Forniceal Reconstruction through Subciliary Approach in a Patient with Shallow Inferior Fornix

ABSTRACT

PURPOSE: To evaluate the usefulness of a new technique for the subciliary approach to the surgical management of anophthalmic, shallow inferior fornices. METHODS: Six patients with difficulty retaining an ocular prosthesis, due to anophthalmic, shallow inferior fornices with sufficient conjunctiva, underwent this operation from October 2003 to April 2005. Surgery consisted of the fixation of the conjunctival fornix to the periosteum immediately posterior to the inferior orbital rim through the subciliary approach. This study was prospective. RESULTS: The mean age of the patients was 40.1+/-14.7 years (range, 21~62 years). Three of six patients were male, and three were female. The mean duration of surgical anophthalmos was 16.8+/-13.2 years (range, 0.6~40 years), and the mean follow-up period was 9.3+/-8.4 months (range, 3~25 months). All 6 patients who could not wear prostheses because of shallow fornices could wear ocular prostheses successfully after the operation. An ocular prosthesis could be fitted at a mean duration of 1.83+/-0.75 weeks (range, 1~3 weeks), postoperatively. Only one patient had mild entropion, but there were no conjunctival contractures or loss of fornices postoperatively. CONCLUSIONS: The authors believe that this new technique through the subciliary approach is simple and easy to perform and enables the patient to wear an ocular prosthesis earlier than does forniceal reconstruction through the transconjunctival approach. This technique is very useful in patients with anophthalmic, shallow inferior fornices who have sufficient conjunctiva but loose attachments of the fornix to the underlying tissue, causing shallow fornices.