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Improved subjective symptoms of conjunctivochalasis using bipolar diathermy method for conjunctival shrinkage.

Kashima T, Akiyama H, Miura F, Kishi S - Clin Ophthalmol (2011)

Bottom Line: The mean postoperative symptom score obtained from the questionnaire was 3.27 ± 3.31, which was significantly lower than the preoperative score (P < 0.0001).Thermal cauterization can achieve conjunctival shrinkage and adherence to the subconjunctival tissues.Operation time is only a few minutes, postoperative pain is not severe, and the procedure can be performed in an outpatient clinic, all of which represent benefits to the patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Gunma University School of Medicine, Gunma, Japan. kasimatomoyuki@yahoo.co.jp

ABSTRACT

Purpose: To evaluate the improvement in subjective symptoms of conjunctivochalasis after bipolar coagulation.

Methods: Forty-three eyes of 26 patients (average age, 75.7 ± 8.4 years) were included in this study. The inferior conjunctivas were cauterized between April 2009 and June 2010. Surgery involved pinching the excess conjunctiva and performing bipolar cauterization after subconjunctival injection of a local anesthetic agent. Patients were asked to describe the postoperative foreign-body sensation and change in subjective symptoms 1 month postoperatively, with the preoperative symptom score defined as 10.

Results: Twenty-two patients (84.6%) reported symptom relief immediately after the procedure, though all patients had a mild gritty sensation for 1-2 weeks postoperatively. The mean postoperative symptom score obtained from the questionnaire was 3.27 ± 3.31, which was significantly lower than the preoperative score (P < 0.0001). No patients had experienced recurrent symptoms at the end of the follow-up period.

Conclusion: Thermal cauterization can achieve conjunctival shrinkage and adherence to the subconjunctival tissues. Operation time is only a few minutes, postoperative pain is not severe, and the procedure can be performed in an outpatient clinic, all of which represent benefits to the patients.

No MeSH data available.


Related in: MedlinePlus

Schema of the coagulation area. The surgical area is in the inferior conjunctiva, 4 mm below the corneal limbus. The inferonasal and inferotemporal areas, which are hidden by the lower eyelid, should also be treated. Five to ten pulsatile coagulations are applied to the inferior conjunctiva (yellow bursts).Notes: Adapted with permission from Kashima T, Miura F, Akiyama H, Kishi S. Simple surgery for conjunctivochalasis using shrinking effect of heat coagulation with biopolar coagulation forceps. Atarashii Ganka 2010;27:229–233.18
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f2-opth-5-1391: Schema of the coagulation area. The surgical area is in the inferior conjunctiva, 4 mm below the corneal limbus. The inferonasal and inferotemporal areas, which are hidden by the lower eyelid, should also be treated. Five to ten pulsatile coagulations are applied to the inferior conjunctiva (yellow bursts).Notes: Adapted with permission from Kashima T, Miura F, Akiyama H, Kishi S. Simple surgery for conjunctivochalasis using shrinking effect of heat coagulation with biopolar coagulation forceps. Atarashii Ganka 2010;27:229–233.18

Mentions: The originally developed technique of bipolar coagulation using the tuck and coagulation method to shrink excessive conjunctiva is described below (Figure 1).1 After application of topical anesthetics of oxybuprocaine hydrochloride, 0.2 mL of 1% lidocaine with epinephrine was injected into the space between the conjunctiva and Tenon’s capsule. Intraoperatively, the patients were instructed to look upward. The excess conjunctiva was grasped 4 mm from the limbus and coagulated, starting with low voltage (power level 0.6) bipolar cauterization (TB50, B Braun Aesculap, Japan) and gradually increasing the voltage until the conjunctiva was coagulated. Coagulation was considered to be adequate when the conjunctiva turned white. Coagulation was performed at 5–10 sites in an arc on the inferior bulbar conjunctiva (Figure 2). The slack conjunctiva shrank and tightened immediately after coagulation. The procedure only took a few minutes to complete for each eye (see Supplementary video “CCh coagulation movie.mpg,” which demonstrates this procedure). Postoperative betamethasone phosphate ophthalmic ointment was administered to prevent acute chemosis, and levofloxacin ophthalmic solution and betamethasone phosphate ophthalmic solution were prescribed to be taken six times daily. One week postoperatively, fluorometholone four times daily was substituted for these drops. All drugs were stopped 1 week later. Patients were asked to remember the severity of the subjective symptoms preoperatively. They were then asked to rate their symptoms 1 month postoperatively on the basis of “If the greatest severity of preoperative symptoms was 10, on a scale of 1 to 10, how great are the present symptoms? (better or worse?)”, and “Was the irritation in the immediate postoperative period mild, moderate, or severe?”.


Improved subjective symptoms of conjunctivochalasis using bipolar diathermy method for conjunctival shrinkage.

Kashima T, Akiyama H, Miura F, Kishi S - Clin Ophthalmol (2011)

Schema of the coagulation area. The surgical area is in the inferior conjunctiva, 4 mm below the corneal limbus. The inferonasal and inferotemporal areas, which are hidden by the lower eyelid, should also be treated. Five to ten pulsatile coagulations are applied to the inferior conjunctiva (yellow bursts).Notes: Adapted with permission from Kashima T, Miura F, Akiyama H, Kishi S. Simple surgery for conjunctivochalasis using shrinking effect of heat coagulation with biopolar coagulation forceps. Atarashii Ganka 2010;27:229–233.18
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3198412&req=5

f2-opth-5-1391: Schema of the coagulation area. The surgical area is in the inferior conjunctiva, 4 mm below the corneal limbus. The inferonasal and inferotemporal areas, which are hidden by the lower eyelid, should also be treated. Five to ten pulsatile coagulations are applied to the inferior conjunctiva (yellow bursts).Notes: Adapted with permission from Kashima T, Miura F, Akiyama H, Kishi S. Simple surgery for conjunctivochalasis using shrinking effect of heat coagulation with biopolar coagulation forceps. Atarashii Ganka 2010;27:229–233.18
Mentions: The originally developed technique of bipolar coagulation using the tuck and coagulation method to shrink excessive conjunctiva is described below (Figure 1).1 After application of topical anesthetics of oxybuprocaine hydrochloride, 0.2 mL of 1% lidocaine with epinephrine was injected into the space between the conjunctiva and Tenon’s capsule. Intraoperatively, the patients were instructed to look upward. The excess conjunctiva was grasped 4 mm from the limbus and coagulated, starting with low voltage (power level 0.6) bipolar cauterization (TB50, B Braun Aesculap, Japan) and gradually increasing the voltage until the conjunctiva was coagulated. Coagulation was considered to be adequate when the conjunctiva turned white. Coagulation was performed at 5–10 sites in an arc on the inferior bulbar conjunctiva (Figure 2). The slack conjunctiva shrank and tightened immediately after coagulation. The procedure only took a few minutes to complete for each eye (see Supplementary video “CCh coagulation movie.mpg,” which demonstrates this procedure). Postoperative betamethasone phosphate ophthalmic ointment was administered to prevent acute chemosis, and levofloxacin ophthalmic solution and betamethasone phosphate ophthalmic solution were prescribed to be taken six times daily. One week postoperatively, fluorometholone four times daily was substituted for these drops. All drugs were stopped 1 week later. Patients were asked to remember the severity of the subjective symptoms preoperatively. They were then asked to rate their symptoms 1 month postoperatively on the basis of “If the greatest severity of preoperative symptoms was 10, on a scale of 1 to 10, how great are the present symptoms? (better or worse?)”, and “Was the irritation in the immediate postoperative period mild, moderate, or severe?”.

Bottom Line: The mean postoperative symptom score obtained from the questionnaire was 3.27 ± 3.31, which was significantly lower than the preoperative score (P < 0.0001).Thermal cauterization can achieve conjunctival shrinkage and adherence to the subconjunctival tissues.Operation time is only a few minutes, postoperative pain is not severe, and the procedure can be performed in an outpatient clinic, all of which represent benefits to the patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Gunma University School of Medicine, Gunma, Japan. kasimatomoyuki@yahoo.co.jp

ABSTRACT

Purpose: To evaluate the improvement in subjective symptoms of conjunctivochalasis after bipolar coagulation.

Methods: Forty-three eyes of 26 patients (average age, 75.7 ± 8.4 years) were included in this study. The inferior conjunctivas were cauterized between April 2009 and June 2010. Surgery involved pinching the excess conjunctiva and performing bipolar cauterization after subconjunctival injection of a local anesthetic agent. Patients were asked to describe the postoperative foreign-body sensation and change in subjective symptoms 1 month postoperatively, with the preoperative symptom score defined as 10.

Results: Twenty-two patients (84.6%) reported symptom relief immediately after the procedure, though all patients had a mild gritty sensation for 1-2 weeks postoperatively. The mean postoperative symptom score obtained from the questionnaire was 3.27 ± 3.31, which was significantly lower than the preoperative score (P < 0.0001). No patients had experienced recurrent symptoms at the end of the follow-up period.

Conclusion: Thermal cauterization can achieve conjunctival shrinkage and adherence to the subconjunctival tissues. Operation time is only a few minutes, postoperative pain is not severe, and the procedure can be performed in an outpatient clinic, all of which represent benefits to the patients.

No MeSH data available.


Related in: MedlinePlus