Fornix deepening reconstruction in conjunctivochalasis surgery
Anny M S Cheng1, Olivia G Mead2, Sean Tighe3, Scheffer C G Tseng4
1 Department of Ophthalmology, Broward Health, Fort Lauderdale; Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, USA
2 Ocular Surface Center, Miami, FL, USA
3 Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine; Ocular Surface Center; Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, Miami, FL, USA
4 Ocular Surface Center; Ocular Surface Research and Education Foundation, Miami, FL, USA
Scheffer C G Tseng,
Ocular Surface Center and Ocular Surface Research and Education Foundation, 7235 Corporate Center Drive, Suite C, Miami, Florida 33126
Source of Support: None, Conflict of Interest: None
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.