title: Five Years' Experience with Tenon-Conjunctival Flaps in Phthisical Eyes.
abstract: BACKGROUND
  To evaluate the efficacy of total Tenon-conjunctival flaps (TCFs) for coverage of phthisical eyes with normal corneal sensitivity.
  
  
  METHODS
  A retrospective chart review was performed on 142 patients with mild monocular phthisis who underwent the TCF procedure to allow monocular scleral shell fitting at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. All patients had normal corneal sensation in their painless phthisical eye and were intolerant to cosmetic scleral shell fitting preoperatively. Consecutive patients over a five-year period were enrolled. Data were collected on functional success, duration of follow-up, and complications. The Tenon's and conjunctival layers were closed separately in 103 eyes and as a single layer in the remaining 39 eyes. Main outcome measures were functional success, defined as tolerance to the prosthetic scleral shell, and rate of postoperative complications such as wound retraction, epithelial cysts, and blepharoptosis. Fisher's exact test was used to analyze the association between the main outcome measures and type of flap closure.
  
  
  RESULTS
  The mean duration of follow-up was 23.7±17.43 months. Functional success was achieved in 98.6% of eyes. Minor complications included epithelial inclusion cysts in 10 (7.04%) eyes and mild blepharoptosis in 9 (6.34%) eyes. Overall flap retraction was noted in 14 (9.86%) eyes. This complication occurred in 13 of 103 (33.3%) eyes with double layer closure and in 1 of 39 (0.97%) eyes with a single layer flap closure (p=0.11).
  
  
  CONCLUSIONS
  TCF is an effective procedure to increase corneal thickness for coverage in phthisical eyes with positive corneal sensation. The incorporation of Tenon's capsule in the flap did not increase complications with a frequency similar to the classic Gundersen procedure.
authors.affiliation: a King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia.|b Complejo Hospitalario , Palencia , Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Galindo-Ferreiro
authors.affiliation: a King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia.|c School of Medicine of Ribeirão-Preto , University of São Paulo , São Paulo, Brazil.
authors.forename: Patricia Santello
authors.initials: PS
authors.lastname: Akaishi
authors.affiliation: a King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Aliwi
authors.affiliation: d College of Medicine, University of Cincinnati , Cincinnati , OH , USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Niespodzany
authors.affiliation: a King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia.
authors.forename: Alberto
authors.initials: A
authors.lastname: Gálvez-Ruiz
authors.affiliation: a King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia.|c School of Medicine of Ribeirão-Preto , University of São Paulo , São Paulo, Brazil.
authors.forename: Antonio Augusto Velasco
authors.initials: AAV
authors.lastname: Cruz
mesh_terms: D000293:Adolescent; D000328:Adult; D003228:Conjunctiva / Q000637:transplantation*; D003316:Corneal Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012529:Saudi Arabia; D013524:Surgical Flaps; D055815:Young Adult
keywords: Blindness; corneal; cosmesis; sensation; shell; tolerance