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Yvon C, Patel B, Malhotra R. Conjunctivochalasis. Int Ophthalmol Clin 2023; 63:209-223. [PMID: 37439619 DOI: 10.1097/iio.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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Mo LJ, Wang HM, Zhou HM, Huang L, Gui YX, Li QS. Collagen changes in rabbit conjunctiva after conjunctival crosslinking. Open Life Sci 2023; 18:20220604. [PMID: 37250838 PMCID: PMC10224626 DOI: 10.1515/biol-2022-0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/15/2023] [Accepted: 03/27/2023] [Indexed: 05/31/2023] Open
Abstract
This study aims to determine the ultrastructural changes in collagen fibrils in rabbit conjunctiva after conjunctival crosslinking using riboflavin and ultraviolet A (UVA) light at an irradiation intensity of 45 mW/cm2. Conjunctival crosslinking may increase conjunctival stiffness. The supertemporal quadrants of the right eyes of 24 adult rabbits were treated with a topical riboflavin solution (0.25%) before irradiation with UVA light at 45 mW/cm2 for 4 min. After 3 weeks, the collagen fibrils in fibril bundles were examined by electron microscopy. Immunohistochemical staining was used to detect the expression levels of collagen I and collagen III in the rabbits' conjunctiva. The diameter of the collagen fibrils in the fibril bundles varied slightly, ranging from 30 to 60 nm in the conjunctival stroma of the control group. In the treatment group, the diameter of collagen fibrils ranged from 60 to 90 nm. The thickest collagen fibrils were observed in the treatment group (up to 90 nm in diameter). In contrast, those in the conjunctival stroma of the control group were considerably smaller (up to 60 nm in diameter). However, thicknesses of collagen fibrils displayed a unimodal distribution. Both collagen I and collagen III increased after treatment with riboflavin and UVA light irradiation at 45 mW/cm2. The data indicate that in rabbits, conjunctival crosslinking with riboflavin and UVA light at 45 mW/cm2 for 4 min is safe and does not induce ultrastructural alterations of the conjunctival cells. The conjunctival crosslinking with riboflavin and UVA light at 45 mW/cm2 can increase the diameter of collagen fibrils, but the average densities of collagen I and collagen III have no statistical significance.
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Affiliation(s)
- Li-Juan Mo
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Putuo District, Shanghai200062, China
| | - Han-Min Wang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Putuo District, Shanghai200062, China
| | - Huan-Ming Zhou
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Putuo District, Shanghai200062, China
| | - Li Huang
- Department of Gerontology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan-Xiang Gui
- Department of Gerontology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing-Song Li
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Putuo District, Shanghai200062, China
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Liu T, Siadati S, Eberhart CG, Akpek E. Clinicopathologic analysis of conjunctivochalasis and paste-pinch-cut conjunctivoplasty for management. Can J Ophthalmol 2021; 57:307-311. [PMID: 34192522 DOI: 10.1016/j.jcjo.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To correlate the histopathologic results of conjunctival specimens with clinical findings in patients with conjunctivochalasis and report the results of the paste-pinch-cut technique for management. DESIGN Retrospective chart review. METHODS SETTING: Single tertiary ophthalmological centre (Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.). PARTICIPANTS Twenty-five patients (32 eyes) with clinically significant conjunctivochalasis. All patients were referred for clinically significant dry eye without previous diagnosis of chalasis. Sixteen patients had an underlying inflammatory systemic condition. Intervention or Observation Procedure(s): Patients underwent surgery with paste-pinch-cut technique. Subjective dry eye symptoms and ocular surface staining scores (corneal and conjunctival staining using fluorescein and lissamine green respectively) were assessed at every visit. MAIN OUTCOME MEASURES Change in patient symptoms and ocular surface staining scores and histopathologic findings in conjunctival specimens. RESULTS After surgery, significant improvement was achieved in dry-eye symptoms as well as both corneal and conjunctival staining scores in 29 eyes on reduced topical therapy. Only 3 eyes had persisting conjunctival lissamine staining. Light microscopic examination disclosed mild to moderate lymphoplasmocytic inflammation of the conjunctivae with areas of epithelial goblet cell loss, squamous metaplasia, stromal edema, and fibrosis. CONCLUSION Conjunctivochalasis appears to be associated with significant inflammation in the setting of dry eye and underlying inflammatory systemic conditions. Although topical anti-inflammatory treatment could be attempted in the initial management, surgical excision should be considered in the absence of clinical response.
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Affiliation(s)
- Tiffany Liu
- Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Sepideh Siadati
- Departments of Pathology, Ophthalmology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Charles G Eberhart
- Departments of Pathology, Ophthalmology, and Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Esen Akpek
- Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md..
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Comparative transcriptome analysis of human conjunctiva between normal and conjunctivochalasis persons by RNA sequencing. Exp Eye Res 2019; 184:38-47. [DOI: 10.1016/j.exer.2019.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/18/2019] [Accepted: 04/05/2019] [Indexed: 11/23/2022]
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Kim ST, Jin LY, Ahn HB. Combination Surgery of Silicone Tube Intubation and Conjunctival Resection in Patients with Epiphora. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:438-444. [PMID: 30549466 PMCID: PMC6288025 DOI: 10.3341/kjo.2018.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/08/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the success rates of performing only silicone tube intubation versus carrying out both conjunctival resection and silicone tube intubation. Methods The subjects of this study involved 62 patients (96 eyes) between October 2015 and May 2017 who were diagnosed as having punctal stricture or nasolacrimal duct stenosis. Out of 96 eyes, 47 underwent only silicone tube intubation, and 49 underwent both silicone tube intubation and conjunctival resection. Three parameters were measured at 1, 3, and 6 months after the surgery: the area of the tear meniscus using RTVue-100 anterior segment optical coherence tomography, the height of the tear meniscus using a slit lamp microscope, and the subjective satisfaction of patients as a result of improved sympotms like epiphora. The surgery was considered successful when the patients' experienced the resolution of symptoms and reduction of the area and height of the tear meniscus. Results The area of the tear meniscus, height of the tear meniscus, and subjective satisfaction of patients was superior in the group that underwent both silicone tube intubation and conjunctival resection compared silicone tube intubation only. Based on these results, the success rate of the surgery was 68.9% in the group that underwent only silicone tube intubation and 78.7% in the group that underwent both silicone tube intubation and conjunctival resection. Conclusions The resection of relaxed plica semilunares seems to increase the success rate of silicone tube intubation through the reduction of the area and height of the tear meniscus. Therefore, after determining the degree of conjunctivochalasis, if it was found to be severe, a combination with conjunctival resection was expected to increase the success rate of the surgery.
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Affiliation(s)
- Seon Tae Kim
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Long Yu Jin
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Hee Bae Ahn
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea.
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Conjunctivochalasis and Related Factors in an Adult Population of Iran. Eye Contact Lens 2018; 44 Suppl 1:S206-S209. [DOI: 10.1097/icl.0000000000000379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harbiyeli II, Erdem E, Erdogan S, Kuyucu Y, Polat S, Yagmur M. Investigation of conjunctivochalasis histopathology with light and electron microscopy in patients with conjunctivochalasis in different locations. Int Ophthalmol 2018; 39:1491-1499. [DOI: 10.1007/s10792-018-0963-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 06/16/2018] [Indexed: 11/28/2022]
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Gan JY, Li QS, Zhou HM, Zhang W, Lian LZ, Yu Z, Zhang ZY. A preliminary study on the establishment of an animal model of conjunctivochalasis. Int J Ophthalmol 2018; 11:899-904. [PMID: 29977798 DOI: 10.18240/ijo.2018.06.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/08/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To explore a feasible method on the establishment of an animal model of conjunctivochalasis (CCH). METHODS Twelve clean-grade New Zealand white rabbits were divided into four groups (n=3/group): the control group (one received no interventions, and the others underwent subconjunctival injection of sterile water), the matrix metalloproteinases (MMPs) group (administered subconjunctival injection of MMP-3), the aging group (administered subcutaneous injection of D-galactose), the tumor necrosis factor-α (TNF-α) solution group (administered eye drops of TNF-α). Anterior segment photography, conjunctival tissue light microscopy and transmission electron microscopy (TEM) were performed after 12wk. RESULTS Among all groups, the MMPs group had the following changes: the looser connection between the inferior bulbar conjunctiva and sclera; the more disordered collagen fibers (Trichrome staining) and the broken elastic fibers (Aldehyde-fuchsin staining); the focal necrosis of fibroblasts (TEM). CONCLUSION Administration of MMPs may be a feasible method for the establishment of an animal model of CCH.
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Affiliation(s)
- Jing-Yun Gan
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Qing-Song Li
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Huan-Ming Zhou
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Wei Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Ling-Zhi Lian
- Department of Pathology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Zhang Yu
- Department of Electron Microscopy, Shanghai Medical College, Fudan University, Shanghai 200062, China
| | - Zhen-Yong Zhang
- Department of Pathology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
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Conjunctivochalasis: a systematic review. Surv Ophthalmol 2017; 63:554-564. [PMID: 29128574 DOI: 10.1016/j.survophthal.2017.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 10/20/2017] [Accepted: 10/30/2017] [Indexed: 01/28/2023]
Abstract
Conjunctivochalasis (CCH) is a conjunctival condition characterized by loose, redundant conjunctival folds, most typically in the inferior bulbar conjunctiva of both eyes. Although CCH is a common cause of ocular irritation and discomfort, especially in the elderly, it is often overlooked in clinical practice. CCH may be associated with various ocular and nonocular conditions; however, the most important risk factor is aging. Although often asymptomatic, CCH may cause symptoms related to tear film instability and/or delayed tear clearance. Pathogenesis of CCH remains largely unknown but may involve different elements such as aged conjunctiva, unstable tear film, mechanical friction, ocular surface inflammation, and delayed tear clearance. Contradictory results have been reported on histopathologic changes in CCH, with some studies showing a normal microscopic structure. For symptomatic CCH, medical treatment may include lubrication and anti-inflammatory medications. For symptomatic patients who fail to respond to medical treatment, a surgical procedure may be considered. Although various surgical procedures have been used for CCH, more often, it consists of conjunctival cauterization or excision of the redundant conjunctiva, with or without amniotic membrane transplantation.
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Gan JY, Li QS, Zhang ZY, Zhang W, Zhang XR. The role of elastic fibers in pathogenesis of conjunctivochalasis. Int J Ophthalmol 2017; 10:1465-1473. [PMID: 28944209 DOI: 10.18240/ijo.2017.09.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/23/2017] [Indexed: 11/23/2022] Open
Abstract
The PubMed, MEDLINE databases and China National Knowledge Infrastructure (CNKI) were searched for information regarding the etiology and pathogenesis of conjunctivochalasis (CCh) and the synthesis and degradation of elastic fibers. After analysis of the literature, we found elastic fibers was a complex protein molecule from the structure and composition; the degradation of elastic fibers was one of the histopathological features of the disease; the vast majority of the factors related to the pathogenesis of CCh ultimately pointed to abnormal elastic fibers. By reasonably speculating, we considered that abnormal elastic fibers cause the conjunctival relaxation. In conclusion, we hypothesize that elastic fibers play an important role in the pathogenesis of CCh. Studies on the mechanism of synthesis, degradation of elastic fibers are helpful to clarify the pathogenesis of the disease and to find effective treatment methods.
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Affiliation(s)
- Jing-Yun Gan
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Qing-Song Li
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Zhen-Yong Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Wei Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Xing-Ru Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
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Kim BK, Mun SJ, Lee DG, Choi HT, Chung YT. Management of incision failure during small incision lenticule extraction because of conjunctivochalasis. Am J Ophthalmol Case Rep 2017; 7:134-137. [PMID: 29260098 PMCID: PMC5722160 DOI: 10.1016/j.ajoc.2017.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 03/31/2017] [Accepted: 06/20/2017] [Indexed: 12/03/2022] Open
Abstract
Purpose We report a case of incision failure during small incision lenticule extraction (SMILE) and its management. Observations The incision could not be made using the femtosecond laser because of a redundant conjunctiva, so it was instead done manually using a diamond knife. The lenticule was successfully separated and extracted. Three months after the procedure, the uncorrected distance visual acuity was 20/20 and no complication was observed. Conclusions and importance This case demonstrates that the conjunctiva should be carefully examined before SMILE. If a complication occurs because of conjunctivochalasis, it can be resolved with proper management without compromising the patient's visual acuity.
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Hashemian H, Mahbod M, Amoli FA, Kiarudi MY, Jabbarvand M, Kheirkhah A. Histopathology of Conjunctivochalasis Compared to Normal Conjunctiva. J Ophthalmic Vis Res 2016; 11:345-349. [PMID: 27994801 PMCID: PMC5139544 DOI: 10.4103/2008-322x.194068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate the histopathologic changes in the conjunctiva of patients with conjunctivochalasis (CCh) compared to age-matched controls. Methods: This cross-sectional, controlled study included 27 eyes of 27 patients with CCh and 16 eyes of 16 age-matched controls. A biopsy of the bulbar conjunctiva was performed along the temporal lower lid margin before cataract surgery in both groups. Histopathologic evaluation of the specimens was done with light microscopy using staining with hematoxylin/eosin, periodic acid Schiff, and van Gieson elastic stain. Various histopathologic features of the conjunctival epithelium and stroma were compared between the two groups. Results: The mean age of patients was 62.4 ± 6.9 years in the CCh group and 65.1 ± 6.3 years in the control group (P = 0.54). No significant differences were noted between the two groups in terms of conjunctival epithelial changes including papillomatosis, epithelial clefts, epithelial goblet cells, or infiltration of inflammatory cells. Mean thickness of the conjunctival stroma was 0.21 ± 0.08 mm in the CCh group and 0.26 ± 0.21 mm in the control group (P = 0.10). For the conjunctival stroma, there were no significant differences between the two groups in terms of elastosis, fibrosis, lymphangiectasia, or infiltration of inflammatory cells. Conclusion: No noticeable differences were found in the histopathologic features by light microscopy between eyes with CCh and those of age-matched controls. Therefore, the primary pathology of CCh may not be within the conjunctiva itself. Instead, loose attachment of the conjunctiva to the underlying tissue may be the reason for the redundant folds in the bulbar conjunctiva.
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Affiliation(s)
- Hesam Hashemian
- Farabi Eye Hospital, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fahimeh A Amoli
- Farabi Eye Hospital, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Y Kiarudi
- Farabi Eye Hospital, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabbarvand
- Farabi Eye Hospital, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Massachusetts, Boston, USA
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Abstract
Purpose To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh). Methods and materials This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded. Results The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60%) eyes with grade 1 CCh; 15 (30%) eyes with grade 2 CCh; and five (10%) eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90%) eyes, and in the remaining five (10%) CCh was located in the superior bulbar conjunctiva. Ten (33.3%) patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6%) patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients. Conclusion Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora.
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Affiliation(s)
- Ozlem Balci
- Ophthalmology Department, Kolan Hospitalium Group, Istanbul, Turkey
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Bae JB, Park WC. Histopathologic Characteristics of Conjunctivochalasis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.8.1165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeong Bum Bae
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Woo Chan Park
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
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Wang S, Ke M, Cai X, Chen X, Yu A, Dai H, Wen X. An improved surgical method to correct conjunctivochalasis: conjunctival semiperitomy based on corneal limbus with subconjunctival cauterization. Can J Ophthalmol 2012; 47:418-22. [PMID: 23036542 DOI: 10.1016/j.jcjo.2012.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 07/02/2012] [Accepted: 07/05/2012] [Indexed: 11/25/2022]
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Paste-pinch-cut conjunctivoplasty: subconjunctival fibrin sealant injection in the repair of conjunctivochalasis. Cornea 2012; 31:959-62. [PMID: 22406947 DOI: 10.1097/ico.0b013e3182400100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a new surgical technique for the repair of conjunctivochalasis (CCh) using subconjunctival injection of fibrin sealant followed by conjunctival resection and to present a case series demonstrating our experience with the paste-pinch-cut technique. METHODS A total of 139 eyes of 70 patients (43 women, 27 men) with CCh unresponsive to medical therapy received the described surgical treatment. The procedure consists of 3 primary steps-paste: fibrin sealant is injected subconjunctivally in a line inferior to the limbus; pinch: the conjunctiva is grasped with curved ptosis forceps, gathering the excess conjunctiva into a ridge, which is held, allowing the sealant to polymerize; and cut: the ridge of excess conjunctiva and sealant is resected. Subjective symptoms were assessed after surgery. RESULTS Conjunctival redundancy was absent postoperatively in all eyes, resulting in a smooth conjunctival surface and restored tear meniscus. At the 3-month follow-up visit, 91.4% of patients reported improvement in symptoms. There were no recurrences or significant complications. CONCLUSIONS The present retrospective, noncomparative, consecutive, interventional case series study introduces paste-pinch-cut conjunctivoplasty as a simple and an effective surgical treatment for the repair of CCh in symptomatic patients.
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Whitaker JK, Alexander P, Chau DYS, Tint NL. Severe conjunctivochalasis in association with classic type Ehlers-Danlos syndrome. BMC Ophthalmol 2012; 12:47. [PMID: 22943506 PMCID: PMC3504533 DOI: 10.1186/1471-2415-12-47] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 08/30/2012] [Indexed: 11/30/2022] Open
Abstract
Background Inferior conjunctivochalasis is common, but is rarely severe enough to require conjunctival excision. This report describes a patient with severe conjunctivochalasis who was subsequently diagnosed with Ehlers Danlos Syndrome, Classic Type. Case presentation A patient suffering from foreign body sensation, frequent blinking and bilateral inferior conjunctivochalasis was referred and treated by topical ocular lubrication. However, no improvement was observed prompting potential excision of conjunctivochalasis. Following patient consultation and clinical diagnosis including hypermobile joints and skin elasticity, poor wound healing and wide scar morphology, Ehlers-Danlos syndrome was confirmed in the patient. Conclusion This case highlights the need for direct patient questioning and provides the first reported association between conjunctiovochalasis and Ehlers-Danlos syndrome.
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Affiliation(s)
- John K Whitaker
- Division of Ophthalmology and Visual Sciences, Queen Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
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Suh JS, Choi S. The Effect of Conjunctivochalasis Surgery Using a High-Frequency Radio-Wave Electrosurgical Unit. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.11.1571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae Shin Suh
- Department of Ophthalmology, Seoul Veterans Hospital, Seoul, Korea
| | - Sangkyung Choi
- Department of Ophthalmology, Seoul Veterans Hospital, Seoul, Korea
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Fodor E, Kosina-Hagyó K, Bausz M, Németh J. Increased tear osmolarity in patients with severe cases of conjunctivochalasis. Curr Eye Res 2011; 37:80-4. [PMID: 22050557 DOI: 10.3109/02713683.2011.623810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate and compare tear osmolarity in different grades of conjunctivochalasis. PATIENTS AND METHODS Forty subjects divided into four groups based on grading of conjunctivochalasis by lid-paralell conjunctival fold (LIPCOF) test and tear osmolarity evaluated by TearLab osmometer. Schirmer test, tear film break up time (BUT) and vital staining were also performed. RESULTS Patients with mild and moderate conjunctivochalasis showed similar tear osmolarity to normal subjects. A significant increase (P < 0.008) of osmolarity was found in patients with severe conjunctivochalasis. A significant increase of osmolarity was found in patients with abnormal BUT (P = 0.018) and in patients with positive lissamine-green staining (P = 0.023). No association could be elicited when results of osmolarity were compared to those of Schirmer test or when compared those of fluorescein staining to osmolarity, respectively. CONCLUSION Hyperosmolarity of tear was reported as a fact of ocular surface inflammation. While in mild and moderate conjunctivochalasis tear osmolarity was similar to normal controls, increased osmolarity can refer to the presence of ocular surface inflammation in these patients with severe conjunctivochalasis.
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Affiliation(s)
- Eszter Fodor
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
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A Histopathological Study of Bulbar Conjunctival Flaps Occurring in 2 Contact Lens Wearers. Cornea 2011; 30:1037-41. [DOI: 10.1097/ico.0b013e318207ec82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pult H, Purslow C, Murphy PJ. The relationship between clinical signs and dry eye symptoms. Eye (Lond) 2011; 25:502-10. [PMID: 21252949 PMCID: PMC3171239 DOI: 10.1038/eye.2010.228] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/02/2010] [Accepted: 12/02/2010] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate (i) the relationship between traditional and new clinical tests (lid-wiper epitheliopathy (LWE), lid-parallel conjunctival folds (LIPCOF)) and dry eye symptoms in non-contact lens wearers, and (ii) that a combination of these tests can improve predictive ability for the development of dry eye symptoms. METHODS Tear meniscus height (TMH), non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining, and LWE grades were observed in a cohort of 47 healthy, non-lens wearers (male=17, female=30, median age=35 years, range=19-70). Symptoms were assessed using the Ocular Surface Disease Index (OSDI). RESULTS LWE was significantly correlated to both temporal and nasal LIPCOF (0.537 -0.248, P < 0.001). Significant correlations were found between NIBUT and TMH (r=0.461, P=0.001) and PRTT (r = 0.640, P < 0.001). OSDI scores were significant correlated to NIBUT, TMH, PRTT, LIPCOF, and LWE (r>∣0.31∣; P<0.05). Significant discriminators of OSDI+/- were NIBUT (area under the receiver operative characteristic curve (AUC)=0.895), TMH (0.715), PRTT (0.781), LIPCOF (temporal/nasal/Sum 0.748/0.828/0.816), and LWE (0.749). Best predictive ability was achieved by combining NIBUT with nasal LIPCOF (AUC=0.944). CONCLUSIONS The individual tests NIBUT, TMH, PRTT, LIPCOF, and LWE were significantly, but moderately, related to OSDI scores. The strongest relationship appeared by combining NIBUT with nasal LIPCOF.
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Affiliation(s)
- H Pult
- Optometry and Vision Research, Weinheim, Germany.
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Park JS, Ha SW, Lew H. Histopathologic Properties of Eyelid Skin and Conjunctiva in Patients with Dermatochalasis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.5.582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong-seo Park
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung-Woo Ha
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Fodor E, Barabino S, Montaldo E, Mingari MC, Rolando M. Quantitative evaluation of ocular surface inflammation in patients with different grade of conjunctivochalasis. Curr Eye Res 2010; 35:665-9. [PMID: 20673042 DOI: 10.3109/02713681003770738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate and compare HLA-DR expression of conjunctival epithelial cells in different grade of conjunctivochalasis (CCh). PATIENTS AND METHODS Thirty patients and seven healthy subjects underwent clinical examination, grading of CCh by lid-parallel conjunctival fold (LIPCOF) test, and impression cytology of the bulbar conjunctiva. HLA-DR expression was analyzed by flow cytometry. Schirmer test, tear break-up time, and vital staining were also performed. RESULTS Patients who presented with mild and moderate CCh showed a similar expression of HLA-DR to normal subjects. A significant increase (p < 0.005) of HLA-DR was found in patients with severe CCh. Positive correlation was found between fluorescein staining and HLA-DR expression (r = 0.36, p = 0.009) and between lissamine-green staining and HLA-DR expression (r = 0.30, p = 0.027). Neither correlation was found between Schirmer test nor break up time and HLA-DR expression. CONCLUSION Inflammation plays a pivotal role on the ocular surface of patients with severe CCh. Since mild and moderate CCh HLA-DR expression was similar to normal controls, we can speculate that the source of inflammation could be the presence of conjunctival folds.
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Affiliation(s)
- Eszter Fodor
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
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Nam K, Jo YJ, Lee SB. The Efficacy of Fibrin Glue in Surgical Treatment of Conjunctivochalasis With Epiphora. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.4.498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kiyup Nam
- Department of Ophthalmology, Chungnam National University College of medicine, Daejeon, Korea
| | - Young Joon Jo
- Department of Ophthalmology, Chungnam National University College of medicine, Daejeon, Korea
- Research Institute for Medical Science, Chungnam National University, Daejeon, Korea
| | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University College of medicine, Daejeon, Korea
- Research Institute for Medical Science, Chungnam National University, Daejeon, Korea
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Mimura T, Usui T, Yamamoto H, Yamagami S, Funatsu H, Noma H, Honda N, Fukuoka S, Amano S. Conjunctivochalasis and contact lenses. Am J Ophthalmol 2009; 148:20-5.e1. [PMID: 19403112 DOI: 10.1016/j.ajo.2009.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Revised: 02/07/2009] [Accepted: 02/09/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the relationship between age and the incidence and severity of conjunctivochalasis in contact lens (CL) wearers by grading of conjunctivochalasis, and to compare the severity of conjunctivochalasis between CL wearers and nonwearers. DESIGN Prospective, nonrandomized consecutive case study. METHODS A total of 600 CL wearers (94 hard CLs [HCL] and 506 soft CLs [SCL]) aged 11 to 60 years and 579 nonwearers aged 10 to 60 years were enrolled. The age, gender, medical history, ocular history, and the grade and other parameters of conjunctivochalasis at 3 locations (nasal, middle, and temporal areas) were determined in all subjects. RESULTS The prevalence of conjunctivochalasis increased dramatically with age in all groups. The mean grade of conjunctivochalasis was higher in CL wearers than in nonwearers (nasal area, P < .00001; temporal area, P < .00001) and was higher in HCL wearers than in SCL wearers (nasal area, P < .00001; temporal area, P = .00003). Parameters such as the downward gaze-dependent or digital pressure-dependent changes of conjunctivochalasis and the presence of superficial punctate keratitis all increased with age in both CL wearers and nonwearers. The gaze-dependent and pressure-dependent changes of conjunctivochalasis showed an increase with age and the duration of CL wear in both SCL and HCL wearers. CONCLUSIONS This was the first assessment of the severity of conjunctivochalasis in a large series of consecutive CL wearers. Our results strongly suggest that wearing CLs is an important risk factor for conjunctivochalasis.
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Offret H, Fabre M, Porras J, Offret O, Labetoulle M. [Bilateral elastosis of the limbus]. J Fr Ophtalmol 2008; 31:335-8. [PMID: 18404130 DOI: 10.1016/s0181-5512(08)74815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report of a case of bilateral limbus involvement by white lesions. A 72-year-old man was referred for bilateral lesions involving the inferior part of the corneal limbus. White excrescences associated with a vascular pannus were observed at biomicroscope examination. Histologic patterns showed degenerative fibroelastosis. Degenerative fibroelastosis can be observed at the inferior corneal limbus.
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Affiliation(s)
- H Offret
- Service d'Ophtalmologie, Université Paris Sud, CHU de Bicêtre, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre.
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The impact of nasal conjunctivochalasis on tear functions and ocular surface findings. Am J Ophthalmol 2007; 144:930-937. [PMID: 17916317 DOI: 10.1016/j.ajo.2007.07.037] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Revised: 06/26/2007] [Accepted: 07/30/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the effect of grade 3 nasal conjunctivochalasis (NCCh) on the tear film inflammation, ocular surface findings, and tear function findings. DESIGN Prospective, observational case series. METHODS Eleven eyes with Yokoi grade 3 NCCh in which the chalatic conjunctiva occluded the punctum and 18 eyes without NCCh but with central or temporal conjunctivochalasis, or both, and 16 eyes of healthy controls were recruited prospectively. Enzyme-linked immunosorbent assay for inflammatory tear cytokines, tear film break-up time (BUT), Schirmer I test measurements, and fluorescein and rose bengal vital stainings and impression cytologic and brush cytologic analysis for real-time reverse-transcriptase polymerase chain reaction analysis of MUC5AC messenger ribonucleic acid (mRNA) expression were performed. RESULTS Eyes with grade 3 NCCh had significantly delayed tear clearance. All inflammatory cytokines showed higher values in eyes with grade 3 NCCh compared with the eyes without nasal chalasis with a comparably significant elevation in interleukin-1b and tumor necrosis factor alpha levels. The mean rose bengal score in eyes with grade 3 NCCh was significantly higher compared with eyes without nasal chalasis and eyes of controls. The mean goblet cell density was significantly lower in eyes with grade 3 NCCh with downregulation of the relative MUC5AC mRNA expression. CONCLUSIONS Inflammation plays an important role in the pathogenesis of conjunctivochalasis and is more pronounced in eyes with nasal chalasis. Pooling of inflammatory cytokines in tears of patients with NCCh associated with delayed tear clearance induces distinct adverse effects that affect the ocular surface health.
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Erdogan-Poyraz C, Mocan MC, Irkec M, Orhan M. Delayed Tear Clearance in Patients With Conjunctivochalasis Is Associated With Punctal Occlusion. Cornea 2007; 26:290-3. [PMID: 17413955 DOI: 10.1097/ico.0b013e31802e1e24] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the impact of punctal occlusion on ocular tear clearance and occurrence of epiphora in patients with conjunctivochalasis (CCh). METHODS Seventy-five eyes with the diagnosis of CCh were included in the study. CCh was graded on the basis of the extent of inferior lid margin involvement as follows: 1 = one location, 2 = 2 locations, and 3 = whole lid. Patients within the 3 groups were also subdivided on the basis of the presence of punctal occlusion. The presence of epiphora, occlusion of the inferior punctum, and fluorescein clearance test (FCT) results were recorded for every patient. RESULTS Of the 75 patients, 56 (75%) had epiphora, 47 (63%) had punctal occlusion, and 54 (72%) had delayed FCT. Twenty-two patients had grade 1 CCh, 43 had grade 2 CCh, and 10 had grade 3 CCh. Epiphora was present in 10 (45%) patients with grade 1 CCh, 38 (88%) patients with grade 2 CCh, and 8 (80%) patients with grade 3 CCh. Punctal occlusion and epiphora were observed more frequently in patients with grades 2 and 3 CCh compared with those with grade 1 CCh (Pearson chi test, P < 0.001). There was a strong correlation between delayed FCT and punctal occlusion (Spearman rank correlation analysis, r = 0.808, P < 0.001). Punctal occlusion was also correlated with the presence of epiphora (Spearman rank correlation analysis, r = 0.691, P < 0.001). CONCLUSIONS A significant proportion of patients with CCh are symptomatic beginning with early stages of CCh. There seem to be no significant differences in any of the clinical parameters between patients with grade 2 and grade 3 CCh. Punctal occlusion seems to play an important role in the impairment of ocular tear clearance and the occurrence of epiphora.
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Affiliation(s)
- Ceren Erdogan-Poyraz
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
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Yokoi N, Komuro A, Nishii M, Inagaki K, Tanioka H, Kawasaki S, Kinoshita S. Clinical Impact of Conjunctivochalasis on the Ocular Surface. Cornea 2005; 24:S24-S31. [PMID: 16227820 DOI: 10.1097/01.ico.0000178740.14212.1a] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the clinical impact of conjunctivochalasis on the ocular surface by evaluating the effect of a new concept of conjunctivochalasis operation on the resolution of patients' symptoms and corneal epithelial damage. Also, the association of inflammation with conjunctivochalasis is examined. PATIENTS AND METHODS A total of 168 eyes of 131 conjunctivochalasis patients with (50 eyes) or without (118 eyes) dry eye who received the newly designed conjunctivochalasis operation were enrolled. All patients had prominent conjunctivochalasis at the lower tear meniscus and their ocular symptoms were not sufficiently controlled by the usual eyedrop therapy. Subjective symptoms of patients were assessed before and after the operation by questionnaires. Scores of corneal fluorescein staining were evaluated before and after the operation in patients with dry eye. Four samples of the lower part of conjunctiva from non-dry eye conjunctivochalasis patients were investigated by immunostaining and compared with samples from 4 normal conjunctiva and 3 conjunctiva showing inflammation due to Mooren ulcer, ocular cicatricial pemphigoid, and alkali burn. RESULTS The most frequent chief subjective symptoms before the operation were irritation (51.7%) and lacrimation (31.4%) in conjunctivochalasis patients without dry eye and irritation (80.0%) in those with dry eye. Improvement of the chief symptoms was obtained in 88.2% and 78.0% of these 2 patient groups, respectively. Furthermore, in patients with dry eye, corneal fluorescein staining scores (mean+/-SD) were significantly improved after the operation compared with before the operation: A (area), 0.6+/-0.7 and D (density), 0.8+/-0.9 versus A, 1.3+/-0.5 and D, 1.9+/-0.9; P<0.0001. Based on the immunostaining study, conjunctival samples from eyes with conjunctivochalasis and normal eyes showed negligible inflammation compared with those from inflamed conjunctiva. CONCLUSIONS This study suggests that conjunctivochalasis has a great clinical impact on the ocular surface, and the newly developed operation is very effective in resolving patient complaints and also ocular surface damage in conjunctivochalasis with dry eye. It may also be suggested that the conjunctivochalasis has a negligible association with conjunctival inflammation.
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Affiliation(s)
- Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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