{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T05:01:57Z","timestamp":1783832517371,"version":"3.55.0"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T00:00:00Z","timestamp":1686182400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82271058"],"award-info":[{"award-number":["82271058"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["2022CXGC010505"],"award-info":[{"award-number":["2022CXGC010505"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Key R&amp;D program of Shandong Province, China","award":["82271058"],"award-info":[{"award-number":["82271058"]}]},{"name":"Key R&amp;D program of Shandong Province, China","award":["2022CXGC010505"],"award-info":[{"award-number":["2022CXGC010505"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFB"],"abstract":"<jats:p>This prospective study aimed to evaluate the effectiveness of decellularized porcine conjunctiva (DPC) in the management of severe symblepharon. Sixteen patients with severe symblepharon were enrolled in this study. After symblepharon lysis and Mitomycin C (MMC) application, tarsus defects were covered with residual autologous conjunctiva (AC), autologous oral mucosa (AOM), or DPC throughout the fornix, and DPC was used for all the exposed sclera. The outcomes were classified as complete success, partial success, or failure. Six symblepharon patients had chemical burns and ten had thermal burns. Tarsus defects were covered with DPC, AC, and AOM in two, three, and eleven cases, respectively. After an average follow-up of 20.0 \u00b1 6 months, the anatomical outcomes observed were complete successes in twelve (three with AC+DPC, four with AC+AOM+DPC, and five with AOM+DPC) (75%) cases, partial successes in three (one with AOM+DPC and two with DPC+DPC) (18.75%) cases, and failure in one (with AOM+DPC) (6.25%) case. Before surgery, the depth of the narrowest part of the conjunctival sac was 0.59 \u00b1 0.76 mm (range, 0\u20132 mm), tear fluid quantity (Schirmer II tests) was 12.5 \u00b1 2.26 mm (range, 10\u201316 mm), and the distance of the eye rotation toward the opposite direction of the symblepharon was 3.75 \u00b1 1.39 mm (range, 2\u20137 mm). The fornix depths increased to 7.53 \u00b1 1.64 mm (range, 3\u20139 mm), eye movement was significantly improved, and the distance of eye movement reaching 6.56 \u00b1 1.24 mm (range, 4\u20138 mm) 1 month after the operation; the postoperative Schirmer II test (12.06 \u00b1 2.90 mm, range, 6\u201317 mm) was similar to that before surgery. Goblet cells were finally found in fifteen patients by conjunctival impression cytology in the transplantation area of DPC, except for one patient who failed. DPC could be considered an alternative for ocular surface reconstruction of severe symblepharon. Covering tarsal defects with autologous mucosa is necessary for extensive reconstruction of the ocular surface.<\/jats:p>","DOI":"10.3390\/jfb14060318","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T02:03:18Z","timestamp":1686276198000},"page":"318","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Decellularized Porcine Conjunctiva in Treating Severe Symblepharon"],"prefix":"10.3390","volume":"14","author":[{"given":"Fengmei","family":"Shan","sequence":"first","affiliation":[{"name":"Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan 250012, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueying","family":"Feng","sequence":"additional","affiliation":[{"name":"Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan 250012, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Li","sequence":"additional","affiliation":[{"name":"Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan 250012, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sha","family":"Yang","sequence":"additional","affiliation":[{"name":"Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan 250012, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuhua","family":"Wang","sequence":"additional","affiliation":[{"name":"Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan 250012, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiyun","family":"Shi","sequence":"additional","affiliation":[{"name":"Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan 250012, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Zhao","sequence":"additional","affiliation":[{"name":"Shandong Provincial Key Laboratory of Ophthalmology, State Key Laboratory Cultivation Base, Eye Institute of Shandong First Medical University, Qingdao 266071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingjun","family":"Zhou","sequence":"additional","affiliation":[{"name":"Shandong Provincial Key Laboratory of Ophthalmology, State Key Laboratory Cultivation Base, Eye Institute of Shandong First Medical University, Qingdao 266071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1136\/bjo.2010.199901","article-title":"Minor salivary glands and labial mucous membrane graft in the treatment of severe symblepharon and dry eye in patients with Stevens-Johnson syndrome","volume":"96","author":"Hazarbassanov","year":"2012","journal-title":"Br. J. Ophthalmol."},{"key":"ref_2","first-page":"e20854","article-title":"Dermatologic and ophthalmologic treatment of erythema multiforme major: A case report","volume":"13","author":"Senger","year":"2021","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"237","DOI":"10.4274\/tjo.galenos.2021.77019","article-title":"Clinical Results of the Use of Amniotic Membrane Transplantation Alone or in Combination with Adjuvant Therapies in Conjunctival Fornix Reconstruction","volume":"52","author":"Kaderli","year":"2022","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/ICO.0b013e318247983d","article-title":"A combined approach of amniotic membrane and oral mucosa transplantation for fornix reconstruction in severe symblepharon","volume":"32","author":"Kheirkhah","year":"2013","journal-title":"Cornea"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1111\/j.1600-0420.1996.tb00596.x","article-title":"Autologous transplantation of nasal mucosa after severe chemical and thermal eye burns","volume":"74","author":"Kuckelkorn","year":"1996","journal-title":"Acta Ophthalmol. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1111\/odi.12590","article-title":"Management of patients with ocular manifestations in vesiculobullous disorders affecting the mouth","volume":"23","author":"Hansen","year":"2017","journal-title":"Oral Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/IOP.0000000000001717","article-title":"Direct Injection of 5-Fluorouracil Improves Outcomes in Cicatrizing Conjunctival Disorders Secondary to Systemic Disease","volume":"37","author":"Jovanovic","year":"2021","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1016\/S0181-5512(06)73902-X","article-title":"Int\u00e9r\u00eat des greffes de membranes amniotiques dans les pathologies oculaires de surface [Advantages of amniotic membrane transplantation in eye surface diseases]","volume":"29","author":"Muraine","year":"2006","journal-title":"J. Fr. D\u2019ophtalmologie"},{"key":"ref_9","first-page":"801","article-title":"Die Amnionmembrantransplantation zur Rekonstruktion der Augenoberfl\u00e4che [Amniotic membrane transplantation for reconstruction of the ocular surface]","volume":"98","author":"Kruse","year":"2001","journal-title":"Der Ophthalmol. Z. Der Dtsch. Ophthalmol. Ges."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4316","DOI":"10.1167\/iovs.05-1415","article-title":"Amniotic membrane for ocular surface reconstruction: Donor variations and the effect of handling on TGF-beta content","volume":"47","author":"Hopkinson","year":"2006","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1038\/eye.2008.410","article-title":"Amniotic membrane in ophthalmology: Indications and limitations","volume":"23","author":"Rahman","year":"2009","journal-title":"Eye"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"541","DOI":"10.3109\/02713683.2013.853803","article-title":"Review of alternative carrier materials for ocular surface reconstruction","volume":"39","author":"Feng","year":"2014","journal-title":"Curr. Eye Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1159\/000131092","article-title":"Mucous membrane grafting","volume":"41","author":"Henderson","year":"2008","journal-title":"Dev. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1159\/000351631","article-title":"Oral mucosal grafts: Old technique in new light","volume":"50","author":"Mai","year":"2013","journal-title":"Ophthalmic Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ajo.2009.07.030","article-title":"Ocular surface reconstruction with autologous nasal mucosa in cicatricial ocular surface disease","volume":"149","author":"Kim","year":"2010","journal-title":"Am. J. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"913","DOI":"10.3109\/02713680903198045","article-title":"Tissue engineering for conjunctival reconstruction: Established methods and future outlooks","volume":"34","author":"Schrader","year":"2009","journal-title":"Curr. Eye Res."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Porzionato, A., Stocco, E., Barbon, S., Grandi, F., Macchi, V., and De Caro, R. (2018). Tissue-Engineered Grafts from Human Decellularized Extracellular Matrices: A Systematic Review and Future Perspectives. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19124117"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.actbio.2019.11.006","article-title":"Ocular surface repair using decellularized porcine conjunctiva","volume":"101","author":"Zhao","year":"2020","journal-title":"Acta Biomater."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ajo.2008.03.028","article-title":"Surgical strategies for fornix reconstruction based on symblepharon severity","volume":"146","author":"Kheirkhah","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00417-008-0934-0","article-title":"Management of severe ocular burns with symblepharon","volume":"247","author":"Shi","year":"2009","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.survophthal.2011.11.003","article-title":"Evaluation of dry eye","volume":"57","author":"McGinnigle","year":"2012","journal-title":"Surv. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1038\/eye.2016.128","article-title":"Upper and lower conjunctival fornix depth in healthy white caucasian eyes: A method of objective assessment","volume":"30","author":"Jutley","year":"2016","journal-title":"Eye"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0161-6420(02)01441-0","article-title":"Amniotic membrane transplantation for reconstruction of the conjunctival fornices","volume":"110","author":"Solomon","year":"2003","journal-title":"Ophthalmology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.actbio.2017.11.054","article-title":"Decellularised conjunctiva for ocular surface reconstruction","volume":"67","author":"Witt","year":"2018","journal-title":"Acta Biomater."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.jtos.2020.08.009","article-title":"Decellularized porcine conjunctiva as an alternative substrate for tissue-engineered epithelialized conjunctiva","volume":"18","author":"Witt","year":"2020","journal-title":"Ocul. Surf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.ajo.2015.06.003","article-title":"Sealing of the gap between the conjunctiva and tenon capsule to improve symblepharon surgery","volume":"160","author":"Zhao","year":"2015","journal-title":"Am. J. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"199","DOI":"10.2147\/OPTH.S40472","article-title":"Pre- and intraoperative mitomycin C for recurrent pterygium associated with symblepharon","volume":"7","author":"Mohammed","year":"2013","journal-title":"Clin. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/S0161-6420(87)33321-4","article-title":"Glaucoma filtering surgery with 5-fluorouracil","volume":"94","author":"Rockwood","year":"1987","journal-title":"Ophthalmology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"697264","DOI":"10.3389\/fmed.2021.697264","article-title":"Allogeneic Cultivated Limbal Epithelial Sheet Transplantation in Reconstruction of Conjunctival Sac After Chemical and Thermal Burns","volume":"8","author":"Wang","year":"2021","journal-title":"Front. Med."}],"container-title":["Journal of Functional Biomaterials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-4983\/14\/6\/318\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:50:55Z","timestamp":1760125855000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-4983\/14\/6\/318"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,8]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["jfb14060318"],"URL":"https:\/\/doi.org\/10.3390\/jfb14060318","relation":{},"ISSN":["2079-4983"],"issn-type":[{"value":"2079-4983","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,8]]}}}