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Yamato Yoshikawa, Norihiko Yokoi, Aoi Komuro, Yukiko Sonomura, Hiroaki Kato, Tsunehiko Ikeda, Chie Sotozono; Surgical treatment for superior limbic keratoconjunctivitis refractory to most recent eye drop treatment. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4881. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Superior limbic keratoconjunctivitis (SLK) is a chronic ocular surface disease characterized by inflammation with epithelial thickening at the upper cornea, limbus, and the bulbar conjunctiva. We previously reported the association of upper conjunctivochalasis (CCh) with SLK, and that the surgery for upper CCh effectively treats SLK (Yokoi N, et al., Am J Ophthalmol. 135, 2003). Recently, 2% rebamipide (RBM) ophthalmic emulsion was reported to be an effective eye-drop treatment for refractory SLK cases. However, SLK cases resistant to RBM treatment are still sometimes encountered. In this present study, upper CCh surgery was performed in SLK cases unresponsive to the most recent eye drop treatment including RBM and its therapeutic effect was investigated.
This study involved 8 eyes of 7 female SLK cases (mean age: 62.5±9.9 years) unresponsive to eye drop treatment including RBM. The mean duration of the eye-drop treatment was 14.8±7.0 months. In all cases, upper CCh surgery was performed, and conjunctival hyperemia (CH) and the superficial epithelial damage at the SLK region was compared between pre and post surgery. The severity of SLK was graded as none (SLK score 0), mild (SLK score 1), moderate (SLK score 2), or severe (SLK score 3) based on the severity of Lissamine green staining and CH.
In all cases, CH and the superficial epithelial damage at the SLK region was improved significantly within 2-months post surgery (mean SLK score: pre: 2.4±0.7, post: 0.1±0.3) (p=0.0078), and no recurrence was noted until the most recent follow-up periods. In all cases, no complications were observed.
Our findings suggest that earlier surgical intervention is better for SLK cases refractory to eye-drop treatment. Considering that RBM is reportedly effective for the treatment of blink-related-friction associated ocular surface diseases such as filamentary keratitis, SLK, and lid-wiper epitheliopathy, complete attenuation of increased friction between the upper bulbar and palpebral conjunctiva is presumably a key in the treatment for SLK. The findings of this study showed that the upper CCh is the most important target for the treatment of SLK, and that surgery for upper CCh was speculated to contribute to the reestablishment of the ‘Kessing’s space’, the area physiologically free from increased friction during blinking.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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