Shoji Marissa K, Al-Sharif Eman, Liu Catherine Y, Korn Bobby S, Kikkawa Don O
Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute, UCSD, La Jolla, California, U.S.A.
Surgery Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
Ophthalmic Plast Reconstr Surg. 2024 Dec 20. doi: 10.1097/IOP.0000000000002866.
To describe and characterize shortened fornix syndrome (SFS), a rare complication following posterior-approach ptosis repair using conjunctival Müller muscle resection.
This retrospective case series evaluates 4 patients who developed SFS after conjunctival Müller muscle resection. Clinical characteristics, surgical histories, management, and outcomes are reviewed.
A total of 4 patients (2 females, 2 males; aged 61-74 years old) presented with ptosis associated with fornix shortening and symblepharon following conjunctival Müller muscle resection performed at outside hospitals. Potential contributing factors included intraoperative complications and multiple posterior-approach surgeries. Management strategies varied, including 5-fluorouracil and triamcinolone injections into the symblepharon, ocular surface reconstruction with symblepharon lysis and amniotic membrane grafting, and external levator advancement. All patients showed improvement in the SFS and eyelid height with treatment.
SFS, characterized by symblepharon, fornix shortening, and associated functional issues including ptosis and restricted eye movements, is a rare but significant complication of posterior-approach ptosis repair. Only one prior report has documented a similar entity in patients after conjunctival Müller muscle resection using glaucoma drops; interestingly, our cases occurred in patients without significant ocular surface or topical ocular medication use, suggesting SFS can develop independently of such treatments. Prevention strategies include meticulous intraoperative technique and a cautious approach to large resections or repeat posterior-based surgeries, with consideration of anterior-based techniques if appropriate. Management of SFS via a staged approach involving ocular surface reconstruction followed by anterior-based ptosis repair may lead to satisfactory outcomes. Awareness of this complication is crucial for proper patient selection and management of ptosis.
描述并特征化短穹窿综合征（SFS），这是一种采用结膜 Müller 肌切除术进行后入路上睑下垂修复术后的罕见并发症。
本回顾性病例系列评估了 4 例在结膜 Müller 肌切除术后发生 SFS 的患者。回顾了其临床特征、手术史、治疗方法及结果。
共有 4 例患者（2 名女性，2 名男性；年龄 61 - 74 岁），在外院进行结膜 Müller 肌切除术后出现上睑下垂伴穹窿缩短和睑球粘连。潜在的促成因素包括术中并发症和多次后入路手术。治疗策略各不相同，包括向睑球粘连处注射 5 - 氟尿嘧啶和曲安奈德、进行睑球粘连松解及羊膜移植的眼表重建，以及外部提上睑肌前移术。所有患者经治疗后 SFS 和眼睑高度均有改善。
SFS 以睑球粘连、穹窿缩短以及包括上睑下垂和眼球运动受限等相关功能问题为特征，是后入路上睑下垂修复术罕见但严重的并发症。此前仅有一份报告记录了使用青光眼滴眼液进行结膜 Müller 肌切除术后患者出现的类似情况；有趣的是，我们的病例发生在无明显眼表疾病或未使用局部眼药的患者中，这表明 SFS 可独立于此类治疗而发生。预防策略包括术中精细操作以及谨慎对待大范围切除或重复后入路手术，必要时考虑采用前入路技术。通过分阶段方法管理 SFS，先进行眼表重建，然后进行前入路上睑下垂修复，可能会取得满意的效果。认识到这种并发症对于正确选择患者和管理上睑下垂至关重要。
