title: New surgical approach for superior conjunctivochalasis.
abstract: OBJECTIVE
  To show poor adhesion between the conjunctiva and the sclera in eyes with superior conjunctivochalasis (CCh) and to introduce a new surgical approach by reinforcing adhesion between the conjunctiva and the sclera for correcting this deficiency.
  
  
  METHODS
  After conjunctival peritomy and removal of the loose Tenon remnants, "Tenon reinforcement" for conjunctival adhesion to the underlying sclera was achieved by transplantation of cryopreserved amniotic membrane with fibrin glue (group A, 9 eyes of 6 patients) or 10-0 nylon sutures (group B, 8 eyes of 6 patients) in 17 eyes of 12 patients with refractory superior CCh.
  
  
  RESULTS
  The mean age of patients was 68.2 +/- 9.8 years (range, 54-80 years). Superior CCh was associated with a superior limbic keratoconjunctivitis (SLK)-like clinical feature before surgery and found to exhibit dissolved Tenon capsule during surgery in all patients. During a mean follow-up of 3.7 +/- 1.9 months after surgery, all eyes achieved smooth conjunctival surface without any sign of CCh. Complete resolution of symptoms was seen in 9 eyes (52.9%) and significant resolution in 8 eyes (47.1%). There was no significant difference between groups A and B in improvement of symptoms and signs. No complications related to surgery were noted during follow-up.
  
  
  CONCLUSIONS
  We propose that loose and dissolved Tenon tissue is correlated with the development of superior CCh, which may result in an SLK-like appearance by blink-related microtrauma. Reinforcement of conjunctival adhesion onto the sclera by amniotic membrane with either fibrin glue or sutures is effective in alleviating symptoms and signs in eyes with superior CCh.
authors.affiliation: Ocular Surface Center, Miami, FL 33173, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kheirkhah
authors.forename: Victoria
authors.initials: V
authors.lastname: Casas
authors.forename: Salomon
authors.initials: S
authors.lastname: Esquenazi
authors.forename: Gabriela
authors.initials: G
authors.lastname: Blanco
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: V-K
authors.initials: VK
authors.lastname: Raju
authors.forename: Scheffer C G
authors.initials: SC
authors.lastname: Tseng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation; D001684:Biological Dressings; D003229:Conjunctival Diseases / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011182:Postoperative Care; D013536:Suture Techniques
chemical_list: D015718:Fibrin Tissue Adhesive