"Key Roles of Conjunctiva Fornix-Bulbar conjunctiva-Tenon's Capsule in Bulbar Conjunctival Prolapse after Conjoint Fascial Sheath Suspension."

Abstract

BACKGROUND:

Bulbar conjunctival prolapse is one of the complications of conjoint fascial sheath (CFS) suspension and has a negative impact on surgical results. To explore the prevention methods of this complication, we compared the incidence of it between the below-conjunctiva fornix-bulbar conjunctiva- Tenon's capsule (CBT) approach and the above-CBT approach to dissecting CFS in CFS suspension and shared our experience in the treatment of bulbar conjunctival prolapse.

METHODS:

From January 2020 to August 2021, 81 patients with severe congenital ptosis who underwent CFS suspension were enrolled and divided into 2 groups. Forty-five patients' (Group A) CFS was dissected via the below-CBT approach and 36 patients' (Group B) CFS was dissected via the above-CBT approach. The incidence and outcomes of bulbar conjunctival prolapse，and the postoperative condition were collected and analyzed.

RESULTS:

The incidence of bulbar conjunctival prolapse was 24.44% in Group A and 2.78% in Group B. Of the 12 bulbar conjunctival prolapse patients, 7 patients' conditions improved after conservative treatment, while 5 did not. All of them underwent bulbar conjunctiva resection within 1 year and were cured. No recurrent prolapse was observed within 3 months post-operation. At the last follow-up, the mean MRD1 and PFH were 4.09±0.19mm and 9.85±0.62mm, respectively. There were no complications except lagophthalmos (16 eyelids), asymmetric eyelid contour (1 patient), and trichiasis (2 eyelids).

CONCLUSION:

The incidence of bulbar conjunctival prolapse decreased significantly by dissecting CFS via the above-CBT approach. For patients with bulbar conjunctival prolapse after CFS suspension, bulbar conjunctiva resection could provide satisfactory results.Level of Evidence IV.

• Authors: Dong-Yue Hao, Xiao Fan, Jiao Cao, Zheng-Qiang Cang, Jiang-Bo Cui, Yong-Jun Chen, Chao-Hua Liu, Bao-Qiang Song, Pai Peng
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) (Mar 27 2023) ISSN: 1529-4242 [Electronic] United States
• PMID: 36988680 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 by the American Society of Plastic Surgeons.