Abstract
PURPOSE: To evaluate the safety and efficacy of a collagen matrix implant (CMI) as an adjunct in ocular surface reconstruction for moderate to severe post-chemical injury symblepharon. METHODS: This prospective interventional pilot study included ten eyes of nine patients (all male, mean age 17.90 ± 9.48 years) with moderate (n = 4) or severe (n = 6) symblepharon secondary to chemical injury. All patients underwent symblepharon lysis, followed by ocular surface reconstruction using mucous membrane graft and amniotic membrane graft, with the additional placement of a CMI secured with 6-0 vicryl sutures. A symblepharon ring was placed postoperatively for 6-8 weeks. All patients were followed for at least 6 months. Surgical success was defined as ≥30% forniceal depth (FD) correction at 3 months, categorized as excellent (75 - 100%), good (60 to <75%), or poor (30 to <60%). Recurrence was defined as a >2 mm decrease in FD from the 3-month value. Statistical analysis was performed using SPSS v23. RESULTS: All nine patients completed 6 months of follow-up. There was no case of failure or recurrence. The mean percent depth correction at 3 months was 78.32% in the upper eyelid and 74.47% in the lower eyelid. The mean upper middle FD increased significantly from 4.40 mm preoperatively to 12.20 mm at 3 months, stabilizing at 11.40 mm at 6 months. Similarly, the mean lower middle FD improved from 2.42 mm to 7.57 mm at 3 months, maintaining 7.28 mm at 6 months (Friedman test: χ2 = 10.78, P = 0.00455). Anatomical outcomes were excellent in 8 eyes, good in 1 eye, and poor in 1 eye. Two patients showed significant visual acuity improvement. One patient developed postoperative orbital cellulitis, and three had pyogenic granuloma (not implant-related). There were no cases of implant extrusion. CONCLUSION: The collagen matrix implant appears to be a safe and effective adjunct for ocular surface reconstruction in moderate to severe post-chemical injury symblepharon, demonstrating encouraging short-term anatomical outcomes with no recurrences at 6 months. Further studies with longer follow-up are warranted.