A 25-year-old woman underwent dermis fat graft on the right side for persistent ocular pain with her polymethylmethacrylate (PMMA) spherical orbital implant. One week later she developed dermal necrosis of the dermis fat graft with potentially devastating fat atrophy if left uncovered. Amniotic membrane graft epithelial side up was sutured to the conjunctiva surrounding the fat. 2 weeks later the graft epithelialized with preservation of fat. Role of amniotic membrane graft as a routine lining over dermis fat grafts to promote conjunctival healing and prevent fat exposure needs to be studied in prospective studies.

Purpose: To determine the efficacy of 0.03% dermatological tacrolimus ointment in patients with refractory vernal keratoconjunctivitis Study Design: Quasi-experimental study Study Place and Duration: Eye Department, DHQ-Teaching Hospital, Gujranwala, Pakistan from April 2018 to March 2019 Material and Methods: After approval from hospital ethical committee and obtaining written informed consent from each patient/guardian, patients of either gender between 4-16 years of age with VKC not responding to conventional treatment for more than 8 weeks or having steroid-induced complications were included in this study. Dermatological tacrolimus ointment 0.03% started to be placed in inferior fornix in BD frequency along with topical lubricants. Patients were followed up on a regular schedule. Individual symptoms score was assessed from the questionnaire and signs score from observer’s clinical assessment. Data were analyzed using SPSS v23.0. P-value <0.05 was considered as statistically significant. Results: 40 eyes of 20 patients were included in this study. Out of which 4(20%) were female and 16 were male (80%). Mean baseline score for clinical symptoms was 6.65±1.81 that reduced to 1.65±0.81 after 12 weeks treatment course of tacrolimus with a significant p-value of 0.006 (p<0.05). Mean baseline score for clinical signs was 5.9±1.59 that improved to 1.80±0.83 after 12 weeks treatment course with a statistically significant p-value of 0.003 (p<0.05). Conclusions: In conclusion, topical tacrolimus dermatological ointment 0.03% is highly effective in refractory VKC and can be safely used as an alternative in VKC patients who are steroid-responders.