Original articles
New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis

https://doi.org/10.1016/S0002-9394(02)01975-XGet rights and content

Abstract

Purpose

To introduce a new surgical procedure for treating superior limbic keratoconjunctivitis (SLK) and to suggest the association of SLK with conjunctivochalasis.

Design

Interventional case series.

Methods

Six eyes of five patients with long-standing severe ocular irritation unresponsive to treatment with topical steroid and artificial tears were operated on using our new procedure. This technique consists of four steps as follows: (1) Rose bengal (RB) staining is used to localize the abnormal conjunctival area; (2) an arc-like conjunctival incision is placed from the 2 to the 10 o’clock position adjacent and distal to the RB-stained area; (3) the conjunctiva is resected to form a crescent using the arc-like incision as the base; the size of the resection is determined by conjunctival redundancy after removal of the subconjunctival connective tissue; and (4) the crescent conjunctival opening is closed with interrupted sutures. In two eyes, the new surgical procedure was performed together with surgery for inferior bulbar conjunctivochalasis.

Results

In all operated eyes, RB staining had disappeared by the end of the second postoperative week; recovery from symptoms and loss of inflammation were recorded by 1 month after treatment. In the case with the longest follow-up (14 months), there was cytologic evidence of goblet cell recovery at 3 months after the operation. In another, there was normalization of the nucleo/cytoplasmic ratio of conjunctival cells without the appearance of goblet cells.

Conclusions

Our treatment very effectively resolved symptoms associated with SLK, even in eyes unresponsive to conventional therapy with eye drops. Considering that we did not address the diseased part of the conjunctiva but rather the adjacent conjunctival redundancy, we propose that superior bulbar conjunctivochalasis is involved in the pathogenesis of SLK.

Section snippets

Methods

Six eyes of five patients (four from three female patients and two from two male patients) ranging in age from 35 to 61 years (51.8 ± 11.0 years [mean ± SD]) were treated using our new surgical technique. All patients had a long history of severe irritative ocular symptoms that were largely unresponsive to treatment with eye drops mixed with preservative-free artificial tears containing 0.1% KCl and 0.4% NaCl (Softsantear; Santen Pharmaceutical, Osaka, Japan), or 0.1% fluoromethorone

Results

As shown in Table 1, hyperthyroidism was present in Case 2, a 55-year-old woman who underwent surgery to both eyes owing to the severity of her symptoms. In her right eye we noted a corneal filament in addition to SPK; her left eye manifested SPK. In Case 1, a 61-year-old woman, the Schirmer I test and fluorescein staining detected tear-deficient dry eye; SPK was also present, and the nasal and temporal portion of the bulbar conjunctiva was stained with RB. All operated-on eyes were moderately

Discussion

Our RB staining data demonstrate that the surgical procedure we developed resulted in the complete resolution of abnormal limbal and conjunctival lesions by 2 weeks after the operation; conjunctival hyperemia associated with SLK was also resolved by 1 month. Our procedure does not target the RB-stained limbal and conjunctival lesion, but rather the superior conjunctival portion distal to the lesion, a site at which histological inspection confirmed the existence of normal conjunctival

References (24)

  • P. Wright

    Superior limbic keratoconjunctivitis

    Trans Ophthalmol Soc U K

    (1972)
  • J.D. Nelson

    Superior limbic keratoconjunctivitis (SLK)

    Eye

    (1989)
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      Citation Excerpt :

      Repeat impression cytology at 3 months following surgery showed improvement of the nuclear/cytoplasmic ratio and reappearance of goblet cells.88 They suggested that this technique was efficacious because the pathogenesis of SLK involves the redundant conjunctiva extending superiorly from the rose bengal stained area to the healthy bulbar conjunctiva.88 Sun and colleagues explored the use of superior bulbar conjunctival resection combined with Tenon capsule excision in 40 patients.

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    This study was supported in part by a research grant from the Kyoto Foundation for the Promotion of Medical Science and the Intramural Research Fund of the Kyoto Prefectural University of Medicine.

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