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Surgical techniques for the treatment of conjunctivochalasis: paste-pinch-cut conjunctivoplasty versus thermal cautery conjunctivoplasty

Published:December 23, 2016DOI:https://doi.org/10.1016/j.jcjo.2016.11.003

      Abstract

      Objective

      The aim of this study was to evaluate the outcomes of paste-pinch-cut conjunctivoplasty and cautery conjunctivoplasty for the treatment of symptomatic conjunctivochalasis.

      Design

      This was a prospective cohort study.

      Participants

      Sixteen patients (32 eyes) with bilateral conjunctivochalasis that was symptomatic after medical therapy were enrolled in the study.

      Methods

      This was a single-centre, contralateral eye, prospective study. Paste-pinch-cut conjunctivoplasty was performed in the left eye, and thermal cautery conjunctivoplasty was performed in the right eye. The outcomes of each procedure were compared preoperatively and at the 1-month follow-up by using the Canadian Dry Eye Assessment (CDEA) scoring system, standard conjunctivochalasis grading, and corneal staining. Intraoperative discomfort and immediate postoperative discomfort were assessed by using a 10-point scale.

      Results

      The mean age of patients was 72.4 ± 8.67 years. Conjunctival redundancy was absent in 14 of 16 patients postoperatively. The mean CDEA score improved after both procedures (7.1 ± 2.8 preoperatively versus 4.5 ± 0.78 at the 1-month follow-up for cautery conjunctivoplasty, 7.4 ± 2.5 versus 4.9 ± 3.1 for paste-pinch-cut conjunctivoplasty). This improvement was statistically significant in the cautery conjunctivoplasty group (p = 0.012). Mean intraoperative discomfort was 2.6 ± 2.1 with the use of paste-pinch-cut conjunctivoplasty and 3.5 ± 3.2 with the use of cautery conjunctivoplasty; however, the difference was not statistically significant. No intraoperative or postoperative complications were observed with either technique.

      Conclusions

      Paste-pinch-cut and thermal cautery conjunctivoplasty are both safe and effective surgical treatments for the repair of conjunctivochalasis, with patients reporting greater improvement in symptoms after the cautery technique.

      RÉSUMÉ

      Objet

      Comparer l’issue de deux techniques de conjonctivoplastie (paste-pinch-cut et cautérisation) dans le traitement du conjonctivochalasis symptomatique.

      Nature

      Étude de cohorte prospective

      Participants

      Cohorte de 16 patients (32 yeux) atteints d’un conjonctivochalasis bilatéral toujours symptomatique après un traitement médical

      Méthodes

      Étude prospective unicentrique de l’œil controlatéral. On a effectué une conjonctivoplastie paste-pinch-cut dans l’œil gauche, et une conjonctivoplastie par cautérisation dans l’œil droit. On a comparé l’état de chaque œil avant les interventions et 1 mois après celles-ci à l’aide du questionnaire CDEA (Canadian Dry Eye Assessment), d’une échelle standard d’évaluation du conjonctivochalasis et de la coloration cornéenne. On a mesuré l’inconfort peropératoire et postopératoire immédiat au moyen d’une échelle en 10 points.

      Résultats

      Les patients étaient âgés en moyenne de 72,4 ± 8,67 ans. Après les interventions, on a noté l’absence d’excès de conjonctive chez 14 des 16 patients. Le score CDEA moyen s’est amélioré par suite des deux interventions (7,1 ± 2,8 avant vs 4,5 ± 0,78 1 mois après la cautérisation; 7,4 ± 2,5 vs 4,9 ± 3,1 après l’opération paste-pinch-cut). L’amélioration était statistiquement significative dans le groupe opéré par cautérisation (p = 0,012). Le score d’inconfort peropératoire moyen était de 2,6 ± 2,1 durant la conjonctivoplastie paste-pinch-cut, et de 3,5 ± 3,2 durant la cautérisation, mais l’écart entre les deux n’était pas statistiquement significatif. Aucune des deux techniques n’a entraîné de complications peropératoires ou postopératoires.

      Conclusions

      La technique paste-pinch-cut et la cautérisation sont toutes deux sûres et efficaces pour la conjonctivoplastie visant la correction chirurgicale d’un conjonctivochalasis. Cela dit, le soulagement des symptômes a été plus marqué après la cautérisation.
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