Abstract
Purpose. To evaluate a new surgical technique using fascia lata to deepen the shallow inferior conjunctival fornix in contracted socket and anophthalmic socket syndrome. Methods. A prospective controlled study in which 24 sockets of 24 patients who were unable to wear and retain their ocular prosthesis due to shallow inferior fornix were enrolled and categorized into anophthalmic socket syndromes (9 patients) and contracted sockets (15 patients). Another 24 patients who underwent evisceration or enucleation with healthy sockets and can wear and retain their prosthesis comfortably were chosen as a control group. Deepening of the fornix was performed using fascia lata strips under general anesthesia. Central depth of the inferior fornix was measured preoperatively and postoperatively. Results. A statistically significant improvement of the postoperative central inferior fornix depth was reported which was marked in anophthalmic subgroup. 100% of anophthalmic sockets and 93.3% of contracted sockets achieved satisfactory results during the follow-up period with no postoperative lower eyelid malposition or obvious skin scar. Conclusion. Fascia lata technique is a new alternative and effective procedure to deepen the shallow inferior fornix that can be used in moderate to severe contracted sockets or anophthalmic socket syndrome with minimal lower eyelid or socket complications.
Highlights
Adequate retention of the ocular prosthesis in the anophthalmic socket requires a well-formed inferior fornix, which in turn requires sufficient conjunctival length and a deep recess
The later occurs possibly as there is no globe and so the inferior rectus muscle is at a higher level in the socket with subsequent elevation of the lower lid retractors and their connections including the fornical conjunctiva [3]
A transconjunctival inferior fornix fixation is another method of repair of shallow inferior fornix in anophthalmic socket syndrome where the edges of the conjunctival incision are directly sutured to the periosteum with no need for externalized sutures and stents [5]
Summary
Adequate retention of the ocular prosthesis in the anophthalmic socket requires a well-formed inferior fornix, which in turn requires sufficient conjunctival length and a deep recess. The shallow inferior fornix is reformed by deepening sutures that exit at the skin of the lower lid where they are tied over bolsters and left for 23 weeks [3]. A transconjunctival inferior fornix fixation is another method of repair of shallow inferior fornix in anophthalmic socket syndrome where the edges of the conjunctival incision are directly sutured to the periosteum with no need for externalized sutures and stents [5]. This procedure yielded good results, it still carries the risk of triggering contracture of the socket as it involved dissection of the fornical conjunctiva and lower. We designed this study to evaluate new surgical technique for deepening the inferior conjunctival fornix using fascia lata in contracted socket and anophthalmic socket syndrome
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