title: New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis.
abstract: OBJECTIVE
  To introduce a new surgical procedure for treating superior limbic keratoconjunctivitis (SLK) and to suggest the association of SLK with conjunctivochalasis.
  
  
  METHODS
  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.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. nyokoi@ophth.kpu-m.ac.jp
authors.forename: Norihiko
authors.initials: N
authors.lastname: Yokoi
authors.forename: Aoi
authors.initials: A
authors.lastname: Komuro
authors.forename: Kunio
authors.initials: K
authors.lastname: Maruyama
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Tsuzuki
authors.forename: Seiya
authors.initials: S
authors.lastname: Miyajima
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D003228:Conjunctiva / Q000473:pathology / Q000601:surgery*; D003229:Conjunctival Diseases / Q000150:complications*; D005260:Female; D006801:Humans; D007637:Keratoconjunctivitis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016850:Limbus Corneae; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D012395:Rose Bengal; D013194:Staining and Labeling / Q000379:methods
chemical_list: D012395:Rose Bengal