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초록
Purpose:
To evaluate cross-sectional areas of conjunctiva and tear meniscus of conjunctivochalasis using Fourier-Domain RTVue-100 optical coherence tomography (OCT) before and after conjunctivochalasis surgery.
Methods:
Thirty-one patients (33 eyes) with symptomatic conjunctivochalasis were recruited for this study between June 2013 and April 2014. All patients underwent crescent-shaped conjunctiva resection and amniotic membrane transplantation. Anterior segment OCT (AS-OCT) imaging was performed and tear break-up time was evaluated prior to and 3 months after the conjunctivochalasis surgery. Cross-sectional areas of conjunctiva and tear meniscus of conjunctivochalasis at 7 locations (1 center, 3 nasal and 3 temporal areas) were measured in all patients.
Results:
The mean age of patients was 66.3 ± 10.8 years. Cross-sectional areas of conjunctivochalasis at all locations significantly decreased from 0.487 ± 0.42 mm2 to 0.007 ± 0.011 mm2 ( p < 0.001), whereas no significant changes in cross-sectional areas of tear meniscus at all 7 locations were observed after the surgery. Mean tear break-up time significantly increased from 2.26 ± 0.69 sec to 3.81 ± 1.22 sec following the surgery.
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Figure 2.
Measurement of cross-sectional conjunctivochalasis area using RTVue-100. (A) Photograph of lower eyelid and cornea where the vertical scans were taken. Arrow means the location and direction scanned by RTvue. (B) The obtained scan image. (C) After the image was digitally magnified, tissue boundaries among the lower lid, pro-lapsed redundant conjunctiva, and bulbar conjunctiva/inferior part of the cornea were discriminated from each based on the different levels the brightness between tissues. (D) Cross-sectional area of the outlined conjunctivochalasis was measured as 0.221 mm2 using the instrument's software.
Figure 3.
Measurement of cross-sectional tear meniscus using RTVue-100. (A) Photograph of lower eyelid and cornea where the vertical scans were taken. Arrow means the location and direction scanned by RTvue. (B) After the image was digitally magnified. (C) Triangular-shaped tear meniscus is seen between the lower cornea and lower lid. (D) Cross-sectional area of the outlined tear meniscus was measure as 0.060 mm 2 using the instrument's software.
Figure 4.
Measurement of cross-sectional tear meniscus using RTVue-100. In case of many tear meniscus caused by tears dispersed among the conjunctival folds, each tear meniscus area was measured separately and then the total meniscus area was determined by summation of each tear meniscus area.
Figure 5.
Schematic design for conjunctivochalasis surgery. After resection of the conjunctivochalasis area (inside of dot-ted line) including the pingueculae (arrows), amniotic membrane transplantations was done in the exposed scleral area.
Table 1.
Cross-sectional conjunctivochalasis area at baseline and following the surgery
| Location | Preoperative (mm2) | Postoperative (mm2) | p-value* |
|---|---|---|---|
| Center | 0.091 ± 0.134 | 0.001 ± 0.001 | <0.05 |
| Nasal 1 | 0.229 ± 0.195 | 0.001 ± 0.001 | <0.05 |
| Nasal 2 | 0.452 ± 0.275 | 0.005 ± 0.006 | <0.05 |
| Nasal 3 | 0.542 ± 0.409 | 0.012 ± 0.011 | <0.05 |
| Nasal average | 0.427 ± 0.254 | 0.007 ± 0.007 | <0.05 |
| Temporal 1 | 0.203 ± 0.155 | 0.001 ± 0.002 | <0.05 |
| Temporal 2 | 0.343 ± 0.192 | 0.007 ± 0.011 | <0.05 |
| Temporal 3 | 0.288 ± 0.139 | 0.015 ± 0.018 | <0.05 |
| Temporal average | 0.281 ± 0.149 | 0.008 ± 0.011 | <0.05 |
Table 2.
Cross-sectional tear meniscus area at baseline and following the surgery
| Location | Preoperative (mm2) | Postoperative (mm2) | p-value* |
|---|---|---|---|
| Center | 0.03 ± 0.02 | 0.01 ± 0.00 | 0.073 |
| Nasal 1 | 0.02 ± 0.02 | 0.04 ± 0.04 | 0.415 |
| Nasal 2 | 0.02 ± 0.02 | 0.02 ± 0.02 | 0.789 |
| Nasal 3 | 0.02 ± 0.02 | 0.03 ± 0.04 | 0.545 |
| Nasal average | 0.02 ± 0.02 | 0.03 ± 0.04 | 0.513 |
| Temporal 1 | 0.04 ± 0.03 | 0.02 ± 0.01 | 0.377 |
| Temporal 2 | 0.02 ± 0.03 | 0.01 ± 0.01 | 0.689 |
| Temporal 3 | 0.02 ± 0.03 | 0.07 ± 0.05 | 0.211 |
| Temporal average | 0.03 ± 0.03 | 0.04 ± 0.04 | 0.104 |
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