Construction of a deep ocular prosthesis socket using a concave bowl-shaped composite graft from the conchal cymba.

Abstract

A deep socket is needed to wear an ocular prosthesis stably in patients with anophthalmia, hypophthalmia, or post-inflammatory fornix adhesions. This report introduces the novel approach of reconstructing a deep fornix using a composite graft from the conchal cymba. Four patients who underwent construction of an inferior fornix by means of a composite graft obtained from the conchal cymba at Shinshu University Hospital between 2004 and 2024 were retrospectively studied. We analyzed graft size, postoperative outcomes, and complications. A composite graft from the conchal cymba was harvested in patients unable to wear an ocular prosthesis. The shallow inferior fornix was incised horizontally, and a vestibule for the composite graft was created by blunt dissection, taking care not to damage the septum. We drilled square holes of 1 × 1 mm into the cartilage side of the composite graft, which was then transplanted into the space created in the fornix and fixed with gauze. The composite graft survived in all 4 patients who underwent reconstruction of the inferior fornix using this technique. All patients were able to wear an ocular prosthesis stably and reported satisfaction with their aesthetic improvement at 6-27 months of follow-up. No major procedure-related adverse events were recorded. A deep concave vestibule was constructed in a single operation using a bowl-shaped composite graft obtained from the conchal cymba. This novel method may enable ocular prosthesis fitting by constructing a deep and stable socket.