Purpose: To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis a nd fornix reconstruction in severe cicatricial ocular surface diseases. Design: Noncomparative interventional case series. Participants: Sixteen patients (8 fem ale, 8male; 18 eyes)with amean age of 41±23.4 years (range, 3-79) and sufferin g from severe chemical/thermal burns (7 eyes), multiple recurrent pterygia and p seudopterygia (5 eyes), Stevens-Johnson syndrome (4 eyes), and ocular cicatrici al pemphigoid (2 eyes) were consecutively enrolled. All except for 2 eyes had ha d prior surgical attempts of surgical reconstruction, including 6 eyes with a mu cous membrane graft (MMG), but still presented with symblepharon and persistent ocular surface inflammation. Intervention: After excision of subconjunctival fib rovascular tissues, 0.04%mitomycin C was applied for 5 minutes in the deep forn ix before amniotic membrane transplantation. Main Outcome Measures: Deeper forni x, noninflamed ocular surface, and full motility. Results: The mean epithelial h ealing time was 4.2±1.9 weeks. During the follow-up of 14.16±5.2 months, all eyes showed a marked reduction of conjunctival inflammation, a deep fornix, and a continuous tear meniscus. Of 12 eyes with motility restriction, 2 eyes with mu ltiple recurrent pterygia and 1 eye with severe thermal burn showed recurrence o f partial motility restriction 2 months after surgery. The vision of 9 eyes was successfully restored by an additional keratolimbal allograft with subsequent pe netrating keratoplasty (6 eyes). Conclusion: Intraoperative application of mitom ycin C is an effective means to reduce chronic and deep-seated conjunctival inf lammation, and helps amniotic membrane restore a deep fornix after symblepharon lysis, even in eyes that had a failed MMG. Restoration of deep fornix and tear m eniscus is an important prerequisite to achieve successful reconstruction by sub sequent limbal stem cell transplantation. Purpose: To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis a nd for nix reconstruction in severe cicatricial ocular surface diseases. Design: Noncomparative interventional case series. Participants: Sixteen patients (8 fem ale, 8male; 18 eyes) with a long age of 41 ± 23.4 years (range, 3-79) and sufferin g from severe chemical / thermal burns (7 eyes), multiple recurrent pterygia and p seudopterygia (5 eyes) All except for 2 eyes had ha prior surgical attempts of surgical reconstruction, including 6 eyes with a mu cous membrane graft (MMG), but still presented with symblepharon and persistent ocular surface inflammation. Intervention: After excision of subconjunctival fibrovascular tissues, 0.04% mitomycin C was applied for 5 minutes in the deep forn ix before amniotic membrane transpla The Outcome Measures: Deeper forni x, noninflamed ocular surface, and full motility. Results: The mean epithelial h ealing time was 4.2 ± 1.9 weeks. During the follow-up of 14.16 ± 5.2 months, all eyes showed a marked reduction of Of 12 eyes with motility restriction, 2 eyes with mu ltiple recurrent pterygia and 1 eye with severe thermal burn showed recurrence of partial motility restriction 2 months after surgery. The vision of 9 eyes was successfully restored by an additional keratolimbal allograft with subsequent penetrating keratoplasty (6 eyes). Conclusion: Intraoperative application of mitomycin C is an effective means to reduce chronic and deep-seated conjunctival inflamation, and helps amniotic membrane restore a deep for nix after symblepharon lysis, even in eyes that had a failed MMG. Restoration of deep fornix and tear m eniscus is an important prequisite to achieve successful reconstruct ionby sub sequent limbal stem cell transplantation.