J Korean Ophthalmol Soc > Volume 57(4); 2016 > Article
Journal of the Korean Ophthalmological Society 2016;57(4):686-690.
DOI: https://doi.org/10.3341/jkos.2016.57.4.686    Published online April 15, 2016.
Double-Layered Conjunctival Autograft and Amniotic Membrane Transplantation to Treat Restrictive Esotropia and Hypotropia.
Jun Woo Park, Kyeong Hwan Kim, Soo Jung Lee
Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. kris9352@hanmail.net
제한성 내사시와 하사시를 양막과 자가결막의 이중 이식술로 치료한 1예
인제대학교 의과대학 해운대백병원 안과학교실
Correspondence:  Soo Jung Lee
Received: 24 September 2015   • Revised: 17 December 2015   • Accepted: 5 February 2016
To report a case of double-layered conjunctival autograft and amniotic membrane transplantation for the effective treatment of esotropia and hypotropia after removal of the recurrent pterygium. CASE SUMMARY: A 58-year-old male who had pterygium surgery of the right eye twice presented with diplopia on right gaze for 3 months. At the first visit, he had orthotropia in the primary position and right esotropia of 12 prism diopters (PD) on right gaze with limited abduction of -1 in the right eye. Fourteen months later, deviation was aggravated by esotropia of 30 PD and 12 PD of right hypotropia in the primary position at distance, and esotropia of 35 PD and 12 PD of right hypotropia at near with limited abduction of -2 and supraduction of -3 in the right eye. The patient complained of diplopia at all gazes and demonstrated chin-up posture. The conjunctival edge was recessed near the medial canthus and fornix, preventing conjunctival autograft after removal of subconjunctival scar tissue. Thus, 5 mm right medial rectus recession and additional half-sized conjunctival autograft were performed after amniotic membrane transplantation. The patient than showed no diplopia and orthotropia at both distance and near, with limited adduction of -1 in the right eye. He experienced no recurrence during 7 months of follow-up. CONCLUSIONS: To prevent poor epithelial regeneration and dehiscence of graft in the patients with severe restrictive strabismus and very extensive conjunctival defect, double-layered conjunctival autograft and amniotic membrane transplantation may be effective for the treatment of severe esotropia and hypotropia.
Key Words: Amniotic membrane transplantation;Conjunctival autograft;Double layer;Recurrent pterygium;Restrictive strabismus

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