Management of conjunctival and corneal melanoma with surgical excision, amniotic membrane allograft, and topical chemotherapy

PURPOSE: To illustrate a novel method of management for extensive conjunctival and corneal melanoma. METHODS: Interventional case report. A 40-year-old Caucasian woman presented with a large, diffuse conjunctival melanoma involving 6 clock hours of the limbus. The remaining bulbar conjunctiva and the entire corneal epithelium were affected by diffuse, flat melanosis. RESULTS: The conjunctival melanoma was completely resected microsurgically in one piece without disrupting the tumor. The conjunctival melanosis was treated with double freeze-thaw cryotherapy. The extensive conjunctival defect, involving one-half of the bulbar conjunctiva, was reconstructed with an amniotic membrane allograft. The corneal melanosis was subsequently treated with topical mitomycin C eyedrops. At 8 months follow-up, the conjunctiva and the cornea were completely healed with resolution of all pigment and 20/20 visual acuity. CONCLUSION: Preliminary evidence suggests that combined therapeutic approaches, consisting of extensive tumor removal, cryotherapy, amniotic membrane allograft, and topical mitomyin C, can be effective in the management of diffuse conjunctival and corneal melanoma arising from primary acquired melanosis.     

Primary eyelid malignant melanoma associated with primary conjunctival malignant melanoma

Two patients presented with the unusual occurrence of isolated foci of malignant melanoma of the upper eyelid and ipsilateral inferior conjunctiva. Neither patient had clinical evidence of primary acquired conjunctival melanosis, but in one case there was histopathologic evidence of this condition. The clinical features, histopathologic findings, and possible significance of this unusual occurrence are discussed.     

Sweat gland tumour of the eyelid with conjunctival involvement

An 87-year-old woman presented with a rapidly growing tumour at the nasal side of the upper eyelid. The clinical diagnosis was basal cell carcinoma. During surgery, the impression of malignancy was accentuated by the finding that even the conjunctiva had been invaded. Histological examination revealed an eccrine acrospiroma with, indeed, many mitoses but, on the other hand, a completely benign aspect. Besides, there was no recurrence after 1 year.     

Efficacy of systemic cyclosporine A and amniotic membrane on rabbit conjunctival limbal allograft rejection

PURPOSE: To evaluate the effect of intramuscular cyclosporine A (CsA) and amniotic membrane (AM) on conjunctival limbal allograft survival in a rabbit model. METHODS: Eighty-two female rabbits (59 New Zealand white rabbits, 23 Dutch pigmented rabbits) were used. The New Zealand white rabbits were divided into 4 treatment groups: group 1 (n=13), conjunctival limbal autograft transplantation; group 2 (n=12), conjunctival limbal allograft transplantation without additional treatment; group 3 (n=18), conjunctival limbal allograft transplantation and human AM; and group 4 (n=16), conjunctival limbal allograft transplantation and systemic CsA (10 mg/kg/day intramuscularly). The 23 Dutch pigmented rabbits were used as limbal stem cell allograft donors. The rejection index, the mean survival time, and the rejection rates were calculated for each group. RESULTS: After 28 days of follow-up, there were no episodes of limbal rejection in groups 1 and 4, whereas the rejection rate was 100% in groups 2 and 3. There was no significant difference in mean survival time of the rejected grafts between groups 2 and 3. CONCLUSIONS: A model of rejection of conjunctival limbal transplantation was developed in the rabbit. Intramuscularly injected CsA effectively prevents limbal allograft rejection. Human AM is not useful for this purpose.     

Reconstruction of conjunctiva with amniotic membrane after excision of large conjunctival melanoma: a long-term study

PURPOSE: To evaluate, on a long- term basis, the role of amniotic membrane in the reconstruction of large conjunctival defects after excision of large conjunctival melanoma. METHODS: Four consecutive patients with diffuse conjunctival melanoma involving both bulbar and palpebral conjunctiva were studied. Conjunctival melanoma was completely excised (with wide clinically disease-free margins) and amniotic membrane immediately sutured to the surrounding conjunctiva and sclera to cover the conjunctival defect. Minimum follow-up was 48 months. RESULTS: Successful conjunctival surface reconstruction and physiologic fornical depth were achieved in all patients within 6 weeks. No recurrence of primary melanoma was observed during long-term follow-up. CONCLUSIONS: Amniotic membrane transplantation is an effective alternative in ocular surface repairing surgery after removal of large conjunctival tumors.     

羊膜移植结膜囊成形术临床报告

目的：观察和评价羊膜在结膜囊成形术中的应用价值。方法：采用保存人羊膜移植于结膜囊狭窄的患者行结膜囊成形术9例9只眼。结果：9只眼无1例感染，7天后移植的羊膜变透明，缝合处结膜向羊膜向羊膜上爬行。1个月后新生的结膜上皮安全覆盖移植区，结论：保存的人羊膜无抗原性，移植后能作为结膜上皮移行生长的载体，替代球结膜用于结膜囊成形术的效果满意。     

活体异体结膜缘和羊膜移植治疗化学性眼外伤造成的角膜缘干细胞缺失(英文)

目的:评价利用活体异体结膜缘和羊膜移植治疗化学性眼外伤造成的角膜缘干细胞缺失的临床效果。方法:从2005-07/2007-12,本研究包括了9名男性化学性眼外伤患者(10眼)。所有患者接受了亲属活体异体结膜缘和羊膜移植,2例眼接受了睑缝术。用环孢菌素和泼尼松龙进行全身性免疫抑制。结果:在3例眼中观察到完全角膜上皮化(30%),其中1例在术后1.5mo出现免疫排斥,角膜溶解引起穿孔,加大全身性免疫抑制剂量来控制病情。3例眼中植片无法在角膜表面重新形成上皮,被定为原发性失败。其余4眼有部分上皮形成,但上皮细胞无法完全覆盖角膜表面。术前最佳矫正视力从手动到1m处数指,术后最佳矫正视力从光感到20/80。有5眼视力得到改进,不需其他治疗。手术失败的主要原因为干眼症和持续性炎症。结论:对于能控制泪量和眼部炎症的病例,亲属活体异体角膜缘和羊膜移植是治疗化学性眼外伤造成的角膜缘干细胞缺失最佳方法之一。     

结膜囊成形联合羊膜移植术治疗严重结膜囊狭窄

目的探讨羊膜移植在治疗严重结膜囊狭窄中的应用。方法对31例严重结膜囊狭窄、无法安装义眼的患者行结膜囊成形术,根据结膜缺损范围,将羊膜上皮面朝上移植于植床上,21例同时行下穹隆加深术。结果术后随访6月～3年,失访5例。26例中24例成功,术后能安装义眼;2例失败,术后不能安装义眼。结论结膜囊成形联合羊膜移植术治疗严重结膜囊狭窄疗效肯定。     

羊膜和桥状结膜瓣移植治疗翼状胬肉

目的研究翼状胬肉切除加羊膜和桥状结膜瓣移植治疗翼状胬肉的疗效。方法31例翼状胬肉患者两眼分别行翼状胬肉切除加羊膜和桥状结膜瓣移植和单纯翼状胬肉切除加羊膜移植，比较二者治疗后翼状胬肉复发率。结果随访1．5a。前者翼状胬肉复发率为3.22％，后者复发率为16．12％。二者相比有显著性差异（P〈0．01）。结论翼状胬肉切除加羊膜和桥状结膜瓣移植治疗翼状胬肉远期复发率低，值得推广。     

异体巩膜联合生物羊膜移植修复眼睑全层大缺损临床观察

目的 探讨异体巩膜联合生物羊膜移植替代睑板修复眼睑全层大缺损的远期效果.方法 对39例因肿瘤切除术或外伤造成的眼睑全层大缺损(超过睑长四分之一时)患者行异体巩膜联合羊膜移植替代睑板的眼睑重建术,并随访观察半年至5年.结果 39例患者经眼睑重建术后,植片生长良好,功能正常,对眼球无刺激,对视功能无影响,肿瘤未见复发.结论 异体巩膜联合生物羊膜移植替代睑板修复眼睑全层大缺损远期疗效确切,术后眼睑形态、功能恢复良好,不影响视功能,是一种较为理想的手术方式.     

Topical mitomycin C chemotherapy for conjunctival melanoma and PAM with atypia

AIM—To evaluate topical mitomycin C (MMC) chemotherapy in the treatment of conjunctival melanoma and primary acquired melanosis with atypia.
METHODS—In a phase I clinical trial, 10 patients with conjunctival melanoma and/or primary acquired melanosis with atypia were treated with topical MMC 0.04% four times daily. Four patients were given MMC for 28 days as a primary treatment. Six patients were treated with MMC for 7 days after excision and cryotherapy in an effort to improve local control. In this series, 10 patients have been followed for an average of 29 months.
RESULTS—All patients were noted to develop transient keratoconjunctivitis during treatment. One patient also developed a transient corneal epithelial defect. Decreased conjunctival pigmentation was noted in the four patients where topical chemotherapy was used as a primary treatment. Nodular tumours were resistant to topical MMC chemotherapy. Of the six patients treated within 2 weeks after primary excision and cryotherapy, there has been no tumour recurrence or symblepharon formation. Nine of the 10 study patients have maintained within one line of their pretreatment visual acuity. No retinal or optic nerve toxicity was noted.
CONCLUSION—Since no complications which might preclude further investigation of topical MMC chemotherapy occurred, it was concluded that topical MMC chemotherapy was tolerated as a treatment for conjunctival melanoma and primary acquired melanosis with atypia.

Keywords: conjunctival melanoma; primary acquired melanosis; mitomycin C     

Repair of a leaking bleb filtration with conjunctival and amniotic membrane transplantation

CLINICAL CASE: A 71-year-old woman presented with a leaking bleb after a combined phacotrabeculectomy performed 13 years ago. To construct a new filtering bleb, the necrotic area was fully excised. The amniotic membrane was inserted over the scleral flap underneath healthy conjunctiva edges. A conjunctiva-Tenon autograft from the contralateral eye was sutured and was sealed with fibrin adhesive. DISCUSSION: We propose a new surgical technique to repair late leak failures after trabeculectomy with mitomycin C in blebs with a large avascular area. Transplantation of amniotic membrane and conjunctival autograft may be used to repair late leak failures with inadequate conjunctiva to advance.     

Sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft for pterygium

To study the efficacy and safety of sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft and to investigate the clinical outcomes. Thirty eyes of 30 patients with primary pterygia were treated in this institutional study with excision followed by sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft using fibrin glue tissue adhesive. The main outcome measures were the operating time for ocular surface reconstruction, the size of the pterygium and of the conjunctival autograft, postoperative complications, subjective complaints, and recurrences. The mean pterygium size was 3.12 ± 0.92 mm and the mean operating time was 4.58 ± 1.10 min. Twenty-nine patients (96.7%) had no complaints after first postoperative week. Twenty-eight (93.3%) patients had no recurrences after 1 year follow-up. The sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft is an effective procedure with low rate of recurrence. This technique can be considered as a preferred grafting procedure for primary pterygium but further randomized controlled studies including larger populations are needed.     

Relapsing Mooren's ulcer after amniotic membrane transplantation combined with conjunctival autografting

PURPOSE: To report a patient with Mooren's ulcer that relapsed 2 months after amniotic membrane (AM) transplantation and conjunctival autografting and its subsequent retreatment. DESIGN: Interventional case report. METHODS: We performed multilayered AM transplantation and conjunctival autografting from the opposite healthy eye to treat a corneoscleral perforation caused by Mooren's ulcer in a 60-year-old woman. MAIN OUTCOME MEASURES: Reformation of the anterior chamber, absence of inflammation, and restoration of visual acuity. RESULTS: The perforated corneoscleral lesion was sealed successfully by the AM and conjunctiva graft and led to a stable condition for 2 months. Relapsing corneal edema, keratic precipitates, and cell infiltration occurred along the margin of the conjunctival graft with severe vessel engorgement. After removing the conjunctival graft and regrafting of additional AM, the lesion subsided for at least 1 year. CONCLUSIONS: Amniotic membrane transplants may be useful in treating corneal perforation of immunologic origin, but conjunctiva and its vessels may play a role in the process of peripheral corneal destruction of Mooren's ulcer.     

Transplantation of conjunctival limbal autograft and amniotic membrane vs mitomycin C and amniotic membrane in treatment of recurrent pterygium

AIM: To compare the efficacy and complications of conjunctival limbal autograft (CLAU) and amniotic membrane transplantation (AMT) vsintraoperative mitomycin C (MMC) and AMT for treatment of recurrent pterygium.METHODS: Forty eyes of 40 patients with recurrent pterygium underwent CLAU and AMT (20 eyes) or intraoperative MMC (0.02%, 3 min) and AMT (20 eyes). Three eyes (15%) had symblepharon before surgery in each group. Recurrence was compared in each group by using chi(2) test.RESULTS: No major postoperative complications occurred during 6-19 months of follow-up. In CLAU/AMT group, no pterygium recurrence was observed. Recurrence occurred in four eyes (20%) in MMC/AMT group after 3 and 4 months (P-value=0.035, chi(2) test). No recurrence of pterygium or symblepharon was seen in six eyes with recurrent pterygium and symblepharon (three eyes in each group).CONCLUSION:CLAU with AMT seems to be more effective than intraoperative MMC with AMT for treatment of recurrent pterygium.     

Treatment of ligneous conjunctivitis with amniotic membrane transplantation and topical cyclosporine

Ligneous conjunctivitis (LC) is a rare form of bilateral chronic recurrent disease in which thick membranes form on the palpebral conjunctiva and other mucosal sites. We report the clinical features and describe the management of two cases. Case 1 was an 8-month-old patient with bilateral membranous conjunctivitis. Case 2 was a 5-year-old patient with unilateral membranous conjunctivitis, esotropia, mechanical ptosis and complicated cataract, and had been treated with a number of medications. Histological investigation of the membrane in both cases showed LC. Treatments with amniotic membrane transplantation and institution of topical cyclosporine have shown good response. There has been complete resolution of the membranes with no recurrence at the end of 40- and 28-month follow-ups, respectively. No treatment related side effects were seen. Thus, it appears that amniotic membrane transplantation and topical cyclosporine are effective alternatives for the treatment of LC.