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The correction of conjunctivochalasis using high-frequency radiowave electrosurgery improves dry eye disease. Sci Rep 2021; 11:2551. [PMID: 33510304 PMCID: PMC7844232 DOI: 10.1038/s41598-021-82088-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
Abstract
We aimed to determine the clinical impact of conjunctivochalasis (CCh) and its correction using high-frequency radiowave electrosurgery (HFR-ES), for signs and symptoms of dry eye disease (DED). Forty patients diagnosed with symptomatic CCh were prospectively enrolled. As a result, patients with CCh had moderate to severe DED and most of them exhibited meibomian gland dysfunction (MGD). Corneo-conjunctival fluorescein staining score (CFS) and all lid-parallel-conjunctival-folds scores (LIPCOFs) were positively correlated. Nasal LIPCOF significantly correlated with symptoms and tear volume. Central, temporal, and total LIPCOF significantly correlated with MG loss, MGD stage, and lipid layer thickness. Independent significant factors associated with total LIPCOF included CFS, tear break-up time, and MGD stage. One month following HFR-ES, CCh was completely resolved in all cases. Patient age and preoperative nasal LIPCOF were determinants of outcomes associated with postoperative improvements in symptoms. Ocular surface parameters significantly improved, but MGD-related signs did not. Collectively, CCh associated with MGD severity deteriorates not only tear film stability and reservoir capacity, leading to DED exacerbation. Therefore, CCh should be corrected in patients with DED and MGD. Younger patients with nasal CCh are likely to experience more symptomatic relief after HFR-ES. Particularly, management for MGD should be maintained after CCh correction.
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Komuro A, Yokoi N, Kato H, Sonomura Y, Sotozono C, Kinoshita S. The Relationship between Subjective Symptoms and Quality of Life in Conjunctivochalasis Patients. Diagnostics (Basel) 2021; 11:diagnostics11020179. [PMID: 33513725 PMCID: PMC7911897 DOI: 10.3390/diagnostics11020179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 01/10/2023] Open
Abstract
The purpose of this study was to evaluate the differences in subjective symptoms between patients with conjunctivochalasis (CCh) and dry eye (DE), and examine the relationship between subjective symptoms and quality of life (QOL). In 75 eyes of 75 CCh patients and 122 eyes of 122 DE patients, 12 subjective symptoms classified into four groups depending on the mechanisms associated with symptoms (ITF: instability of tear film, IF: increased friction, R: reflex, and DTC: delayed tear clearance) were evaluated by use of a visual analogue scale (VAS). Fifteen items related to DE symptoms and their influence on daily life were evaluated by use of the dry eye-related quality-of-life score (DEQS) questionnaire, with overall degree of QOL impairment calculated as a QOL score. The correlation between the Total VAS score and QOL score were evaluated. Between the CCh and DE patients, significant differences in subjective symptoms were found in eye dryness, pain, tearing sensitivity to light, and heavy eyelids, while tearing was higher in CCh. A significant strong correlation was found between QOL score and Total VAS score, ITF, and IF in CCh patients. The QOL of CCh patients is strongly determined by decreased tear-film stability and increased friction during blinking.
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Affiliation(s)
- Aoi Komuro
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
- Correspondence: ; Tel.: +81-75-251-5578
| | - Hiroaki Kato
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
| | - Yukiko Sonomura
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
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Zhao Y, Huang L, Xiang M, Li Q, Miao W, Lou Z. Trends in conjunctivochalasis research from 1986 to 2017: A bibliometric analysis. Medicine (Baltimore) 2018; 97:e12643. [PMID: 30278590 PMCID: PMC6181528 DOI: 10.1097/md.0000000000012643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/07/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND With the aging of the population and the use of video terminals, the incidence of Conjunctivochalasis is getting higher, and related research is increasing. So our research aimed to use visualization software to display the research trends of Conjunctivochalasis. METHODS Retrieved the document (from 1986 to 2017) of conjunctivochalasis in the web of science core collection, analyzed by Citespace V. RESULTS The main language is English. Article is the key type of document. The average annual number of publications in the time period from 2008 to 2017 was 11.6, which was significantly higher than the period from 1994 to 2007, indicating that the total number of publications has been continuously developed. The law of frequency quoted showed an upward trend yearly. Furthermore, we can find out that Japan, USA, and People's Republic of China were the most productive countries, Kyoto Prefectural University of Medicine was the most prolific institution, Shanghai Jiaotong University is a key institution. The average IF of journals was 3.0508. Cornea and Canadian Journal of Ophthalmology are core journals. Tseng SCG is the most active scholar. All cited author contributed to 5 classifications. Di PMA paper is a classic literature. Huang YK paper can be regarded as the frontier document. All cited-reference dedicated to 7 categories. Conjunctivochalasis is the hot topic, related to observe indicators, risk factors, treatment, graded diagnosis of conjunctivochalasis, etc. In addition, fibroblast was research hotspot. At length, the cluster map of keyword was divided into 7 categories. CONCLUSION This research will help relevant clinicians and researchers to accurately and quickly grasp the research trends in the field, and continue to conduct new research on the basis.
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Affiliation(s)
- Yanqing Zhao
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Li Huang
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Minhong Xiang
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Qingsong Li
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Wanhong Miao
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Zhengchi Lou
- Third Affiliated Hospital of Xinxiang Medical College, Xinxiang City, Henan Province, People's Republic of China
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Conjunctivochalasis: a systematic review. Surv Ophthalmol 2017; 63:554-564. [PMID: 29128574 DOI: 10.1016/j.survophthal.2017.10.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 10/20/2017] [Accepted: 10/30/2017] [Indexed: 01/28/2023]
Abstract
Conjunctivochalasis (CCH) is a conjunctival condition characterized by loose, redundant conjunctival folds, most typically in the inferior bulbar conjunctiva of both eyes. Although CCH is a common cause of ocular irritation and discomfort, especially in the elderly, it is often overlooked in clinical practice. CCH may be associated with various ocular and nonocular conditions; however, the most important risk factor is aging. Although often asymptomatic, CCH may cause symptoms related to tear film instability and/or delayed tear clearance. Pathogenesis of CCH remains largely unknown but may involve different elements such as aged conjunctiva, unstable tear film, mechanical friction, ocular surface inflammation, and delayed tear clearance. Contradictory results have been reported on histopathologic changes in CCH, with some studies showing a normal microscopic structure. For symptomatic CCH, medical treatment may include lubrication and anti-inflammatory medications. For symptomatic patients who fail to respond to medical treatment, a surgical procedure may be considered. Although various surgical procedures have been used for CCH, more often, it consists of conjunctival cauterization or excision of the redundant conjunctiva, with or without amniotic membrane transplantation.
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Kiss HJ, Németh J. Isotonic Glycerol and Sodium Hyaluronate Containing Artificial Tear Decreases Conjunctivochalasis after One and Three Months: A Self-Controlled, Unmasked Study. PLoS One 2015; 10:e0132656. [PMID: 26172053 PMCID: PMC4501551 DOI: 10.1371/journal.pone.0132656] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/14/2015] [Indexed: 11/21/2022] Open
Abstract
Dry eye complaints are ranked as the most frequent symptoms of patients visiting ophthalmologists. Conjunctivochalasis is a common dry eye disorder, which can cause an unstable tear film and ocular discomfort. The severe conjunctivochalasis characterized by high LId-Parallel COnjunctival Folds (LIPCOF) degree usually requires surgical intervention, where a conservative therapy would be highly desirable. Here we examined the efficacy of a preservative-free, inorganic salt-free unit-dose artificial tear, called Conheal containing isotonic glycerol and 0.015% sodium hyaluronate in a prospective, unmasked, self-controlled study involving 20 patients. The regular use of the glycerol/hyaluronate artificial tear in three months caused a significant improvement in the recorded parameters. Conjunctivochalasis decreased from a mean LIPCOF degree of 2.9±0.4 on both eyes to 1.4±0.6 on the right (median decrease of -2 points, 95% CI from -2.0 to -1.0), and to 1.4±0.7 on the left eye (median decrease of -1 points, 95% CI from -2.0 to -1.0) (p<0.001 for both sides). The tear film breakup time (TFBUT) lengthened from 4.8±1.9 seconds on both eyes to 5.9±2.3 seconds (mean increase of 1.1 seconds, 95% CI from 0.2 to 2.0) and 5.7±1.8 seconds (mean increase of 0.9 seconds, 95% CI from 0.3 to 1.5) on the right and left eyes, respectively (pright eyes = 0.020, pleft eyes = 0.004). The corneal lissamine staining (Oxford Scheme grade) was reduced from 1.3±0.6 on the right and 1.4±0.6 on the left eye significantly (p<0.001) to 0.3±0.4 and 0.2±0.4 on the right and the left eyes. The Ocular Surface Disease Index (OSDI) questionnaire score indicating the subjective complaints of the patients also decreased from a mean value of 36.2±25.3 to 15.6±16.7 (p<0.001). In this study, the artificial tear, Conheal decreased the grade of the conjunctivochalasis significantly after one month of regular use already, from the LIPCOF degree 3, considered as indication of conjunctival surgery, to a LIPCOF degree 2 or lower requiring a conservative therapy. Our results raise the possibility that vision-related quality of life can be significantly improved by conservative therapies even in severe conjunctivochalasis.
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Affiliation(s)
- Huba J. Kiss
- Semmelweis University, Department of Ophthalmology, Mária str. 39, H-1085, Budapest, Hungary
| | - János Németh
- Semmelweis University, Department of Ophthalmology, Mária str. 39, H-1085, Budapest, Hungary
- * E-mail:
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Impact of conjunctivochalasis on visual quality of life: a community population survey. PLoS One 2014; 9:e110821. [PMID: 25330252 PMCID: PMC4203838 DOI: 10.1371/journal.pone.0110821] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/18/2014] [Indexed: 11/19/2022] Open
Abstract
Conjunctivochalasis (Cch) is a very common ocular disorder, which can cause an unstable tear film and ocular discomfort. The study of vision-related quality of life (VR-QoL) in a community population with Cch can provide a better understanding of the impact of Cch on common people than objective clinical examinations alone. This cross-sectional comparative study enrolled 360 participants ≥40 years old living in Sanle Community, Shanghai. In the study, 198 subjects were diagnosed with Cch and 86 with dry eye syndrome (DES) without Cch. The remaining 76 subjects were normal controls. Socio-demographical data were collected, and Cch and related ocular symptoms and signs were evaluated. In addition, all participants were required to complete the Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and Ocular Surface Disease Index Questionnaire (OSDI). Main outcome measures include the comparison on the OSDI score and VFQ-25 score among the subgroups, and the correlation of these scores with the socio-demographical and clinical data. The results revealed that subjects with Cch had significantly decreased tear film stability even compared with those with DES (P = 0.001). The participants with either Cch or DES reported significantly higher OSDI scores and lower VFQ-25 composite scores than the normal controls (P<0.001 and 0.007 respectively). Further comparisons among the subgroups of Cch revealed that the following factors were associated with higher OSDI scores and lower VFQ-25 composite scores: nasal-side Cch, chalasis folds higher than tear meniscus height, punctal occlusion, or increased extent of chalasis on digital pressure. In conclusion, Cch was associated with an adverse impact on VR-QoL in a community population, and the impairment in VR-QoL had a significant correlation with disease severity and tear film abnormalities.
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Abstract
Purpose To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh). Methods and materials This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded. Results The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60%) eyes with grade 1 CCh; 15 (30%) eyes with grade 2 CCh; and five (10%) eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90%) eyes, and in the remaining five (10%) CCh was located in the superior bulbar conjunctiva. Ten (33.3%) patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6%) patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients. Conclusion Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora.
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Affiliation(s)
- Ozlem Balci
- Ophthalmology Department, Kolan Hospitalium Group, Istanbul, Turkey
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Aragona P, Rolando M. Towards a dynamic customised therapy for ocular surface dysfunctions. Br J Ophthalmol 2013; 97:955-60. [DOI: 10.1136/bjophthalmol-2012-302568] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Seo HW, Choi SK, Lee DH, Kim JH. The Effects of Conjunctival Shield on Pain Alleviation During Cataract Surgery in Conjunctivochalasis Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hae Won Seo
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
| | | | - Do Hyung Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
| | - Jin Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
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Fodor E, Kosina-Hagyó K, Bausz M, Németh J. Increased tear osmolarity in patients with severe cases of conjunctivochalasis. Curr Eye Res 2011; 37:80-4. [PMID: 22050557 DOI: 10.3109/02713683.2011.623810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate and compare tear osmolarity in different grades of conjunctivochalasis. PATIENTS AND METHODS Forty subjects divided into four groups based on grading of conjunctivochalasis by lid-paralell conjunctival fold (LIPCOF) test and tear osmolarity evaluated by TearLab osmometer. Schirmer test, tear film break up time (BUT) and vital staining were also performed. RESULTS Patients with mild and moderate conjunctivochalasis showed similar tear osmolarity to normal subjects. A significant increase (P < 0.008) of osmolarity was found in patients with severe conjunctivochalasis. A significant increase of osmolarity was found in patients with abnormal BUT (P = 0.018) and in patients with positive lissamine-green staining (P = 0.023). No association could be elicited when results of osmolarity were compared to those of Schirmer test or when compared those of fluorescein staining to osmolarity, respectively. CONCLUSION Hyperosmolarity of tear was reported as a fact of ocular surface inflammation. While in mild and moderate conjunctivochalasis tear osmolarity was similar to normal controls, increased osmolarity can refer to the presence of ocular surface inflammation in these patients with severe conjunctivochalasis.
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Affiliation(s)
- Eszter Fodor
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:497-502. [PMID: 21878753 DOI: 10.1097/aci.0b013e32834bbdcd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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