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Clinicopathologic analysis of conjunctivochalasis and paste-pinch-cut conjunctivoplasty for management

      Abstract

      Objective

      To correlate the histopathologic results of conjunctival specimens with clinical findings in patients with conjunctivochalasis and report the results of the paste-pinch-cut technique for management.
      Design: Retrospective chart review.
      Methods:

      Setting

      Single tertiary ophthalmological centre (Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.).

      Methods

      Twenty-five patients (32 eyes) with clinically significant conjunctivochalasis. All patients were referred for clinically significant dry eye without previous diagnosis of chalasis. Sixteen patients had an underlying inflammatory systemic condition. Intervention or Observation Procedure(s): Patients underwent surgery with paste-pinch-cut technique. Subjective dry eye symptoms and ocular surface staining scores (corneal and conjunctival staining using fluorescein and lissamine green respectively) were assessed at every visit.

      Main Outcome Measures

      Change in patient symptoms and ocular surface staining scores and histopathologic findings in conjunctival specimens.

      Results

      After surgery, significant improvement was achieved in dry-eye symptoms as well as both corneal and conjunctival staining scores in 29 eyes on reduced topical therapy. Only 3 eyes had persisting conjunctival lissamine staining. Light microscopic examination disclosed mild to moderate lymphoplasmocytic inflammation of the conjunctivae with areas of epithelial goblet cell loss, squamous metaplasia, stromal edema, and fibrosis.

      Conclusion

      Conjunctivochalasis appears to be associated with significant inflammation in the setting of dry eye and underlying inflammatory systemic conditions. Although topical anti-inflammatory treatment could be attempted in the initial management, surgical excision should be considered in the absence of clinical response.
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      References

        • American Academy of Ophthalmology
        Conjunctivochalasis. Practicing Ophthalmologists Learning System, 2017–2019.
        American Academy of Ophthalmology, San Francisco2017
        • Holland E
        • Mannis M
        • Barry W.
        Ocular Surface Disease.
        Saunders Elsevier, London2013
        • Marmalidou A
        • Palioura S
        • Dana R
        • Kheirkhah A.
        Medical and surgical management of conjunctivochalasis.
        Ocul Surf. 2019; 17: 393-399
        • Watanabe A
        • Yokoi N
        • Kinoshita S
        • Hino Y
        • Tsuchihashi Y.
        Clinicopathologic study of conjunctivochalasis.
        Cornea. 2004; 23: 294-298
        • Denti AV.
        Sulla formazione di una plica della congiuntiva bulbare [On the development of a pleat of the bulbar conjunctiva].
        Boll Spec Med Chir. 1930; 4: 26-32
        • Hughes WL
        Conjunctivochalasis.
        Am J Ophthalmol. 1942; 25: 48-51
        • Francis IC
        • Chan DG
        • Kim P
        • et al.
        Case-controlled clinical and histopathological study of conjunctivochalasis.
        Br J Ophthalmol. 2005; 89: 302-305
        • Harbiyeli II
        • Erdem E
        • Erdogan S
        • Kuyucu Y
        • Polat S
        • Yagmur M.
        Investigation of conjunctivochalasis histopathology with light and electron microscopy in patients with conjunctivochalasis in different locations.
        Int Ophthalmol. 2019; 39: 1491-1499
        • Akpek EK
        • Amescua G
        • Farid M
        • et al.
        Dry eye syndrome preferred practice pattern.
        Ophthalmology. 2019; 126: P286-P334
        • Whitcher JP
        • Shiboski CH
        • Shiboski SC
        • et al.
        A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry.
        Am J Ophthalmol. 2010; 149: 405-415
        • Shiboski CH
        • Shiboski SC
        • Seror R
        • et al.
        2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: a consensus and data-driven methodology involving three international patient cohorts.
        Ann Rheum Dis. 2017; 76: 9-16
        • Yokoi N
        • Komuro A
        • Maruyama K
        • Tsuzuki M
        • Miyajima S
        • Kinoshita S.
        New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis.
        Am J Ophthalmol. 2003; 135: 303-308
        • Zoroquiain P
        • Sanft D-M
        • Esposito E
        • et al.
        High inflammatory infiltrate correlates with poor symptomatic improvement after surgical treatment for superior limbic keratoconjunctivitis.
        Cornea. 2018; 37: 495-500
        • Hashemian H
        • Mahbod M
        • Amoli FA
        • Kiarudi MY
        • Jabbarvand M
        • Kheirkhah A.
        Histopathology of conjunctivochalasis compared to normal conjunctiva.
        J Ophthalmic Vis Res. 2016; 11: 345-349
        • Zhang X
        • Cai R
        • Wang B
        • Li Q
        • Liu Y
        • Xu Y.
        [The analysis of histopathology of conjunctivochalasis].
        Chinese J Ophthalmol. 2004; 40: 37-39
        • Park W
        • Bae JB
        • Ryu WY.
        Histologic characteristics of conjunctivochalasis and its correlation with lymphangiectasis.
        Invest Ophthalmol Vis Sci. 2013; 54: 2118