Conjunctival Flap Surgery Using Calcium Plaque Scissors for Calcified Scleromalacia after Cosmetic Conjunctivectomy

Young Jae Woo; Hong Seok Kim; Kyoung Yul Seo

doi:10.3341/jkos.2014.55.11.1618

Journal List > J Korean Ophthalmol Soc > v.55(11) > 1009831

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Woo, Kim, and Seo: Conjunctival Flap Surgery Using Calcium Plaque Scissors for Calcified Scleromalacia after Cosmetic Conjunctivectomy

Original Article

J Korean Ophthalmol Soc 2014;55(11):1618-1624.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.11.1618

Conjunctival Flap Surgery Using Calcium Plaque Scissors for Calcified Scleromalacia after Cosmetic Conjunctivectomy

Young Jae Woo, MD¹, Hong Seok Kim, MD³, Kyoung Yul Seo, MD, PhD^1,²

¹Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

³Siloam Eye Hospital, Seoul, Korea

Address reprint requests to Kyoung Yul Seo, MD, PhD, Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea, Tel: 82-2-2228-3581, Fax: 82-2-312-0541, E-mail: SEOKY@yuhs.ac

Received 27 June 2014 Revised 17 July 2014 Accepted 3 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To research the advantage of using calcium plaque scissors in conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy.

Methods

We analyzed 55 eyes that had undergone conjunctival flap surgery for calcified scleromalacia occurring after cosmetic conjunctivectomy. Surgical blade was used in 30 eyes (Group 1) and calcium plaque scissors in 25 eyes (Group 2). Time after conjunctivectomy, plaque size, operation time and visual acuity before and after the flap surgery were analyzed and compared. Additionally, necessity of additional scleral surgery was evaluated. Optical coherence tomography (OCT) of the sclera was performed both pre- and postoperatively and the results were compared.

Results

An average of 3.9 ± 1.0 years elapsed until conjunctival flap surgery and follow-up time was 5.2 ± 3.8 months. Post conjunctivectomy time and plaque size were similar in both groups (p = 0.87 and 0.49, respectively). The surgery time in Group 2 was shorter than in Group 1 (17.5 ± 6.3 minutes and 21.9 ± 8.5 minutes, respectively, p = 0.20). Uncorrected visual acuity was similar in both groups before and after conjunctival flap surgery (p = 0.53 and p = 0.20, respectively). In Group 1, one sclera transplantation and three Ologen^TM insertion surgeries were performed as an additional scleral surgery. Based on OCT, calcium plaque scissors were confirmed as a new surgical tool for calcium plaque removal with minimal scleral damage.

Conclusions

Using calcium plaque scissors when performing conjunctival flap surgery for calcium plaque removal that occurred after cosmetic conjunctivectomy reduces the necessity of an additional scleral surgery and surgery time.

Keywords: Calcium plaque, Conjunctival flap surgery, Conjunctival resection, Scleromalacia

References

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Figure 1.

Intraocular lens scissors and calcium plaque scissors. (A) Shimowake Nucleus/intraocular lens (IOL) scissors. (B) Calcium plaque scissors, modified from Shimowake Nucleus/IOL scissors to have thinner tips.

Figure 2.

The surgical procedure for calcified plaque removal and conjunctival flap surgery. (A) Firstly, the margin of calcified lesions are dissected using a surgical blade. (B) W ith calcium plaque scissors, calcified lesions are dissected just beneath the plaque. (C) After dissection, calcified plaque was cut by calcium plaque scissors. (D) The flap bed is prepared by scraping the epithelialized but nonvascularized area. (E) The conjunctival flap is pulled on the nonvascularized sclera and the subconjunctival tissue is released to decrease the flap contraction. (F) The conjunctival flap is sutured with enough 8-0 Vicryl stitches to fix it onto the sclera.

Figure 3.

The comparison of operation time between two groups. Box plot showing operation time in group 1 (knife) and group 2 (scissors). The mean operation time was 21.9 ± 8.5 minutes in group 1 (knife), and 17.5 ± 6.3 minutes in group 2 (scissors) (p = 0.03).

Figure 4.

Slit-lamp and fourier domain optical coherence tomography (FD-OCT) findings. (A, D, E) Preoperative slit-lamp and horizontal and vertical findings of FD-OCT images. Broad calcium plaque with dark margin is shown in FD-OCT (arrows). The image plane is indicated on photographs besides each OCT images. (B, F, G) One day after conjunctival flap surgery. Slit-lamp and horizontal and vertical FD-OCT images showed removed calcium plaque. (C) One month after conjunctival flap surgery.

Table 1.

Baseline demographics

	Group 1	Group 2	p-value
Number of eyes	30	25
Age (years)	39 27 ± 8 37	45 84 ± 5 96	<0.05
Duration from whitening surgery to conjunctival flap surgery (years)	3 97 ± 1 19	3 92 ± 0 95	0.88
Calcium plaque width (mm)	2 34 ± 0 96	2 52 ± 0 98	0.49
Calcium plaque height (mm)	2 72 ± 0 93	3 30 ± 1 53	0.11
Operation time (min)	21 97 ± 8 59	17 48 ± 6 30	<0.05
Preoperative VA (snellen)	0 92 ± 0 15	0 90 ± 0 20	0.63
Postoperative VA (snellen)	0 96 ± 0 14	0 93 ± 0 17	0.60
Follow-up duration (months)	7 47 ± 3 66	2 48 ± 1 50	<0.05

Values are presented as mean ± SD unless otherwise indicated; Student's t-test performed in comparing each group.

VA = visual acuity.

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