ABSTRACT
BACKGROUND: Conjunctival prolapse (CP) is an uncommon but challenging condition following maximal levator resection (MLR) and other extensive periorbital procedures. MLR extending beyond the Whitnall's ligament is frequently performed to address severe blepharoptosis with poor levator function (LF). Patients with CP may encounter symptoms such as ocular discomfort, tearing, vision impairment, persistent conjunctival chemosis, lagophthalmos, or exposure keratopathy. Typically, surgical intervention becomes necessary if conservative measures prove to be ineffective; nevertheless, there is no consensus regarding the optimal treatment approach. OBJECTIVES: This study aimed to propose a simple sutureless direct excision method and explore the surgical advancements in CP correction through a systematic review. METHODS: Patients with recurrent CP after MLR who underwent sutureless direct excision of the conjunctiva using loupe magnifiers at a tertiary hospital were included in this study. The clinical evolution and surgical results were recorded. PubMed, MEDLINE, EMBASE, and Web of Science databases were queried following The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. RESULTS: The comprehensive analysis of 1858 articles identified 88 patients from 24 studies, highlighting that blepharoptosis surgery is predominantly associated with CP (36.6%). Surgically treated CP showed a higher resolution rate compared to those managed conservatively (54.8% vs. 45.2%; p = 0.034). No relapse was observed in patients treated with sutureless direct excision of CP in long-term follow-up. CONCLUSION: We proposed a simple sutureless direct excision technique that offers a straightforward and efficient approach in treating CP, which is particularly suitable for cases requiring excision lengths >16 mm during MLR. Furthermore, stitch removal can be obviated after surgery.
ABSTRACT
Negative differential resistance (NDR) refers to a unique electrical property where current decreases with increasing voltage. Herein, we report experimental evidence showing that the NDR effect can be observed in mesopores that feature charged pore walls and are subjected to a KCl concentration gradient. NDR in our system originates from the solution and ion flows driven by the synergistic effects of electroosmosis [electroosmotic flow (EOF)] and diffusioosmosis, the so-called electrodiffusioosmosis. Experiments reveal that in addition to the ion current rectification, the mesopores considered here exhibit the NDR phenomenon that is dependent on the magnitude and direction of the salinity gradient and on pH. The NDR behavior can be observed only at conditions at which the EOF and diffusioosmosis occur in the opposite directions: diffusioosmosis fills the tip opening with a high concentration solution, while EOF brings a low concentration solution to the pore. All experimental findings are supported by our numerical model, which takes into account the interfacial site reactions of acidic and basic functional groups on the entire pore membrane surfaces. Our results provide an important insight into how liquid pH, salinity gradients, interfacial site reactions, and pore geometries can influence the current-voltage characteristics of mesopores, enriching transport modes that can be induced by voltage.
