Cosmetic shell fitting over a sensitive cornea in mild phthisis bulbi using total conjunctival flap.
BACKGROUND
Cosmetic scleral shells provide a superior alternative to enucleation or evisceration in the setting of phthisis bulbi. However, corneal irritation often minimizes the wearing time of a scleral shell. This study aimed to evaluate the clinical effectiveness of a total conjunctival flap covering in the management of mild phthisis bulbi with a sensitive cornea.


METHODS
The surgical technique involved a total conjunctival flap covering combined with superficial lamellar keratectomy to allow the fitting of a cosmetic scleral shell over a sensitive cornea. The records of patients with mild phthisis bulbi who underwent this technique from September 2003 through July 2011 were reviewed. Postoperative and long-term complications were noted. Outcome measures included cosmetic appearance, complications, and patient satisfaction.


RESULTS
A total of 58 patients (58 eyes) were identified. The mean age at surgery was 28.5 years (range=2-65 years) and the mean follow-up period (follow-up rate=66%) was 42.6 months (range=6-98 months). Postoperative complications like epithelial inclusion cyst (one eye), intolerance of scleral shell wear (2 eyes), and deterioration of phthisis bulbi (3 eyes) were observed during the follow-up interval. Surgical success was achieved in 52 subjects (90%) with the desired prosthetic appearance and motility and no further intervention was required.


CONCLUSIONS
The total conjunctival flap is an easy and effective globe-conserving alternative to enucleation or evisceration in the cosmetic rehabilitation of patients with mild phthisis bulbi.


METHODS
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Beijing Tongren Eye Center, Beijing Tongren Hospital Beijing Ophthalmology & Visual Science Key Lab, Capital Medical University, Beijing, 100730, China.
Jingwen
J
Ding
Tao
T
Chen
Zhijia
Z
Hou
Yi
Y
Qin
Lei
L
Hao
Dongmei
D
Li
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003228:Conjunctiva / Q000601:surgery / Q000637:transplantation; D003315:Cornea / Q000503:physiopathology / Q000601:surgery; D004954:Esthetics; D005137:Eye, Artificial; D005260:Female; D006801:Humans; D008297:Male; D008850:Microphthalmos / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D020273:Orbital Implants; D017755:Prosthesis Fitting / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012590:Sclera / Q000601:surgery*; D012720:Severity of Illness Index; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult