TREATMENT FOR CONJUNCTIVOCHALASIS: A COMBINED APPROACH UTILIZING RADIOFREQUENCY CAUTERIZATION AND THERMALIDTM PROCEDURE
Main Article Content
Abstract
Background
Dry Eye Disease (DED) and related ocular surface diseases have multiple etiologies, but two of the most prevalent are Meibomian Gland Dysfunction (MGD) and Conjunctivochalasis (CCH). This study examines a customizable two-step approach utilizing radiofrequency to treat these two commonly coexisting condi-tions and provide patients with relief from DED signs and symptoms.
Study Design
An IRB approved retrospective chart review of 25 consecutively treated patients was conducted. Patients were included if they presented with DED symptoms and were treated with a combination treatment approach to improve both MGD and CCH, with pre- and post-treatment dry eye metrics outlined below. Follow-up visit information was compared to pre-treatment baseline to evaluate the efficacy and safety of treatment.
Results
Statistically significant results were observed in a decrease in symptoms as evaluated by the primary endpoints of the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and an increase in the number of Meibomian Glands Yielding Liquid Secretion (MGYLS). Tear Meniscus Height also saw statistically significant improvement while Non-invasive Tear Break-Up Time (NTBUT) and Schirmer’s saw minor progress. Clinical evaluation and ocular surface photographs showed marked improvement in CCH with minimal observed side effects during post-operative follow-up visits.
Conclusion
A two-step approach utilizing a radiofrequency device to treat dry eye symptoms provides significant clinical improvement and symptomatic relief for a broad spectrum of patients who had received a variety of prior treatments for DED.
Downloads
Article Details
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
References
Hughes WL. Conjunctivochalasis. Am J Ophthalmol 1942;25:48–51.
Wang Y, Dogru M, Matsumoto Y, Ward SK, Ayako I, et al. The impact of nasal conjunctivochalasis on tear functions and ocular surface findings. Am J Ophthalmol 2007;144:930–37.
Murube J. Characteristics and etiology of con-junctivochalasis: historical perspective. Ocul Surf 2005;3:7–14.
Heiligenhaus A, Koch JM, Kemper D, Kruse FE, Waubke TN. [Therapy in tear film deficiencies]. Therapie von Benetzungsstorungen. Klin Monatsbl Augenheilkd 1994;204:162–68.
Bron AJ, Tiffany JM. The contribution of meibomian disease to dry eye. Ocul Surf 2004;2:149–65.
Mimura T, Yamagami S, Usui T, Funatsu H, Mimura Y, et al. Changes of conjunctivochalasis with age in a hospital-based study. Am J Ophthalmol 2009;147: 171–77.
Di Pascuale MA, Espana EM, Kawakita T, Tseng SC. Clinical characteristics of conjunctivochalasis with or without aqueous tear deficiency. Br J Ophthalmol 2004;88:388–92.
Meller D, Li DQ, Tseng SC. Regulation of collagenase, stromelysin, and gelatinase B in human conjunctival and conjunctivochalasis fibroblasts by interleukin-1beta and tumor necrosis factor-alpha. Invest Ophthalmol Vis Sci 2000;41:2922–29.
Wang Y, Dogru M, Matsumoto Y, Ward SK, Ayako I, Hu Y et al. The impact of nasal conjunctivochalasis on tear functions and ocular surface findings. Am J Ophthalmol 2007;144:930–37 e1.
Le Q, Cui X Xiang J, et al. Impact of conjunctivochalasis on visual quality of life: a community population survey. PLoS One 2014;9:e110821.
McDonald JE, Brubaker S. Meniscus-induced thinning of tear films. Am J Ophthalmol. 1971;72:139–46.
Doane MG. Blinking and the mechanics of the lacrimal drainage system. Ophthalmology 1981;88:844–51. 13. Yokoi N, Komuro A, Nishii M, Inagaki K, Tanioka H,
et al. Clinical impact of conjunctivochalasis on the ocular surface. Cornea 2005;24:S24–S31.
Pflugfelder SC, Gumus K, Feuerman J, Alex A. Tear Volume-based Diagnostic Classification for Tear Dysfunction. Int Ophthalmol Clin 2017;57(2):1–12. doi:10.1097/IIO.0000000000000162
Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea 2012;31(5):472–78.
Jaccoma E, Litherland C, Jaccoma A, Ahmed A. Pellevé™ vs Lipiflow™ MGD-Related Dry Eye Treat-ment Study: The ThermaLid™ Procedure. J Dry Eye Dis 2018;1:11–21. 10.22374/jded.v1i1.2.
Marmalidou A, Kheirkhah A, Dana R. Conjunc-tivochalasis: a systematic review Surv Ophthalmol 2017;63:554–64.
Haefliger IO, Vysniauskiene I, Figueiredo AR, Piffaretti JM. Superficial conjunctiva cauterization to reduce moderate conjunctivochalasis Klin Monatsblätter Augenheilkd 2007;224:237–39.
Gumus K, Crockett CH, Pflugfelder SC. Anterior segment optical coherence tomography: a diagnostic instrument for conjunctivochalasis. Am J Ophthalmol 2010;50:798–806.
Kashima T, Akiyama H, Miura F, Kishi S. Improved subjective symptoms of conjunctivochalasis using bipolar diathermy method for conjunctival shrinkage. Clin Ophthalmol 2011;5:1391–96.
Arenas E, Munoz D. A new surgical approach for the treatment of conjunctivochalasis: reduction of the conjunctival fold with bipolar electrocautery forceps. Sci World J 2016;2016:6589751
Trivli A, Dalianis G, Terzidou C. A Quick surgical treatment of conjunctivochalasis using radiofrequencies. Healthcare (Basel) 2018;6(1):14. Published 2018 Feb 12. doi:10.3390/ healthcare6010014.
Na KS, Mok JW, Kim JY, Rho CR, Joo CK. Correlations between tear cytokines, chemokines, and soluble receptors and clinical severity of dry eye disease. Invest Ophthalmol Vis Sci 2012;53(9):5443–50.
Lemp MA, Foulks GN. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop Ocul Surf 2007;5(2):75–92.
M. Caglayan, P. Kosekahya. Comparison of electrocoagulation and conventional medical drops for treatment of conjunctivochalasis: short-term results. Turk J Ophthalmol 2018;48:61–65.
Tomlinson A, Bron AJ, Korb DR, et al. The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee. Invest Ophthalmol Vis Sci 2011;52(4):2006–2049. Published 2011 Mar 30. doi:10.1167/iovs.10-6997f