A Novel Conservative Approach for Managing the Phthisical Silicone Oil-Filled Eye: Conjunctival Flap Coverage and Prosthetic Fitting

Objective: To evaluate the clinical efficacy and safety of shallow lamellar keratectomy combined with total conjunctival flap coverage and subsequent customized prosthetic shell fitting for the management of atrophic, silicone oil-filled eyes following severe open globe injury. Methods: This retrospective case series included 24 patients (24 eyes) with phthisical, silicone oil-dependent eyes after open globe injury repair between October 2010 and May 2020. All patients underwent shallow lamellar keratectomy to remove diseased corneal tissue, followed by total conjunctival flap coverage. A customized prosthetic shell was fitted approximately one month postoperatively after confirmed flap healing. Outcome measures included corneal symptom relief assessed by the Numeric Rating Scale (NRS), palpebral fissure height, exophthalmometry, cosmetic satisfaction rated on a 5-point scale, and postoperative complications. Results: The mean postoperative follow-up duration was 4.75 ± 2.51 years. All patients achieved complete resolution of pain and foreign body sensation (postoperative NRS=0 for all; preoperative median: 2.00 IQR: 1.75– 3.00 vs postoperative median: 0.00 IQR: 0.00– 0.00, P=0.001). Ocular protrusion increased significantly from a preoperative median of 7.00 mm (IQR: 6.00– 8.00 mm) to 12.00 mm (IQR: 10.00– 13.00 mm) postoperatively (P=0.001). Lid height increased from a preoperative median of 3.00 mm (IQR: 2.75– 4.00 mm) to 10.00 mm (IQR: 8.00– 11.25 mm) postoperatively (P=0.001). Patient satisfaction with ocular appearance improved markedly from a preoperative median of 1.00 (IQR: 1.00– 1.25) to 5.00 (IQR: 4.75– 5.00) postoperatively (P=0.001). Two eyes developed limbal epithelial implantation cysts, which were successfully managed without recurrence. Cranial CT revealed no silicone oil migration or sympathetic ophthalmia. Conclusion: This globe-preserving technique effectively alleviates corneal irritation and restores ocular symmetry in atrophic, silicone oil-filled eyes, offering a safe, cost-effective, and satisfactory conservative alternative to enucleation or evisceration. Further prospective studies with longer follow-up are warranted. Keywords: open globe injuries, OGI, silicone oil tamponade, phthisis bulbi, conjunctival flap, ocular prosthesis, cosmetic rehabilitation