下眼瞼内側眼瞼内反症に対する結膜側眼瞼縫合術：シンプルかつ効果的な手技

Introduction We developed a novel technique, conjunctival medial tarsorrhaphy (CMT), to treat medial ectropion through a minimally invasive, skin-sparing approach. We evaluated the efficacy and safety of CMT in patients with lower eyelid medial ectropion (LEME). Methods We retrospectively analyzed 22 eyelids from 18 patients who underwent CMT between June 2018 and August 2024. The procedure involved conjunctival resection nasal to the puncta and direct skin approximation without skin incisions. Clinical outcomes included changes in margin reflex distance 2 (MRD2), vertical distance between the puncta, and superficial punctate keratopathy (SPK) score. Adverse events were also recorded. Results The mean age was 71±14 years. LEME etiologies included involutional (five cases), facial nerve palsy (five cases), previous surgery (seven cases), and trauma (one case). Concomitant procedures were performed in some cases. The mean follow-up was 6.5±4.6 months. MRD2 decreased (improved) from 8.99±1.77 mm to 7.07±1.57 mm (p<0.001), punctal distance from 4.21±1.12 mm to 1.70±1.10 mm (p<0.001), and SPK score from 3±2 to 1±2 (p<0.001). Minor complications included two canalicular epithelial injuries, managed successfully with silicone intubation. Conclusions CMT is a simple, minimally invasive, and reproducible technique that provides effective LEME correction with improvements in eyelid position and ocular surface health. It can be safely repeated and may serve as a first-line surgical option for LEME. Further studies are warranted to evaluate long-term outcomes and effects on lacrimal function.