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Alexander Weiss, Anne Steiner, Carolyn Shih, Jules Winokur, Ira J Udell; Symptomatic improvement with surgical intervention in conjunctivochalasis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4354.
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© ARVO (1962-2015); The Authors (2016-present)
Symptomatic conjunctivochalasis (CCh) is routinely treated with topical medications, and can be managed surgically for recalcitrant cases. We performed a retrospective case review of patients who underwent surgical repair of CCh, with the goal of identifying characteristics that portend positive patient satisfaction.
We reviewed clinical, surgical, and pathological details of fourteen eyes of eleven patients who underwent surgical repair of CCh following prolonged failed courses of topical therapy. Three surgeons performed all cases, utilizing a similar technique of conjunctivoplasty with amniotic membrane graft. Clinical factors including age, duration and severity of symptoms, coexisting ocular surface abnormalities, number of topical agents, and location of CCh were evaluated. Patient satisfaction was assessed via self-report at follow-up visits and recent telephone calls. Pathologic analysis of surgical specimen was performed. Our data was evaluated using chi-squared test and descriptive statistics.
The mean age at time of surgery was 70 years ± 12.5, and 10/11 (91%) patients were female. Mean length of follow-up was 49.2 months (range= 1-93 months). At baseline, all eleven patients described their symptoms as severe. The mean topical agents used prior to surgery was 4.5 ± 1.7 (including artificial tears and lubricants, anti-histamines, preservative-free steroids, and immunosuppressant eye drops), over a mean of 17.3 months. On average, patients had 2.5 other comorbid ocular surface diagnoses, such as blepharitis, meibomian gland disease, dry eye syndrome, and floppy eyelid syndrome. All 14 eyes had inferior CCh, and 2 had superior CCh as well. Post-operative satisfaction was stratified into three groups: symptoms much improved (n=8, 73%); somewhat improved (n=1, 9%); not improved (n=2, 18%). The extent of post-operative satisfaction compared to pre-operative symptoms was statistically significant (chi-squared test, P=0.002). The pathology in all cases included varying degrees of chronic inflammation, lymphangiectasia, and elastotic fiber degeneration.
CCh may be a debilitating, often overlooked and undertreated cause of ocular morbidity. Surgery may improve symptoms in refractory cases. Our study suggests that patients with severe symptoms may benefit from swifter escalation to surgery.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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