In this paper, the authors describe the surgical management of complex strabismus using amniotic membrane grafts in six patients with complex, repeat previous strabismus surgery and two patients with periocular surgery. Frozen amniotic membrane allograft was used. The study had a mean follow-up of 15 months (9-24), mean age of 34±21.5 years and mean number of previous surgeries of 3.2±1.5. Indication for surgery was a large hypotropia with inferior conjunctival fibrosis in seven cases and one patient with a large consecutive horizontal deviation. The mean preoperative vertical angle was 32.1±13PD reducing postoperatively to 19.75±11.4PD. Six patients had objective improvement with an increase in their binocular field of vision. There were no complications. Two patients needed follow-up botulinum toxin or prisms. The authors conclude that this treatment is beneficial and can be considered in early six stages of surgical planning. They discuss its dual role acting as a platform for healthy conjunctiva to grow over the previous fibrosis and secondary as a barrier between the conjunctiva and tenons / sclera.

The use of amniotic membrane for the management of fibrosis in complex strabismus surgery.
Frangouli O, Adams GG.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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