Adjunctive amniotic membrane transplantation in the surgical management of fat adherence syndrome: A retrospective clinical series

This study evaluates the clinical outcomes of adjunctive amniotic membrane transplantation (AMT) in the surgical management of fat adherence syndrome (FAS), a rare but challenging cause of restrictive strabismus following inferior oblique surgery. This retrospective clinical series included patients diagnosed with FAS between 2016 and 2022 who presented with hypotropia, supraduction limitation, and a positive forced duction test after prior inferior oblique surgery. All patients underwent meticulous adhesiolysis, conjunctival recession, and, when indicated, inferior rectus recession, with adjunctive AMT. Surgical success was predefined as postoperative deviation ≤10 prism diopters, improved supraduction without mechanical restriction, and resolution of abnormal head posture. Seven patients (mean age: 17.7 years) met the inclusion criteria. Intraoperatively, dense adhesions involving the inferior rectus muscle, Tenon capsule, and prolapsed fat were identified and successfully released in all cases. Postoperatively, all patients demonstrated improvement in both alignment and motility, and 6 of 7 met the predefined surgical success criterion of ≤10 prism diopters. Diplopia and abnormal head posture resolved in affected patients. No cases of anterior segment ischemia, recurrent restriction, or other complications were observed during 6 to 36 months of follow-up. Adjunctive AMT may help improve postoperative healing and reduce recurrent fibrosis in patients undergoing surgery for FAS. In this retrospective series, favorable functional and cosmetic outcomes were observed following combined surgical management with AMT. Larger prospective controlled studies are required to further clarify its therapeutic contribution.