New surgical approach for superior conjunctivochalasis

Area of Science:

• Ophthalmology
• Ophthalmic Surgery
• Cornea and External Disease

Background:

• Superior conjunctivochalasis (CCh) is characterized by poor adhesion between the conjunctiva and sclera.
• This condition can present with a superior limbic keratoconjunctivitis (SLK)-like clinical feature.
• Dissolved Tenon capsule is observed in patients with refractory superior CCh.

Purpose of the Study:

• To demonstrate the poor conjunctiva-sclera adhesion in superior CCh.
• To introduce and evaluate a novel surgical approach for superior CCh by reinforcing conjunctival adhesion.
• To correct the deficiency causing superior conjunctivochalasis.

Main Methods:

• A surgical technique involving "Tenon reinforcement" was performed on 17 eyes with refractory superior CCh.
• Reinforcement involved transplanting cryopreserved amniotic membrane using either fibrin glue (Group A) or 10-0 nylon sutures (Group B).
• Conjunctival peritomy and removal of loose Tenon remnants preceded the reinforcement procedure.

Main Results:

• The study included 12 patients (mean age 68.2 years) with superior CCh.
• Following a mean follow-up of 3.7 months, all eyes showed a smooth conjunctival surface without CCh signs.
• Complete or significant symptom resolution occurred in 100% of eyes, with no significant difference between the two surgical groups. No complications were reported.

Conclusions:

• Loose and dissolved Tenon tissue is implicated in the development of superior CCh and an SLK-like appearance due to microtrauma.
• Reinforcing conjunctival adhesion to the sclera using amniotic membrane (with fibrin glue or sutures) is an effective surgical strategy.
• This approach successfully alleviates symptoms and signs associated with superior conjunctivochalasis.