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. 2022 Jul 15;13(1):49-54.
doi: 10.4103/tjo.tjo_28_22. eCollection 2023 Jan-Mar.

Fornix deepening reconstruction in conjunctivochalasis surgery

Anny M S Cheng  1   2 , Olivia G Mead  3 , Sean Tighe  2   3   4 , Scheffer C G Tseng  3   5
Affiliations

Fornix deepening reconstruction in conjunctivochalasis surgery

Anny M S Cheng et al. Taiwan J Ophthalmol. .

Abstract

Purpose: To assess the extent of inferior fornix shortening in conjunctivochalasis (CCh) and to evaluate whether fornix deepening reconstruction can restore the fornix tear reservoir in patients with CCh.

Materials and methods: This was a retrospective review of five patients (3 unilateral and 2 bilateral eyes, total 7 eyes) with CCh who underwent fornix deepening reconstruction with conjunctival recession and amniotic membrane transplantation. Postsurgical outcome measures included changes in fornix depth with correlation to basal tear volumes, symptoms, corneal staining, and conjunctival inflammation.

Results: For the three patients with unilateral surgery, both the fornix depth (8.3 ± 1.5 mm) and wetting length (9.3 ± 8.5 mm) of the operative eyes were less than the fellow eyes (10.3 ± 1.5 mm and 10.3 ± 8.5 mm, respectively). At 5.3 ± 2.7 months (range 1.7-8.7) postoperatively, the fornix depth increased significantly by 2.0 ± 1.1 mm (P = 0.02). Deepening of the fornix depth was accompanied by overwhelming symptomatic relief (91.5%) that could be subdivided into complete relief (87.5%) and partial relief (4%) of symptoms, with blurred vision being the most notably relieved symptom (P = 0.03). Furthermore, superficial punctate keratitis and conjunctival inflammation were significantly improved at follow-up (P = 0.008 and 0.05, respectively).

Conclusion: Deepening of the fornix to restore the tear reservoir is an important surgical objective that may change the tear hydrodynamic state to provide a stable tear film and improve outcomes in CCh.

Keywords: Amniotic membrane; conjunctivochalasis; fornix deepening; fornix reconstruction; tear reservoir.

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Conflict of interest statement

S.T. has obtained a patent for the method of preparation and clinical uses of amniotic membrane and has licensed the rights to TissueTech, Inc., which procures and processes, and to Bio-Tissue, Inc., which is a subsidiary of TissueTech, Inc., to distribute cryopreserved amniotic membrane for clinical and research uses. S.T.O.M. and S.T. are employees of BioTissue, Inc. Dr. Scheffer C.G. Tseng, an editorial board member at Taiwan Journal of Ophthalmology, had no role in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper.

Figures

Figure 1
Figure 1
Surgical Procedure. An arc-like conjunctival peritomy is created 1–2 mm posterior to the limbus in the area of redundant conjunctival tissue (a). Rearrangement of conjunctiva by recessing from the limbus to the fornix (b, arrow). The recessed conjunctiva is lifted up by a forceps to identify the prolapsed fat (star) that is distributed in the fornix. The excess Tenon's capsule (asterisk) is grabbed and dissected off from the overlying conjunctival epithelial tissue and removed by a pair of sharp scissors (c). The prolapsed fat is cauterized to create a gap (d) for prevention of fat herniation through fornix. Two separate layers of cryopreserved AM are laid down to replace Tenon (e) and the conjunctival tissue (f) to help prevent recurrence and expedite patient's recovery. The conjunctiva is recessed to anchor at the fornix with 8-0 vicryl. AM transplantation with conjunctival recession and fornix deepening reconstruction restores normal fornix structure. AM: Amniotic membrane
Figure 2
Figure 2
Fornix measurement by a ruler. The millimetric scale in this ruler (a) enables the measurement of fornix depth before (b) and after (c) surgery in a representative eye
See this image and copyright information in PMC

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