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Abstract
Purpose
We evaluated the effect of amniotic membrane transplantation with fibrin glue after redundant conjunctival resection.
Methods
After enchelon-shaped resection of inferior redundant conjunctiva, an amniotic membrane was transplanted using fibrin glue in symptomatic conjunctivochalasis. Conjunctiva was fixed to the episclera with 10-0 nylon.
Results
The subjects were 18 eyes of 9 patients (two males=4 eyes, seven females=14 eyes) with an average age of 67.9±7.7 years (range: 54-79 years). Mean operation time was 35.6±5.6 minutes/eye (range: 30-45 minutes/eye) and mean numbers of sutures were 8±0.76 (range: 7-9). The mean follow-up period was 10.4±3 months (range: 6-14 months) and the mean time to full epithelization was 14.5±3.4 days (range: 11-20 days). At postoperative days 1-2, the lower tear meniscus was reconstructed. There were no recurrences or any postoperative complications observed.
Conclusions
Amniotic membrane transplantation after redundant conjunctival resection in conjunctivochalasis resulted in reconstruction of the lower tear meniscus with stable conjunctival surface and marked improvement of subjective symptoms. Operation time and early postoperative irritation symptoms could be reduced with the use of fibrin glue.
References
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Figure 2.
(A) Conjunctivochalasis at ordinary condition. (B) Worsening of conjunctivochalasis after vigorous blinking.
Figure 3.
Objective signs of conjunctivochalasis. (A) Redundancy of conjunctiva. (B) Ectopic tear meniscus. (C) Interruption of lower tear meniscus. (D) Anterior migration of the mucocutaneous junction.
Figure 4.
Schematic presentation of conjunctivochalasis surgery. (A) The conjunctival incision 1mm from the limbus (black arrow: lower punctum). (B) Enchelon-shaped resection of redundant conjunctiva. (C) Covering of amniotic membrane leaving 2 mm excess margin in length and width. (D) Conjunctiva fixed to the episclera with interrupted 10-0 nylon sutures.
Figure 5.
(A) An enchelon-shaped resection was performed to remove inferior redundant conjunctiva. (B) The amniotic membrane was peeled off the carrier paper from the storage medium. (C) Thrombin solution was placed on the exposed sclera. (D) A drop of fibrinogen solution was applied on stromal side of amniotic membrane. (E) The graft was immediately transferred onto the exposed sclera and rapidly smoothered with a muscle hook. (F) The surrounding conjunctival edge was then secured to the episclera by interrupted sutures with 10-0 nylon.
Figure 6.
(A, B) Preoperative appearance showed the redundant conjunctival tissue and interruption of lower tear meniscus. (C, D) One week after operation, the size of epithelial defect decreased. (E, F) One month after operation, smooth, quiet, non-inflamed conjunctival surface and complete epithelization is found.
Fig. 7.
(A) Preoperative photograph shows interruption of the lower tear meniscus. (B) Three months after operation, panoramic picture of representative example of a patient with conjunctivochalasis. There is no evidence of redundant conjunctiva between the cornea and lower lid, and a completely reconstructed lower tear meniscus is found.
Table 1.
Grading of conjunctivochalasis (LIOCF)19
Table 2.
Symptoms before and after surgery
| Before | Resolved | ‡ RI | Improved | Unchanged | Aggravated | |
|---|---|---|---|---|---|---|
| * FBS(eyes) | 18 | 6 | 8 | 4 | 0 | 0 |
| † MD(eyes) | 18 | 4 | 6 | 8 | 0 | 0 |
Table 3.
Schirmer I test and tear break-up time before and after surgery
| Before | 1 month | 3 months | 6 months | |
|---|---|---|---|---|
| Schirmer I test (mm/5 min) | 14.44±3.50 | 15.78±4.41 (P=0.488) | 15.89±4.31 (P=0.447) | 17.33±4.69 (P=0.158) |
| TBUT* (seconds) | 5.22±2.28 | 5.89±1.97 (P=0.516) | 6.33±1.41 (P=0.232) | 5.89±1.62 (P=0.484) |
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