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New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis.
Am J Ophthalmol. 2003 Mar; 135(3):303-8.AJ

Abstract

PURPOSE

To introduce a new surgical procedure for treating superior limbic keratoconjunctivitis (SLK) and to suggest the association of SLK with conjunctivochalasis.

DESIGN

Interventional case series.

METHODS

Six eyes of five patients with long-standing severe ocular irritation unresponsive to treatment with topical steroid and artificial tears were operated on using our new procedure. This technique consists of four steps as follows: (1) Rose bengal (RB) staining is used to localize the abnormal conjunctival area; (2) an arc-like conjunctival incision is placed from the 2 to the 10 o'clock position adjacent and distal to the RB-stained area; (3) the conjunctiva is resected to form a crescent using the arc-like incision as the base; the size of the resection is determined by conjunctival redundancy after removal of the subconjunctival connective tissue; and (4) the crescent conjunctival opening is closed with interrupted sutures. In two eyes, the new surgical procedure was performed together with surgery for inferior bulbar conjunctivochalasis.

RESULTS

In all operated eyes, RB staining had disappeared by the end of the second postoperative week; recovery from symptoms and loss of inflammation were recorded by 1 month after treatment. In the case with the longest follow-up (14 months), there was cytologic evidence of goblet cell recovery at 3 months after the operation. In another, there was normalization of the nucleo/cytoplasmic ratio of conjunctival cells without the appearance of goblet cells.

CONCLUSIONS

Our treatment very effectively resolved symptoms associated with SLK, even in eyes unresponsive to conventional therapy with eye drops. Considering that we did not address the diseased part of the conjunctiva but rather the adjacent conjunctival redundancy, we propose that superior bulbar conjunctivochalasis is involved in the pathogenesis of SLK.

Authors+Show Affiliations

Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. nyokoi@ophth.kpu-m.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12614746

Citation

Yokoi, Norihiko, et al. "New Surgical Treatment for Superior Limbic Keratoconjunctivitis and Its Association With Conjunctivochalasis." American Journal of Ophthalmology, vol. 135, no. 3, 2003, pp. 303-8.
Yokoi N, Komuro A, Maruyama K, et al. New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis. Am J Ophthalmol. 2003;135(3):303-8.
Yokoi, N., Komuro, A., Maruyama, K., Tsuzuki, M., Miyajima, S., & Kinoshita, S. (2003). New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis. American Journal of Ophthalmology, 135(3), 303-8.
Yokoi N, et al. New Surgical Treatment for Superior Limbic Keratoconjunctivitis and Its Association With Conjunctivochalasis. Am J Ophthalmol. 2003;135(3):303-8. PubMed PMID: 12614746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis. AU - Yokoi,Norihiko, AU - Komuro,Aoi, AU - Maruyama,Kunio, AU - Tsuzuki,Masakatsu, AU - Miyajima,Seiya, AU - Kinoshita,Shigeru, PY - 2003/3/5/pubmed PY - 2003/3/18/medline PY - 2003/3/5/entrez SP - 303 EP - 8 JF - American journal of ophthalmology JO - Am J Ophthalmol VL - 135 IS - 3 N2 - PURPOSE: To introduce a new surgical procedure for treating superior limbic keratoconjunctivitis (SLK) and to suggest the association of SLK with conjunctivochalasis. DESIGN: Interventional case series. METHODS: Six eyes of five patients with long-standing severe ocular irritation unresponsive to treatment with topical steroid and artificial tears were operated on using our new procedure. This technique consists of four steps as follows: (1) Rose bengal (RB) staining is used to localize the abnormal conjunctival area; (2) an arc-like conjunctival incision is placed from the 2 to the 10 o'clock position adjacent and distal to the RB-stained area; (3) the conjunctiva is resected to form a crescent using the arc-like incision as the base; the size of the resection is determined by conjunctival redundancy after removal of the subconjunctival connective tissue; and (4) the crescent conjunctival opening is closed with interrupted sutures. In two eyes, the new surgical procedure was performed together with surgery for inferior bulbar conjunctivochalasis. RESULTS: In all operated eyes, RB staining had disappeared by the end of the second postoperative week; recovery from symptoms and loss of inflammation were recorded by 1 month after treatment. In the case with the longest follow-up (14 months), there was cytologic evidence of goblet cell recovery at 3 months after the operation. In another, there was normalization of the nucleo/cytoplasmic ratio of conjunctival cells without the appearance of goblet cells. CONCLUSIONS: Our treatment very effectively resolved symptoms associated with SLK, even in eyes unresponsive to conventional therapy with eye drops. Considering that we did not address the diseased part of the conjunctiva but rather the adjacent conjunctival redundancy, we propose that superior bulbar conjunctivochalasis is involved in the pathogenesis of SLK. SN - 0002-9394 UR - https://www.unboundmedicine.com/medline/citation/12614746/New_surgical_treatment_for_superior_limbic_keratoconjunctivitis_and_its_association_with_conjunctivochalasis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S000293940201975X DB - PRIME DP - Unbound Medicine ER -