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Surgical Technique | Surgeon's Corner

A Novel Technique of Modified Continuous Blanket Suture for Amniotic Membrane Fixation in Severe Ocular Surface Diseases

Zong-Duan Zhang, MD1; Hui-Xiang Ma, MD1; Ding Chen, MD, OD1; Mei Li, MD1; Jing-Bo Liu, MD2; Fan Lu, MD, OD1; Jia Qu, MD1
[+] Author Affiliations
1Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China
2Weill Cornell Medical College, New York, New York
JAMA Ophthalmol. 2013;131(7):941-947. doi:10.1001/jamaophthalmol.2013.2125.
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The purpose of this article is to demonstrate a novel technique using modified continuous blanket suture (MCBS) to fix the amniotic membrane (AM) in different severe ocular surface disease lesions. The MCBS techniques were used to fix the AMs of 5 representative patients with different ocular surface lesions related to severe ocular surface diseases. In all cases, stable adherence of the AM was maintained until the epithelialization of the ocular surface was completed. No early detachment, dissolution, or dislocation of the AM patch was observed. During follow-up, all patients acquired a smooth and acceptable ocular surface without any persistent epithelial defect, infection, or ulceration. The MCBS method achieved good AM fixation on the ocular surface in cases of severe ocular surface lesions and could prevent the early detachment of the AM and promote the epithelialization of the ocular surface.

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Figures

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Figure 1.
Slitlamp Photographs of a Patient With a Chemical Burn Who Underwent Amniotic Membrane Transplantation Using Modified Continuous Blanket Suture

A, Schematic diagram of the modified continuous blanket suture approach for the amniotic membrane fixed on the entire cornea and limbus. A detailed description is presented in the Methods section. B, A severe (grade III) alkaline burn was observed. C, On the day of amniotic membrane transplantation surgery, the modified continuous blanket suture technique was used to shape 2 loops around the cornea, and the amniotic membrane was placed over the entire cornea and bulbar conjunctiva. D, After the corneal epithelialization was completed, fibrovascular tissue invaded to the nasal peripheral cornea after 1 month.

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Figure 2.
Amniotic Membrane Transplantation for Fornix Reconstruction

A, Amniotic membrane transplantation for fornix formation was performed in a patient with an acute thermal burn (copper). B, Eight weeks after surgery, the lesions were restored and a functional fornix was obtained.

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Figure 3.
Amniotic Membrane Transplantation for a Traumatic Corneal Defect Without Perforation

A, A deep corneal stromal defect occupying more than 90% of the corneal thickness developed in the patient’s right eye as a result of hot scrap iron. B and C, Multilayer amniotic membranes were stacked to fill the stromal defect, 2 more pieces of amniotic membrane patch were anchored as a bandage using modified continuous blanket suture, and a simple shoelace suture was used. D, Complete epithelialization was observed within 3 weeks postoperation. A whitish scar tissue without neovascularization was observed in the corneal lesion.

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Figure 4.
Slitlamp Photographs Illustrating the Amniotic Membrane Sutured to the Perilimbal Episclera and the Conjunctiva Covering the Entirety of the Lesion Sites and Part of the Nasal Corneal Surface

A, Before surgery, the patient presented with a severe thermal burn with sclera perforation 2 weeks after injury. B and C, After 3 unsuccessful sclera sutures and 1 unsuccessful conjunctival autograft, the patient underwent amniotic membrane transplantation surgery with sclera graft. D, Four weeks after surgery, the amnion was removed along with the conjunctival epithelialization. Finally, ocular surface reconstruction was achieved.

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Figure 5.
Slitlamp Photographs of Patient 1 (Thermal Burn), Who Underwent Amniotic Membrane Transplantation Using Modified Continuous Blanket Suture

A, Before surgery, the patient presented with severe (grade III) burns on the conjunctiva and eyelids. B, The first day after amniotic membrane transplantation, amniotic membrane covered the whole globe of the eye. C, Two weeks postoperatively, epithelialization and symptomatic relief was completely obtained. D, Four weeks after amniotic membrane transplantation, the amniotic membrane was removed, and quiet, smooth, and stable epithelialization of the ocular surface were regained.

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Figure 6.
Slitlamp Photographs of Patient 2, With Amniotic Membrane Covering a Large Defect Following the Excision of Conjunctival Intraepithelial Neoplasia

A, Before surgery, the patient presented with a large conjunctival tumor. B, One day after amniotic membrane transplantation, modified continuous blanket suture was used to shape 2 loops. C, Eight days after amniotic membrane transplantation, corneal epithelialization and conjunctival vascularization were achieved. D, Two months after transplantation, the ocular surface reconstruction was completed.

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Figure 7.
Slitlamp Photographs of Patient 3, Who Had Necrotic Scleritis Treated With Modified Continuous Blanket Suture

A, A large area of deep scleral ulceration with the uvea exposed at the superior nasal quadrant of the right eye. B, Surgery video showing a 13 × 6-mm scleral ulcer. The donor scleral graft was sutured and covered the ulcer area. C, One day after amniotic membrane transplantation, the amniotic membrane was anchored to the normal perilimbal episclera and bulbar conjunctiva, covering the temporal conjunctiva and portions of the cornea. D, The scleral graft had vascularized, the conjunctival wound was healed, and a stable ocular situation was achieved 3 weeks after transplantation.

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Figure 8.
Slitlamp Photographs of Patient 4, Who Presented With Forniceal Conjunctival Acute Lesions

A, Amniotic membrane transplantation with modified continuous blanket suture was performed to treat extensive symblepharon of the lower fornix and severe thermal burns. B, Three months after surgery, fornix reconstruction was obtained, and the conjunctival epithelialization and neovascularization were improved.

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Figure 9.
Slitlamp Photographs of Patient 5, Who Was Treated for Corneal Fistula Using Modified Continuous Blanket Suture

A, A 2-mm-diameter spontaneous, sterile central corneal fistula was observed after an unsuccessful conjunctival autograft. B and C, One day and 2 weeks after amniotic membrane transplantation, respectively, the deep amniotic pieces were incorporated into the corneal stroma. D, Two years after transplantation, a smooth and quiet corneal surface was achieved, and a fibrovascular membrane had invaded the damaged cornea as a result of a total limbal stem cell deficiency.

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