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N. Yokoi, A. Komuro, K. Maruyama, S. Kinoshita; Association of Superior Limbic Keratoconjunctivitis with Conjunctivochalasis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2453.
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Purpose: To suggest the association of SLK with conjunctivochalasis. Methods: Six eyes of 5 patients with long-standing severe ocular irritation due to superior limbic keratoconjunctivitis (SLK), which had been unresponsive to treatment with topical steroid and/or artificial tears were operated by a newly-developed surgical procedure. This technique consists of 4 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. 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 2nd postoperative week; recovery from symptoms and loss of inflammation were recorded by one month after treatment. In three cases with 7, 8, and 18 months’ follow-up periods, there was cytologic evidence of goblet cell recovery at 3, 5, and 7 months respectively after the operation. Even in other cases, however, there was normalization of the nucleo/cytoplasmic ratio of conjunctival cells without the appearance of goblet cells. Conclusions: Considering that we did not address the diseased part of the conjunctiva but rather the adjacent conjunctival redundancy, we posit that superior bulbar conjunctivochalasis is involved in the pathogenesis of SLK. Also, our treatment very effectively resolved symptoms associated with SLK even in eyes unresponsive to conventional therapy with eye drops.
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