This is a retrospective, non-comparative interventional case series of 30 patients who underwent amniotic membrane transplantation to lower lid margin as part of Hughes lid reconstruction to prevent a hyperaemic, hypertrophic conjunctival margin with excessive discharge. Patients undergoing more than one type of reconstructive procedure, reconstruction without use of amniotic membrane graft, or concurrent treatment with radiation or oral steroid use were excluded. Amniotic membrane was grafted after division of Hughes flap to the raw lower eyelid margin. The graft was cut to the size of the raw margin and sutured to the eyelid margin using interrupted 6-0 plain gut sutures to the conjunctival edge posteriorly and skin edge anteriorly. The mean follow-up time after this stage of surgery was 4.41+2.91 months. There was no evidence of recurrence of the hyperaemic margin following primary addition of amniotic membrane graft. One patient developed a small pyogenic granuloma and another developed mild ectropion not requiring any surgical intervention. Authors discuss that amniotic membrane alters the transforming growth factor-beta signaling and promotes healing by facilitating epithelialisation and reducing inflammation and scarring.

Modified second stage Hughes tarsoconjunctival reconstruction for lower eyelid defects.
Aggarwal S, Shah CT, Kirzhner M.
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Rina Bhatt

Wolverhampton Eye Infirmary, UK.

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