LAUSR

BACKGROUND Bulbar conjunctival prolapse is one of the complications of conjoint fascial sheath (CFS) suspension and has a negative impact on surgical results. To explore the prevention methods of this complication, we compared the incidence of it between the below-conjunctiva fornix-bulbar conjunctiva- Tenon's capsule (CBT) approach and the above-CBT approach to dissecting CFS in CFS suspension and shared our experience in the treatment of bulbar conjunctival prolapse. METHODS From January 2020 to August 2021, 81 patients with severe congenital ptosis who underwent CFS suspension were enrolled and divided into 2 groups. Forty-five patients' (Group A) CFS was dissected via the below-CBT approach and 36 patients' (Group B) CFS was dissected via the above-CBT approach. The incidence and outcomes of bulbar conjunctival prolapse，and the postoperative condition were collected and analyzed. RESULTS The incidence of bulbar conjunctival prolapse was 24.44% in Group A and 2.78% in Group B. Of the 12 bulbar conjunctival prolapse patients, 7 patients' conditions improved after conservative treatment, while 5 did not. All of them underwent bulbar conjunctiva resection within 1 year and were cured. No recurrent prolapse was observed within 3 months post-operation. At the last follow-up, the mean MRD1 and PFH were 4.09±0.19mm and 9.85±0.62mm, respectively. There were no complications except lagophthalmos (16 eyelids), asymmetric eyelid contour (1 patient), and trichiasis (2 eyelids). CONCLUSION The incidence of bulbar conjunctival prolapse decreased significantly by dissecting CFS via the above-CBT approach. For patients with bulbar conjunctival prolapse after CFS suspension, bulbar conjunctiva resection could provide satisfactory results.Level of Evidence IV.