Management of symblepharon with Gore-tex as a novel treatment option for ocular chemical burns.

PURPOSE: To assess the clinical outcomes of symblepharon release in patients with ocular surface chemical injury using Gore-Tex as a novel treatment option. METHODS: This was a retrospective analysis of 23 eyes of 22 chemical injury patients done during a period of January 2014 to December 2021 at a tertiary eye care centre in South India. All patients underwent symblepharon lysis along with Gore-Tex application over the sclera with minimum 1 year follow up. The patients were assessed for demographic details, visual acuity, intraocular pressure, anterior and posterior segment details, photographic documentation, preoperative diagnosis, previous surgical details in recurrent cases, surgical procedures, final visual acuity, surgical outcomes, and complications. The clinical outcomes were assessed and outcomes were defined as success, partial success, or failure. RESULTS: The median age was 17 years (IQR, 12-39 years). Among them 10 eyes with symblepharon had grade 3 length, 12 eyes grade 3 width and 12 eyes had grade 3 loss of palisades of Vogt. The success was achieved in 52.2% of the patients; partial success in 34.8% and 13.3% had failure. The mean duration of recurrence was 6.75 ± 3.6 months. Failure was noted in young patients with mean age 9.75years and with grade 3c symblepharon. There was no sight threatening complications noted. CONCLUSION: The study showed very good results with Gore-Tex as a novel treatment option for chemical injury patient with symblepharon formation. It can be easily employed to prevent the symblepharon recurrence of various ocular surface disorders.

Decellularized Porcine Conjunctiva in Treating Severe Symblepharon.

This prospective study aimed to evaluate the effectiveness of decellularized porcine conjunctiva (DPC) in the management of severe symblepharon. Sixteen patients with severe symblepharon were enrolled in this study. After symblepharon lysis and Mitomycin C (MMC) application, tarsus defects were covered with residual autologous conjunctiva (AC), autologous oral mucosa (AOM), or DPC throughout the fornix, and DPC was used for all the exposed sclera. The outcomes were classified as complete success, partial success, or failure. Six symblepharon patients had chemical burns and ten had thermal burns. Tarsus defects were covered with DPC, AC, and AOM in two, three, and eleven cases, respectively. After an average follow-up of 20.0 ± 6 months, the anatomical outcomes observed were complete successes in twelve (three with AC+DPC, four with AC+AOM+DPC, and five with AOM+DPC) (75%) cases, partial successes in three (one with AOM+DPC and two with DPC+DPC) (18.75%) cases, and failure in one (with AOM+DPC) (6.25%) case. Before surgery, the depth of the narrowest part of the conjunctival sac was 0.59 ± 0.76 mm (range, 0-2 mm), tear fluid quantity (Schirmer II tests) was 12.5 ± 2.26 mm (range, 10-16 mm), and the distance of the eye rotation toward the opposite direction of the symblepharon was 3.75 ± 1.39 mm (range, 2-7 mm). The fornix depths increased to 7.53 ± 1.64 mm (range, 3-9 mm), eye movement was significantly improved, and the distance of eye movement reaching 6.56 ± 1.24 mm (range, 4-8 mm) 1 month after the operation; the postoperative Schirmer II test (12.06 ± 2.90 mm, range, 6-17 mm) was similar to that before surgery. Goblet cells were finally found in fifteen patients by conjunctival impression cytology in the transplantation area of DPC, except for one patient who failed. DPC could be considered an alternative for ocular surface reconstruction of severe symblepharon. Covering tarsal defects with autologous mucosa is necessary for extensive reconstruction of the ocular surface.

[Ocular mucous membrane pemphigoid]. / Okuläres Schleimhautpemphigoid.

Mucous membrane pemphigoid refers to a heterogeneous group of autoimmune diseases with subepidermal blister formation that can affect all mucous membranes with varying frequencies. This is a rare disease without any geographic or sexual predisposition that is characterized by recurrent inflammation and progressive scarring. The specific diagnostics can be negative in up to 50% of cases. The diagnosis is predominantly made in patients aged 60-80 years. Ophthalmologists play an important role in the care of affected individuals as the conjunctiva is the second most frequent site of involvement. The treatment is often tedious and primarily consists of long-term systemic immunosuppression.

Insights into the clinical development of regenerative medical products through a comparison of three cell-based products recently approved for limbal stem cell deficiency.

Three regenerative medical products for limbal stem cell deficiency (LSCD), a rare and intractable ocular surface disease, have recently been approved in Japan. To our knowledge, this is the first time multiple stem-cell-based medical products have been approved for the same ocular disease. Development plans and study designs for each product differ, resulting in differences in indications. Since cell-based products have a heterogeneous formulation and often target rare diseases, they require a flexible approach to development. This review article describes the status and prospects of the clinical development of regenerative medical products by summarizing the issues of the three products from the Pharmaceuticals and Medical Devices Agency (PMDA) standpoint. Implementing stem cell-based products is challenging, requiring scientific and flexible review by regulatory authorities. To overcome these issues in the development process, developers and regulatory authorities need to communicate and fully discuss study protocols from the early stage of development.

Clinical efficacy of a new surgical technique of oral mucosal epithelial transplantation for severe ocular surface disorders.

BACKGROUND: Severe ocular surface disorders are one of the major blinding diseases, and a paucity of original tissue obscures successful reconstruction. We developed a new surgical technique of direct oral mucosal epithelial transplantation (OMET) to reconstruct severely damaged ocular surfaces in 2011. This study elaborates on the clinical efficacy of OMET. METHODS: A retrospective review of patients with severe ocular surface disorders who underwent OMET from 2011 to 2021 at the Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine was conducted. Patients who were followed up for at least 3 months postoperatively and had sufficient pre or postoperative records were included. Surgical efficacy was evaluated by comparing the best-corrected visual acuity (BCVA), corneal transparency, neovascularization grade, and symblepharon grade. Additionally, postoperative ocular surface impression cytology was used to study the morphology of the newborn epithelial cells. RESULTS: Forty-eight patients (49 eyes; mean age: 42.55 ± 12.40 years, range:12-66 years) were enrolled in the study. The etiology included chemical burns (30 eyes), thermal burns (16 eyes), explosive injuries (1 eye), Stevens-Johnson syndrome (1 eye), and multiple pterygiums (1 eye). The mean follow-up period was 25.97 ± 22.99 months. Postoperatively, 29 eyes (59.18%) showed improved corneal transparency, 26 eyes (53.06%) had improved BCVA, 47 eyes (95.92%) had a stable epithelium until the final follow-up, 44 eyes (89.80%) had a reduced neovascularization grade. Of the 20 eyes with preoperative symblepharon, 15 (75%) were completely resolved, and five (25%) were partially resolved. Impression cytological studies showed no postoperative conjunctival invasion onto the corneal surface. CONCLUSIONS: OMET is a safe and effective surgical technique for reconstruction in severe ocular surface disorder by maintaining a stable epithelium and reducing the neovascularization and symblepharon grade.

[Clinical aspects of ocular mucosal pemphigoid]. / Klinik des okulären Schleimhautpemphigoids.

Mucosal pemphigoid is a rare chronic autoimmune disease that also affects the eyes in more than two thirds of all cases. Especially in the early phase of the ocular manifestation, the findings are subtle and the disease is often not recognized. The aim of this article is to provide the clinical aspects of ocular mucosal pemphigoid so that timely diagnostics can be initiated when this disease is suspected.

[Initial results of the German ocular pemphigoid register]. / Erste Ergebnisse des Deutschen okulären Pemphigoid-Registers.

Mucous membrane pemphigoid (MMP) is a rare disease that presents clinicians with a diagnostic and therapeutic challenge. The aim of this article is to present the German ocular pemphigoid register, which is a retrospective data collection and a collaborative network to improve the care of these patients. It was founded in 2020 and currently comprises 17 eye clinics/cooperation partners. An initial evaluation of the results shows a known epidemiological profile and an expected high proportion of patients with negative diagnostics (48.6%) despite a clinically suspected diagnosis. In this register study predominantly recruiting from eye clinics, the proportion of patients with a strictly ocular involvement was 65.4%. Also of interest was the high number of patients with glaucoma (22.3%) as the most frequent comorbidity. Based on the working group formed, a prospective survey will be conducted in the future, which enables a follow-up.

Sandwich (Amnion/Conjunctival-Limbal Autograft/Amnion) Transplantation for Recurrent Pterygium with Restrictive Strabismus.

(1) Background: This study aimed to evaluate the clinical outcome of Sandwich (Amnion/Conjunctival-Limbal Autograft/Amnion) transplantation for recurrent pterygium with restrictive strabismus. (2) Methods: This retrospective study included 11 eyes in 11 patients diagnosed with recurrent pterygium with restrictive strabismus who received sandwich transplantation. The outcomes were measured by pterygium recurrence, best-corrected visual acuity, esotropia (prism diopters), and treatment complications. (3) Results: Eleven patients (six males, five females) had a mean age of 60.5 (range 36-80) years. The previously received pterygium excision surgery number was 1.8 ± 1.02 (range 1-4). The mean follow-up period was 19.9 ± 8.41 (range 12-36) months. All patients had a restriction of abduction in the previously operated eye, causing esotropia in the primary position. Pre-operative esotropia was 17.2 (range 10-30) prims diopter (PD). Five eyes (45.5%) had symblepharon before surgery. All patients were orthotropic until the last follow-up. Symblepharon was released in all eyes. Free ocular motility was present in all eyes. No donor site scar formation, scleral melt, or corneal ulcer was noted. (4) Conclusions: Sandwich transplantation for recurrent pterygium with restrictive strabismus is safe and effective.

Gore-tex a magic sheet for symblepharon prevention!

Background: Symblepharon occurs as chronic sequelae of severe chemical injuries. The risk of recurrence is high due to unpredictable wound healing of conjunctiva and tenons following excision in young patients. Gore-tex aids in prevention of the recurrence of pterygium 1. Purpose: To present a surgical video on role of Gore-tex in grade 4 Symblepharon lysis. Synopsis: A 28-year-old male with a previous history of Grade 4 chemical injury presented with symblepharon and total obliteration of both upper and lower fornices after one year in the right eye. He underwent symblepharon lysis, Living related conjunctival allograft, Amniotic membrane graft and Gore-tex. The video explains the surgical steps in detail. A 360-degree complete peritomy was done, Symblepharon was released from the corneal surface, and the fibrotic tissue was extensively dissected away from the corneal surface and released into the fornix. Further, cryopreserved AMG was placed over the entire raw ocular surface and sutured to the episclera with glue. Prepared Gore-tex was placed on the superior and inferior fornix and sutured with 10-0 nylon suture. Again, AMG was placed over the Gore-tex in the fornices and covered with glue. A small 2x2mm biopsy of limbal stem cells from the superior limbus was already excised from the fellow eye (CLAG) and then Lr-CLAL was prepared from the patient's mother. These two grafts were placed on the nasal and temporal bulbar surface over the AMG and sutured to the underlying AMG and the episclera with glue. The entire surface was then covered with the AMG to promote epithelisation. At one month postoperative period, patient had stable ocular surface with intact Limbal conjunctival graft with mild conjunctival recurrence of fibrosis superiorly. Highlights: The video clearly explains the surgical steps of Symblepharon and the benefits of using Gore-tex. Online Video Link: https://youtu.be/aFfq2x9QBwA.

Irreversible Bilateral Cicatricial Keratoconjunctivitis after Dupilumab Therapy.

This report highlights a case of irreversible bilateral cicatricial keratoconjunctivitis related to dupilumab therapy for the treatment of severe atopic dermatitis (AD). After 38 years of AD, the patient began dupilumab therapy and achieved disease control. Two years into treatment, his ophthalmic examination was significant for bilateral cicatricial keratoconjunctivitis with severe foreshortening of the inferior conjunctival fornices, symblepharon, and ankyloblepharon, which persisted even after topical steroid eye drops and discontinuation of dupilumab. Treating dermatologists should be aware of this potential irreversible adverse effect, and we recommend that patients are monitored for ocular complications while on dupilumab therapy.

Clinical Results of the Use of Amniotic Membrane Transplantation Alone or in Combination with Adjuvant Therapies in Conjunctival Fornix Reconstruction.

Objectives: To evaluate the clinical results of amniotic membrane transplantation alone or in combination with adjuvant therapies in conjunctival fornix reconstruction. Materials and Methods: The clinical results of patients who presented to our clinic between 2002 and 2016 due to conjunctival fornix obliteration and underwent amniotic membrane transplantation alone or in combination with additional treatments were retrospectively analyzed. The Foster and Mondino classifications were used to grade fornix obliteration. In all cases, the area of conjunctival defect formed after symblepharon lysis was covered with amniotic membrane. In advanced fornix obliteration, amniotic membrane transplantation was combined with 0.04% mitomycin-C (MMC), oral mucosal transplantation, fornix formation (anchoring) sutures, symblepharon ring, eyelid surgery, fibrin glue, and limbal autograft. Deep and scarless restoration of the fornix was considered surgical success. Results: Twenty-two men and 5 women with a mean age of 45.54±4.17 years were included in the study. The etiology of fornix obliteration was mechanical trauma in 16 cases, chemical burn in 6 cases, recurrent pterygium in 3 cases, thermal burn in 1 case, and recurrent chalazion surgery in 1 case. Indications for amniotic membrane transplantation were socket insufficiency in 12 cases, cosmetic reasons in 4 cases, keratoplasty preparation in 3 cases, ptosis in 3 cases, entropion in 2 cases, strabismus in 2 cases, and diplopia in 1 case. The mean follow-up period was 45.04±8.4 months. Twenty-four of 27 cases (88.8%) were successful, while 3 (12.2%) failed due to recurrence of symblepharon. Conclusion: Amniotic membrane transplantation is a successful method when used alone in the reconstruction of early-stage conjunctival fornix obliteration and provides safe and effective results in advanced-stage fornix obliteration when performed in combination with topical 0.04% MMC, oral mucosal transplantation, and limbal autograft surgeries.

Management of Symblepharon Prior to Keratoprosthesis in Chronic Ocular Burns: A Sequential Approach.

This report describes two cases with stepwise management of chronic ocular burn sequelae with concurrent total limbal stem cell deficiency (LSCD) and advanced symblepharon. Both were mono-ocular patients with the other eye being phthisical. In both cases, a sequential approach was planned, and at the first stage, the symblepharon was released to stabilize the ocular surface and form the fornices. This was followed by a type 1 keratoprosthesis (KPro) after four months of symblepharon release in the first case, and after nine months in the second case. In the first case, after symblepharon release, the resultant bare sclera was addressed with an oral mucous membrane graft (MMG). Over two years of follow-up, there was no evidence of recurrence of the symblepharon. No further surgical interventions were required. In the second case, after symblepharon release, the resultant bare sclera was addressed with a cryopreserved amniotic membrane (AM). Over eight years of follow-up, six episodes of recurrence of the symblepharon were noted over the optic of the KPro, necessitating trimming of the conjunctiva from over the optic. Thus, with these two cases, we would like to emphasize that addressing adnexal pathologies such as a symblepharon with an oral MMG before implanting a KPro, may help prevent further recurrences of symblephara and the need for multiple surgical interventions. The oral mucosa is a better alternative to the conjunctiva as compared to the AM in a mono-ocular patient where conjunctiva cannot be harvested from the contralateral eye.

Symblepharon, Ankyloblepharon, and Salt Gland Dysfunction in a Loggerhead Sea Turtle (Caretta caretta).

Adhesions involving the bulbar and the palpebral conjunctiva (Symblepharon) may interfere with tear drainage, cause chronic conjunctivitis, and reduce ocular motility. This condition may be associated with adhesion of the edges of the upper and lower eyelids (ankyloblepharon). The present case describes bilateral symblepharon, ankyloblepharon and salt gland dysfunction in a juvenile Caretta caretta. The loggerhead presented both eyelids swollen, ulcerated, and not separable when rescued. Eye examination was not possible, but ultrasonography showed right bulbar integrity, while the left eye was smaller, with a thicker cornea that had lost its normal doubled lined structure. Surgical dissection of the fibrous adhesions between the palpebral and bulbar conjunctiva, cornea, and third eyelid was performed, and large dacryoliths were removed. The microscopic findings were consistent with chronic keratoconjunctivitis. Ultrastructurally, no virus-like particles were observed. In addition, tissue samples were negative for herpesvirus by qualitative PCR. The eyelids of both eyes and the corneal epithelium of the right eye healed; moreover, the vision was restored in the right eye. There were no recurrences after 12 months of follow-up, and the turtle was released 16 months after the end of treatments on the southern Tyrrhenian coast in the western Mediterranean Sea. To the authors' knowledge, this is the first report of symblepharon with ankyloblepharon and salt gland dysfunction in Caretta caretta turtle. Ocular ultrasonography was helpful in the preliminary diagnostic work-up.

Challenges in the management of bilateral eyelid closure in Stevens-Johnson Syndrome.

Purpose: To describe the challenges of surgically treating Stevens-Johnson syndrome (SJS) cases with bilateral eyelid closure, a serious ocular sequela. Observations: This study involved two 69-year-old females, with subacute-stage SJS (Case 1 and Case 2), and a 37-year-old male with chronic-stage SJS (Case 3). Case 1 had undergone simultaneous bilateral symblepharon lysis at 4-months post SJS onset, and her logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (VA) (BCVA) improved from 2.8 (both eyes) to 0.7 OD and 0.4 OS. Cases 2 and 3 underwent symblepharon lysis with intraoperative use of mitomycin C (MMC) and amniotic membrane transplantation (AMT) at 9 months (OD) and 11 months (OS) (Case 2) and at 31 years (OD) (Case 3) post SJS onset. At 3-months postoperative, Case 3 underwent cultivated oral mucosal epithelial sheet transplantation (COMET). In both cases, BCVA (logMAR) improved with the postoperative use of limbal-rigid contact lenses (CLs); i.e., from 2.8 to 0.5 OD and 1.2 OS (Case 2) and from 2.8 to 1.1 OD (Case 3). In all 5 treated eyes, eyelid opening and VA were maintained through final follow-up. Conclusion and importance: In severe bilateral symblepharon cases, it can be difficult to predict postoperative outcomes, as proper surgical treatment is often delayed. In SJS cases with bilateral eyelid closure, the surgical intervention strategy of AMT and COMET, combined with limbal-rigid CL wear post surgery, can result in improved vision, and symblepharon surgery might be easier and possibly result in a better prognosis when performed at the early phase.

[Viral conjunctivitis as the first sign of COVID-19 infection (clinical observation)]. / Virusnyi kon"yunktivit kak pervyi priznak koronavirusnoi infektsii COVID-19 (klinicheskoe nablyudenie).

The article presents a case of complicated viral conjunctivitis. Conjunctivitis was the initial sign of the new coronavirus infection (COVID-19) in the patient. The disease had a fairly long course and led to symmetrical scarring in the form of partial external symblepharon and dry eye syndrome. Ophthalmologists should be aware about this disease and its complications. Early treatment with corticosteroids in combination with symptomatic therapy can contribute to prevention of the development of conjunctival scarring. In addition to conjunctival scarring, this disease can possibly potentiate the development of keratitis, optic neuritis, and uveitis.

Surgical Management of Unilateral Partial Limbal Stem Cell Deficiency: Conjunctival Autografts versus Simple Limbal Epithelial Transplantation.

PURPOSE: To evaluate the clinical outcomes of conjunctival autograft (CAG) versus simple limbal epithelial transplant (SLET) for management of unilateral partial limbal stem cell deficiency (LSCD). METHODS: This retrospective, comparative, interventional case series evaluated 30 eyes of 30 patients with unilateral partial LSCD. After corneal pannus dissection, 17 patients underwent CAG where graft was harvested from the ipsilateral or contralateral eye, while 13 patients underwent SLET where limbal biopsy was harvested from the contralateral eye. The primary outcome measure was anatomical success in the form of restoration of a completely epithelised, stable, and avascular corneal surface at last follow-up. RESULTS: Both groups were comparable in terms of age at time of surgery, preoperative best-corrected visual acuity, median duration since injury, number of clock hours of limbus involved, and number of previous surgeries performed. The most common etiology for LSCD was chemical burns in both groups. The median duration of post-operative follow-up was 5.6 months [interquartile range [(IQR): 3.6-15.1] in the CAG group versus 6.2 months (IQR: 4.5-12.2) in the SLET group (p=0.75)]. The anatomical success rates were 86.5 ± 8.9% in the CAG group and 28.3 ± 13.7% in the SLET group at final follow-up visit (p = 0.025). Most failures in both groups occurred within the first 8 months after surgery. CONCLUSION: For eyes with unilateral partial LSCD secondary to chemical burns, CAG is a safe and effective method for restoring the corneal epithelium. Limbal transplantation may not be necessary for the treatment of partial LSCD.

Sutureless Amniotic Membrane (ProKera®) and Intravenous Immunoglobulin in the Management of Ocular Complications of Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis Overlap.

PURPOSE: To report a case of Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap, with severe acute ocular manifestations successfully managed with sutureless Amniotic Membrane device ProKera® (Bio-Tissue, Inc., Miami, FL) and topical steroids, followed by late complications that were successfully managed with intravenous immunoglobulin (IVIG) therapy. OBSERVATIONS: A 24-year-old lady, known case of epilepsy, admitted to the burn unit with SJS-TEN overlap attributed to a recent change of her anti-convulsant therapy, with severe ocular manifestations, inability to open both eyes, and poor visual acuity. Early management included intensive topical steroids and lubrication, in addition to the application of a ProKera® device. Despite achieving full epithelialization within two weeks with the improvement of ocular manifestations, the patient presented three weeks later with recurrence of conjunctival epithelial defects, partial ankyloblepharon, and severely dry corneas. These late sequelae were managed with bandage contact lens (BCL) application, intensive topical steroid, and lubrication in addition to IVIG therapy. After six cycles of IVIG therapy, ocular manifestations improved significantly and the patient achieved uncorrected visual acuity of 6/9 in both eyes. Conclusion and importance: Existing evidence suggests that the use of IVIG in combination with systemic steroids in the early phase of SJS-TEN can reduce mortality, without affecting the final visual outcome in patients with ocular manifestations. This case highlights the possible role of IVIG therapy alone - without systemic steroids - in managing and preventing long-term ocular complications of SJS-TEN.

Allogeneic Cultivated Limbal Epithelial Sheet Transplantation in Reconstruction of Conjunctival Sac After Chemical and Thermal Burns.

The study aims to evaluate the effect of allogeneic cultivated limbal epithelial cell sheet transplantation (CLET) in reconstructing conjunctival sac for severe symblepharon after chemical and thermal burns. A retrospective, non-comparative case series. Thirty-six eyes (36 patients) underwent CLET for severe symblepharon and conjunctival sac stenosis or atresia. Symblepharon was separated, and pseudopterygium was preserved to replace the palpebral conjunctiva. Allogeneic cultivated limbal epithelial cell sheet using human amniotic membrane as a carrier was transplanted into the recipient's eye to reconstruct the conjunctival sac. The effect of conjunctival sac reconstruction, eye and eyelid movement, ocular surface restitution, and symblepharon recurrence were analyzed after surgery. Symblepharon was completely relieved in 30 of the 36 eyes (83.3%) by a single surgical procedure, with fornix reconstruction, as well as free movement of eye globe and eyelids. Strip-like symblepharon remained in 6 eyes (16.7%) and was completely relieved after the second CLET. Twenty patients without visual function received prostheses 3 months after surgery and the other sixteen patients underwent different corneal transplantation for visual acuity improvement. During the follow-up period, no one had symblepharon recurrence. The transplantation of cultivated allogeneic limbal epithelial sheets offers an effective and safe alternative in the treatment of symblepharon and reconstruction of conjunctival sac in eyes with severe ocular burns, which lays the foundation for subsequent treatments.

Long-term follow up of oral mucosa autograft sutured to the sclera in severe symblepharon.

PURPOSE: To evaluate the clinical outcomes and complications of oral mucosa autograft (OMAU) sutured to the sclera to treat symblepharon after severe chemical or fireworks burn. METHODS: Our surgical technique for OMAU sutured to the sclera is presented along with clinical data and outcomes of 7 symblepharon carriers. Our surgical technique was performed unilateral in all cases. An OMAU with a mean length of 3 cm and 2 cm wide was sutured to the bare sclera 1-3 mm behind the limbus. Amniotic membrane transplant was placed covering the rectus muscles and bare sclera proximal to the limbus. The fornix was secured into the skin with deepening bolster sutures. A temporary tarsorrhaphy was performed, and a symblepharon ring was placed on top of a bandage contact lens. RESULTS: There were no cases of intraoperative complications. Three years postoperatively, all patients had perfect integration of the OMAU and there were no cases of symblepharon's recurrence. Two patients developed mild superior entropion and 2 patients developed mild strabismus (one esotropia and another exotropia). CONCLUSION AND IMPORTANCE: OMAU sutured to the sclera after symblepharon release caused by severe ocular burns, results in excellent cosmetic and anatomical outcomes with no recurrence.