Symblepharon refers to the adhesion between the bulbar and palpebral conjunctiva, which may occur due to inflammatory diseases such as Steven-Johnson syndrome, ocular cicatricial pemphigoid, sarcoidosis, traumatic etiologies, or infections [1]. The severity and complications of symblepharon depend on its location. For example, adhesions on the limbus or over the cornea can lead to vision loss, while near the lacrimal gland orifice, adhesions can cause dry eye. Adhesions can also result in diplopia and restricted eye movement. Thus, when the aforementioned pathogenic elements of symblepharon are present, the patient should receive treatments to prevent progressive and permanent damage to the visual function.

Surgery and medical therapy are the main treatments for symblepharon [2]. Traditionally, surgical techniques involve cicatrix lysis and the reconstruction of the defect with tissue grafts from either conjunctival autografting, oral mucosa transplantation or amniotic membrane transplantation [1]. However, to date, no surgical procedure for treating symblepharon has yet to be standardized, and the relatively high recurrence rate after surgery is a significant obstacle.

Sutureless amniotic membrane (ProKera®; Bio-Tissue, Inc., Miami, FL), approved by the U.S. Food and Drug Administration (FDA), is a medical device specifically designed for eye conditions such as damage to the ocular surface cells, underlying stromal inflammation, or scarring. Sufficient evidence has proved that sutureless amniotic membrane can reduce inflammation, promote healing, prevent further corneal epithelial defects, and preserve visual acuity without severe cicatricial complications or limbal stem cell deficiency in patients with ocular surface diseases [3]. As compared to traditional amniotic membrane transplantation, ProKera® is a quicker and safer technique that does not require sutures, thus reducing the time patients spend in the operating room under general or local anesthesia [4]. Furthermore, ProKera® can be preserved in a standard freezer or a refrigerator at a temperature lower than 4 °C for up to two years, providing significant flexibility. With this sutureless, quick, and safe technique, ProKera® is now possible to apply the amniotic membrane in a bedside or clinic-based setting to treat patients with ocular surface diseases.