Treatment of ligneous conjunctivitis with amniotic membrane transplantation and topical cyclosporine
A 5-year-old female child was brought to us with a right sessile and dense membrane on the right upper eyelid since 1 month after birth. The membrane had previously been removed, and she had received long-term topical steroid treatment in another clinic. Upon examination, we found that she had right mechanical ptosis, esotropia, corneal leukoma, and complicated cataract, possibly steroid induced. The membrane had a firm, fibrous consistency with elevated edges and measured 20 × 14 mm in the right upper eyelid []. There was minimal inflammation in the lower eyelid. Her visual acuity was motion hand-20/20 in her right and left eyes, respectively. The membrane was excised from the upper eyelid. Histopathological analysis of the removed pseudomembrane showed eroded epithelium with massive subepithelial deposits of amorphous hyaline-like eosinophilic material and granulation tissue together with inflammatory cell which consisted of plasma cells and lymphocytes []. The eosinophilic materials were negative for Congo red stain. After surgery, she was treated with CsA 2% drops in olive oil, four times daily. Recurrence of the conjunctival lesion was noted at the site of excision 2 months later. The lesion was again excised. The child did not come back for follow-up. The patient returned 2 years later with the same lesion. The lesion was excised and the AM epithelium was secured up to the conjunctival edge at the mucocutaneous junction and the fornices with 8-0 polyglactin sutures in the right upper eyelid []. The right eye was treated with topical CsA four times daily and tobramycin eye drops six times daily.\nFour months after AM transplantation (AMT), the patient showed new recurrence at the same site. The new pseudomembranous lesion was much smaller and softer; it was removed and the AM was used to cover the excision site. Treatment with topical CsA four times daily was continued for 6 months postoperatively. There was no recurrence of the membranes at the end of 28-months follow-up [].