Ocular Surface Reconstruction Surgery | PristynCare

Risk Factors

Patients most likely to require ocular surface reconstruction include those with:

• History of severe chemical or thermal eye burns
• Autoimmune conditions affecting the ocular surface (pemphigoid, SJS)
• Failed previous ocular surface procedures
• Graft-versus-host disease after bone marrow transplant
• Longstanding severe dry eye with surface breakdown
• Multiple prior conjunctival surgeries

Who Benefits

Patients with total or near-total limbal stem cell deficiency, severe conjunctival scarring, or persistent corneal epithelial breakdown despite maximum medical therapy are candidates for ocular surface reconstruction. Surgery is staged, beginning with surface stabilization before addressing visual rehabilitation through corneal transplantation.

Diagnosis

Assessment before ocular surface reconstruction includes:

• Detailed slit-lamp examination with fluorescein and rose bengal staining
• Impression cytology to assess corneal conjunctivalization
• Tear film assessment including Schirmer test and tear break-up time
• Anterior segment OCT for surface mapping
• Eyelid examination for trichiasis, entropion, and symblepharon
• Systemic evaluation for underlying autoimmune disease

Staged Treatment Plan

Ocular surface reconstruction follows a staged approach. The first stage addresses inflammation control, symblepharon lysis, and conjunctival reconstruction using mucous membrane grafts or amniotic membrane. The second stage involves limbal stem cell transplantation to restore corneal epithelialization. After surface stability is achieved, corneal transplantation (DALK or PK) can be planned for visual rehabilitation.

Surface Reconstruction Steps

Ocular surface reconstruction is performed in stages:

• Stage 1: Control of active inflammation with systemic immunosuppression before surgery
• Symblepharon lysis under anesthesia to restore eyelid-globe anatomy
• Amniotic membrane transplantation to cover the cornea and reduce inflammation
• Mucous membrane grafting using palatal or buccal mucosa to reconstruct the conjunctival fornices
• Tarsorrhaphy to protect the cornea during healing
• Stage 2: Limbal stem cell transplantation once the surface is stable
• Stage 3: Corneal transplantation (DALK or PK) for visual rehabilitation after the surface is healthy
• Ongoing topical and systemic immunosuppression throughout all stages

Post-Surgery Recovery

Recovery after ocular surface reconstruction involves:

• Long-term topical cyclosporine and lubricating drops for surface support
• Systemic immunosuppression for allogeneic stem cell procedures
• Regular monitoring of the corneal surface every 1 to 2 months
• Use of moisture chamber spectacles for severe dry eye
• Avoid exposure to dusty or smoky environments
• Follow-up planning for subsequent corneal transplantation if visual rehabilitation is the goal

Risks and Complications of Surface Reconstruction

Possible complications of ocular surface reconstruction include:

• Graft failure: Non-engraftment of limbal stem cells or conjunctival grafts
• Recurrent symblepharon: Re-formation of adhesions after lysis
• Persistent epithelial defect: Prolonged corneal surface healing
• Infection: Bacterial or fungal keratitis in the post-operative period
• Corneal melt: Sterile stromal dissolution in severely compromised eyes
• Failure to achieve visual rehabilitation: If corneal transplant subsequently fails on a compromised surface