Reconstruction of the Anophthalmic Conjunctival Sac. A Review of Surgical Procedures to Achieve Stability of the Ocular Prosthesis in Our Practice

Overview

Aim: A systematic review of surgical procedures on eyelids and the conjunctival sac in the case of instability of an ocular prosthesis from the author’s own experience.

Material and methods: In a prospective follow-up conducted from March 2022 to July 2024, the study comprised 51 patients with an unstable prosthesis who were referred by a prosthetist. The study examined the demographic data, cause of enucleation of the eyeball, the time interval between the onset of prosthesis instability and the surgical procedure of enucleation, and the surgical methods of correction to provide functional and aesthetic improvement.

Results: The 49 patients included 13 women with a mean age of 61.4 years (39–78) and 36 men with a mean age of 56.3 years (22–82). The most common causes of enucleation were trauma and malignant melanoma. The time interval from surgery/enucleation was 24.4 years for trauma etiology. After enucleation for malignant melanoma, the time interval was 4.2 years. In the 49 patients, 61 surgical procedures were performed to improve stability of the prosthesis. Lateral tarsorrhaphy was performed in 10 cases, 4 of which were combined with an orbital periosteal sling. Horizontal shortening of the lower eyelid was performed in 24 cases, 18 times separately and 6 times in combination with another procedure on the lower eyelid. Upper eyelid droop surgery was performed 8 times, including 5 times separately. Surgery for increasing the volume of the conjunctival sac with amniotic membrane transplantation was performed in 17 cases, 7x separately and 9x in combination with procedures on the lower eyelid . 44 patients underwent 1 surgical procedure, 4 patients underwent 2 procedures, and 3 patients underwent 3 procedures. Three patients also underwent hyaluronic acid injection to supplement the volume of the conjunctival sac. Cosmetically, the result and stability of the ocular prosthesis was achieved in 47 patients out of 49, 2 patients did not attend further procedures.

Conclusion: Conjunctival sac changes with instability of the ocular prosthesis have a significant functional and psychological consequences. The causes of instability are varied, which influences the choice of surgical procedures. The surgical procedures presented in this paper may be effective separately, or a combination of them may be required.

Keywords:

amniotic membrane transplantation – conjunctival sac contracture – horizontal shortening of the lower eyelid – upper eyelid ptosis surgery