Recurrent Symblepharon In Stage 3–4 Ocular Cicatricial Pemphigoid Managed With Amniotic Membrane Grafting And Frost Sutures
Published 2026 - 44th Congress of the ESCRS
Reference: PP25.09 | Type: Poster | DOI: 10.82333/ncjh-5462
Authors: Dr Jethro Chua Kho* 1 , Dr Victor Caparas 1
1Ophthalmology,The Medical City Eye and Vision Institute,Manila ,Philippines
Purpose
To present the management of recurrent symblepharon with restrictive strabismus in a 69-year-old male with Stage 3–4 Ocular Cicatricial Pemphigoid (OCP) who previously underwent ocular surface reconstruction and entropion repair of the left eye.
Setting
The Medical City Eye and Vision Institute, a private tertiary care hospital in Metro Manila, Philippines
Methods
A 69-year-old male with advanced OCP of the left eye and prior ocular surface reconstruction with amniotic membrane transplantation, symblepharon release, and entropion repair (tarsal fracture procedure and anterior lamellar lid strip), done 5 years prior, presented with recurrent symblepharon and limitation of adduction. Surgical management included repeat symblepharon release, fornix reconstruction with placement of an amniotic membrane graft, and frost sutures with a soft tube bolster to maintain eyelid eversion and prevent re-adhesion. Postoperatively, topical tobramycin-dexamethasone, cyclosporine, and preservative-free lubricants were given to reduce inflammation and stabilize the ocular surface.
Results
Postoperatively, the fornix depth was restored and ocular motility improved with reduction in adduction restriction. The amniotic membrane graft remained well positioned, and the frost suture with bolster effectively maintained eyelid eversion during the immediate healing period. No intraoperative complications were noted. Early postoperative follow-up demonstrated satisfactory ocular surface stability with no immediate recurrence of symblepharon.
Conclusions
Recurrent symblepharon remains a significant challenge in advanced OCP due to chronic cicatrizing inflammation. Repeat symblepharon release combined with amniotic membrane transplantation and temporary frost sutures with bolsters may effectively restore fornix anatomy, improve ocular motility, and reduce early recurrence. Meticulous surgical technique and close postoperative monitoring are essential in managing progressive cicatricial disease.