Purpose

Complex conjunctival defects often require reconstruction of multiple anatomic sites using different graft types. Most publications focus on single graft types for single indications. This study reports the outcomes of ocular surface reconstruction using site-specific graft selection across diverse pathologies.

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Methods

Retrospective case series of patients who underwent conjunctival reconstruction at an academic institution (2024–2026). Patients requiring enucleation or evisceration without surface reconstruction, or procedures without grafting, were excluded. Anatomic success was defined as graft survival without recurrent symblepharon. Secondary outcomes included reoperation rates and complications.

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Results

29 eyes of 29 patients (mean age 69 years, 40% female, mean follow-up 8 months) were included. Indications included periocular malignancy (13; 5 squamous cell carcinoma, 5 basal cell carcinoma, 2 melanoma, 1 primary acquired melanosis), cicatricial disease (3; 2 Stevens-Johnson syndrome, 1 ocular cicatricial pemphigoid), recurrent pterygium or post-keratoprosthesis symblepharon (6), post-traumatic or socket contracture (3), and unknown etiology (4). 18 eyes (62%) required two or more graft types. A total of 46 grafts were placed: 22 oral mucous membrane, 7 nasal floor mucosa, and 17 conjunctival autograft. Oral mucosa was most commonly used for palpebral and forniceal reconstruction, while conjunctival autograft was preferred for bulbar defects. Amniotic membrane was used as an adjunctive overlay in 52% of cases. No graft loss was observed. Recurrence near the reconstruction site occurred in 3 eyes. Unplanned reoperation was required in 4 eyes. No donor site morbidity occurred.

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Conclusion

This series demonstrates favorable outcomes using site-specific, multi-graft reconstruction across diverse conjunctival pathologies. Reserving amniotic membrane as an overlay rather than a primary graft aligns with evidence showing high recurrence when amniotic membrane is used alone. Matching graft type to reconstruction site may optimize results in complex ocular surface disease.

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Additional Authors

First name	Last name	Base Hospital / Institution
Sara S.	Emami	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Angela	Oh	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Tatiana	Rosenblatt	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Frank	Mei	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
Daniel	Rootman	Department of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA

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