New urgical treatment for uperior limbic keratoconjunctiviti and it aociation with conjunctivochalai

Purpoe To introduce a new urgical procedure for treating uperior limbic keratoconjunctiviti (LK) and to ugget the aociation of LK with conjunctivochalai. Deign Interventional cae erie. Method ix eye of five patient with long-tanding evere ocular irritation unreponive to treatment with topical teroid and artificial tear were operated on uing our new procedure. Thi technique conit of four tep a follow: (1) Roe bengal (RB) taining i ued to localize the abnormal conjunctival area; (2) an arc-like conjunctival inciion i placed from the 2 to the 10 o’clock poition adjacent and dital to the RB-tained area; (3) the conjunctiva i reected to form a crecent uing the arc-like inciion a the bae; the ize of the reection i determined by conjunctival redundancy after removal of the ubconjunctival connective tiue; and (4) the crecent conjunctival opening i cloed with interrupted uture. In two eye, the new urgical procedure wa performed together with urgery for inferior bulbar conjunctivochalai. Reult In all operated eye, RB taining had diappeared by the end of the econd potoperative week; recovery from ymptom and lo of inflammation were recorded by 1 month after treatment. In the cae with the longet follow-up (14 month), there wa cytologic evidence of goblet cell recovery at 3 month after the operation. In another, there wa normalization of the nucleo/cytoplamic ratio of conjunctival cell without the appearance of goblet cell. Concluion Our treatment very effectively reolved ymptom aociated with LK, even in eye unreponive to conventional therapy with eye drop. Conidering that we did not addre the dieaed part of the conjunctiva but rather the adjacent conjunctival redundancy, we propoe that uperior bulbar conjunctivochalai i involved in the pathogenei of LK.