Shallow Inferior Conjunctival Fornix in Contracted Socket and Anophthalmic Socket Syndrome: A Novel Technique to Deepen the Fornix Using Fascia Lata Strips

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.

Modified Treatment of Shallow Fornix for Better Retention of Ocular Prosthesis

“…No expensive consumables were required for this procedure and required less surgical time along with absence of an additional donor site since silicone tubes are widely available. This modified technique had a 96% success rate with minimal risk of complication; whereas other studies reported a 93.3% success rate with fascia lata strips 10 , 83.33% success rate with amniotic membrane grafts 8 and 77.3% with oral mucosal grafts 9 . Since, the silicone bolsters are placed within the fornix, they are cosmetically acceptable for the patient as well.…”

“…8,16 Fascia lata strips have also been used to deepen the shallow inferior fornix in anophthalmic sockets but necessitates a donor site and has risk of complications. 10 The eventual aim of management is to allow the ocular prosthesis to stay in place and resemble the fellow eye as much as possible as an improper fitting prosthesis can be psychologically disturbing for an individual. 3 A modified surgical technique was performed in the present study by applying 3 sutures from within the fornix centrally, medially and laterally, full thickness through the lower eyelid taking the inferior orbital rim periosteum in the suture bite together with closure of the fornix sutures with silicone tube bolsters.…”

“…7 Such an adequate forniceal depth can be attained by an increment of the surface area with the utilization of grafts such as amniotic membrane, buccal mucosa, conjunctival or tarsal grafts whereas shallow fornix in an anophthalmic socket can be made deep with the help of separation of bands followed by placing deepening sutures or fascia lata strips within the fornices. [8][9][10] This present study shares a modified surgical technique for deepening the shallow inferior fornix with a better retention of the ocular prosthesis in anophthalmic contracted sockets.…”

Augenprothetische Rehabilitation in Deutschland heute – Versorgungsmöglichkeiten, Handhabung, Komplikationen und psychologische Aspekte

“…Diese narbigen Veränderungen können u. a. durch Verkürzung und Schrumpfung der konjunktivalen Fornices das Einsetzen einer Prothese unmöglich machen [61]. Die Prothesenfähigkeit kann dann nur durch eine chirurgische Intervention wiederhergestellt werden [62].…”

Recurrent contracted sockets treated with personalized, three-dimensionally printed conformers and buccal grafts

“…Standard procedures for fornix reconstruction include fornix-deepening sutures with or without the use of buccal mucosal transplant. 1 A dermis fat graft (DFG) may also be used to increase the lining of the socket. In a subset of patients these standard procedures unfortunately fail, and severe recurrent contraction of the socket results in the inability to wear any ocular prosthesis.…”