Abstract：
BACKGROUND: Conjunctival prolapse (CP) is an uncommon but challenging condition following maximal levator resection (MLR) and other extensive periorbital procedures. MLR extending beyond the Whitnall\'s ligament is frequently performed to address severe blepharoptosis with poor levator function (LF). Patients with CP may encounter symptoms such as ocular discomfort, tearing, vision impairment, persistent conjunctival chemosis, lagophthalmos, or exposure keratopathy. Typically, surgical intervention becomes necessary if conservative measures prove to be ineffective; nevertheless, there is no consensus regarding the optimal treatment approach.
OBJECTIVE: This study aimed to propose a simple sutureless direct excision method and explore the surgical advancements in CP correction through a systematic review.
METHODS: Patients with recurrent CP after MLR who underwent sutureless direct excision of the conjunctiva using loupe magnifiers at a tertiary hospital were included in this study. The clinical evolution and surgical results were recorded. PubMed, MEDLINE, EMBASE, and Web of Science databases were queried following The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.
RESULTS: The comprehensive analysis of 1858 articles identified 88 patients from 24 studies, highlighting that blepharoptosis surgery is predominantly associated with CP (36.6%). Surgically treated CP showed a higher resolution rate compared to those managed conservatively (54.8% vs. 45.2%; p = 0.034). No relapse was observed in patients treated with sutureless direct excision of CP in long-term follow-up.
CONCLUSIONS: We proposed a simple sutureless direct excision technique that offers a straightforward and efficient approach in treating CP, which is particularly suitable for cases requiring excision lengths >16 mm during MLR. Furthermore, stitch removal can be obviated after surgery.
OBJECTIVE: This study aimed to propose a simple sutureless direct excision method and explore the surgical advancements in CP correction through a systematic review.
METHODS: Patients with recurrent CP after MLR who underwent sutureless direct excision of the conjunctiva using loupe magnifiers at a tertiary hospital were included in this study. The clinical evolution and surgical results were recorded. PubMed, MEDLINE, EMBASE, and Web of Science databases were queried following The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.
RESULTS: The comprehensive analysis of 1858 articles identified 88 patients from 24 studies, highlighting that blepharoptosis surgery is predominantly associated with CP (36.6%). Surgically treated CP showed a higher resolution rate compared to those managed conservatively (54.8% vs. 45.2%; p = 0.034). No relapse was observed in patients treated with sutureless direct excision of CP in long-term follow-up.
CONCLUSIONS: We proposed a simple sutureless direct excision technique that offers a straightforward and efficient approach in treating CP, which is particularly suitable for cases requiring excision lengths >16 mm during MLR. Furthermore, stitch removal can be obviated after surgery.
摘要：
背景：结膜脱垂（CP）是一种罕见但具有挑战性的疾病，在最大提上肌切除术（MLR）和其他广泛的眶周手术后。经常进行超出Whitnall韧带的MLR，以解决严重的上睑下垂功能（LF）差。CP患者可能会出现眼部不适等症状，撕裂,视力障碍,持续性结膜化学，眼球，或暴露性角膜病变。通常,如果保守措施被证明是无效的，手术干预是必要的；然而，关于最佳治疗方法尚无共识。
目的：本研究旨在提出一种简单的无缝线直接切除方法，并通过系统评价探讨CP矫正的手术进展。
方法：本研究纳入了在三级医院使用放大镜无缝线直接切除结膜的MLR后复发性CP患者。记录临床进展和手术结果。PubMed,MEDLINE,EMBASE,根据系统审查和荟萃分析（PRISMA）协议的首选报告项目查询和WebofScience数据库。
结果：对1858篇文章的综合分析确定了24项研究中的88名患者，强调上睑下垂手术主要与CP相关(36.6%)。与保守治疗的患者相比，手术治疗的CP显示出更高的分辨率（54.8%vs.45.2%；p=0.034）。在长期随访中，接受无缝线直接切除CP治疗的患者未观察到复发。
结论：我们提出了一种简单的无缝线直接切除技术，为治疗CP提供了一种直接有效的方法，这特别适用于在MLR期间需要切除长度>16mm的情况。此外，手术后可以避免拆线。
目的：本研究旨在提出一种简单的无缝线直接切除方法，并通过系统评价探讨CP矫正的手术进展。
方法：本研究纳入了在三级医院使用放大镜无缝线直接切除结膜的MLR后复发性CP患者。记录临床进展和手术结果。PubMed,MEDLINE,EMBASE,根据系统审查和荟萃分析（PRISMA）协议的首选报告项目查询和WebofScience数据库。
结果：对1858篇文章的综合分析确定了24项研究中的88名患者，强调上睑下垂手术主要与CP相关(36.6%)。与保守治疗的患者相比，手术治疗的CP显示出更高的分辨率（54.8%vs.45.2%；p=0.034）。在长期随访中，接受无缝线直接切除CP治疗的患者未观察到复发。
结论：我们提出了一种简单的无缝线直接切除技术，为治疗CP提供了一种直接有效的方法，这特别适用于在MLR期间需要切除长度>16mm的情况。此外，手术后可以避免拆线。
