):1107-1118.

Issue: August 10, 2011

Amniotic membrane transplantation should be considered when treating difficult cases of restrictive strabismus because it helps prevent adhesion recurrence, a study found.

"Because amniotic membrane has anti-inflammatory and anti-fibrosis characteristics, it may reduce secondary scarring and help prevent recurrence of restrictive strabismus and the diplopia and pain that often accompany this type of strabismus," the authors said.

The retrospective, interventional case series included eight eyes of seven consecutive patients who had developed restrictive strabismus after periocular surgery due to conjunctival scarring, fat adherence syndrome or rectus muscle contracture.

After failed additional standard surgery to remove the adhesions, patients underwent amniotic membrane transplantation.

Six of seven patients experienced improved ocular motility, with no recurrent scarring. Their motility remained stable for the 5- to 13-month follow-up period, according to the study.

One patient had recurrent scarring with persistent diplopia.

The idea of amniotic membrane transplantation (AMT) for the treatment of restrictive strabismus is very fascinating as it addresses a challenging and often frustrating clinical problem. The rationale behind the use of AMT is sound in that it acts as a scaffold for re-epithelialization, as well as a barrier to the adherence of scar tissue, muscle and fat. Periocular reconstruction using AMT is a relatively safe procedure as it is immunologically inert and avoids the potential risks of mitomycin C use, steroid injections and synthetic implants. Data presented in this article support the thought that AMT use should be routinely considered when approaching cases of restrictive strabismus.

– Erin Stahl, MD
OSN Pediatrics/Strabismus Board Member
Disclosure: Dr. Stahl has no direct financial interests related to the study.