Conjunctival resection combined with tenon layer excision and the involvement of mast cells in superior limbic keratoconjunctivitis.
OBJECTIVE
To evaluate the effectiveness of conjunctival resection combined with Tenon layer excision in treating superior limbic keratoconjunctivitis (SLK) and the involvement of mast cells in SLK.


METHODS
Retrospective, interventional case series.


METHODS
Forty eyes of 30 SLK patients who were unresponsive to medical treatment received superior bulbar conjunctival resection, and another 20 patients who underwent cataract and retinal surgery served as a control group. The conjunctiva specimens from study and control patients were examined by hematoxylin and eosin staining and immunohistochemistry using antibodies against mast cell tryptase.


RESULTS
In all operated eyes, the clinical symptoms and signs, including irritation and redness and superior bulbar conjunctival hyperemia and superior tarsal conjunctival papillary hypertrophy, subsided significantly three months after the operation. Only three eyes had recurrence from the margin of conjunctival resection, and this was relieved after reoperation. Keratinized conjunctival epithelium, loss of goblet cells, and increased mast cell numbers (P<.05) were found in the SLK group.


CONCLUSIONS
Our cases demonstrate that superior bulbar conjunctival resection combined with Tenon layer excision is an effective treatment for SLK. The pathologic findings suggest that mast cells may play a role in the pathogenesis of SLK.
Sun
Yi-Chen
YC
Department of Ophthalmology, Buddhist Tzu Chi General Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
Hsiao
Cheng-Hsiang
CH
Chen
Wei-Li
WL
Wang
I-Jong
IJ
Hou
Yu-Chih
YC
Hu
Fung-Rong
FR
D000328:Adult; D000368:Aged; D003228:Conjunctiva / Q000601:surgery*; D003238:Connective Tissue / Q000601:surgery*; D004848:Epithelium / Q000473:pathology; D005260:Female; D020397:Goblet Cells / Q000473:pathology; D006801:Humans; D007124:Immunoenzyme Techniques; D007637:Keratoconjunctivitis / Q000473:pathology / Q000601:surgery*; D016850:Limbus Corneae / Q000473:pathology*; D008297:Male; D008407:Mast Cells / Q000201:enzymology / Q000473:pathology*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D053802:Tryptases / Q000378:metabolism
D053802:Tryptases