Ocular Surface Reconstruction With Keratolimbal Allograft for the Treatment of Severe or Recurrent Symblepharon

Purpose: To describe an ocular surface reconstruction technique using keratolimbal allograft (KLAL) tissue to repair and treat severe or recurrent symblepharon. Methods: Five eyes of 5 patients (age 23-71 years) with severe or recurrent symblepharon causing symptomatic restrictive diplopia in primary gaze have been treated. After meticulous symblepharon lysis and scar tissue removal, KLAL tissue was sutured onto the ocular surface and used as a spacer to prevent recurrent scar formation. Patients have been followed from 12 to 28 months. Results: All eyes have been free of symblepharon recurrence in areas reconstructed with KLAL tissues. Mild recurrences of adhesions have occurred in areas posterior to the KLAL graft and none have recurred over the KLAL segments. Primary gaze diplopia has been resolved in all cases with only mild residual diplopia in extreme lateral gazes for 3 patients. Conclusions: Ocular surface reconstruction with KLAL tissue effectively achieves functional and anatomic success in fornix repair for patients with severe or recurrent symblepharon. Donor KLAL is a robust tissue alternative to traditional amniotic membrane or conjunctival autografts.