Conjunctivochalasis Research Articles

Management of Conjunctivochalasis

Conjunctivochalasis is defined as a redundant, nonedematous conjunctiva that causes a wide variety of symptoms. Excess conjunctival tissue may not cause any symptoms and may cause some symptoms like subconjunctival hemorrhage, epiphora, dry eye findings and corneal ulceration. Disturbance of tear meniscus, impaired tear distribution and punctal occlusion play a role in the onset of symptoms.
 Although the etiopathogenesis of the disease is not yet clearly understood, several theories have been proposed. According to the mechanical theory, age-related mechanical changes in the conjunctiva lead to a chronic obstruction of the lymphatic flow and lymphatic dilatation after this chronic obstruction leads to conjunctivochalasis. According to inflammatory theory, collagenolytic activity increases as a result of inflammation on the ocular surface, causing degeneration of elastic fibers. As a result, degeneration of elastic fibers lead to alterations in the extracellular components of the conjunctival tissue. This inflammatory changes resulting in conjunctival laxity.
 Although conjunctivosalasis (CCh) is a clinical diagnosis, it is often overlooked by clinicians. CCh patients are can be symptomatic or asymptomatic. Medical and / or surgical treatment is generally needed in symptomatic patients, whereas treatment is not necessary in asymptomatic patients. Medical treatment is the first choice in the treatment of conjunctivochalasis. Artificial tear preparations are widely used in the treatment of CCh due to the deterioration of the tear film layer and dry eye symptoms. In clinical practice, topical anti-inflammatory eye drops are often preferred to reduce ocular surface inflammation. In cases where medical treatment is not sufficient, surgical treatment should be performed.
 Today, there are many studies showing that surgical treatment is effective in reducing ocular symptoms and ocular surface damage in patients with CCh and in cases with and without dry eye.The surgical treatment plan should include the loose conjunctival tissue located in the lower part, as well as the excess conjunctival tissue located in the nasal and temporal regions and aim to correct the tear meniscus along the entire lower lid margin. The most preferred surgical method is crescent excision of CCh tissue and primary suture of the conjunctiva. Other surgical approaches include fibrin glue and amniotic membrane transplantation and direct scleral suture of CCh tissue. Another surgical method is electrocauterization of the conjunctival tissue. It is applied 5 mm away from limbus and there is no harm to fornixes.

Argon laser treatment for symptomatic inferior conjunctivochalasis refractory to medical therapy

Purpose The aim of this study was to present argon laser procedure as a treatment option for symptomatic inferior conjunctivochalasis (CCh) refractory to medical therapy and to evaluate its efficacy. Patients and methods A prospective interventional study was conducted to evaluate the clinical results after argon laser photocoagulation for symptomatic inferior CCh using a slit-lamp-mounted argon laser under topical anesthesia. Twenty eyes with CCh refractory to medical treatment were enrolled in the study. Results The symptoms significantly improved in all patients, and the conjunctival laxity disappeared in eight (40%) of 20 eyes and improved in the remaining 12 (60%) eyes after the treatment of CCh with argon laser. Conclusion Argon laser photocoagulation of the conjunctiva can successfully treat CCh with symptomatic attenuation.

Inflammatory mechanism and significance of tumor necrosis factor-α and interleukin-1β in pathogenesis of conjunctivochalasis

Background Conjunctivochalasis (CCh) is a common age-related ocular surface diseases.Researches showed that the inflammatory factors are upregulated in conjunctiva and tear of CCh patients, inferring inflammation participates in the pathogenesis of CCh, however, its mechanism is unclear now.Studies also showed that the expression of matrix metalloproteinases (MMPs) in CCh conjunctiva is elevated.However, the association between inflammatory factors and MMPs is unknown. Objective This research was to observe the effects of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) on the expression of MMP-1, MMP-3, tumor necrosis factor-stimulated gene-6(TSG-6) and pentraxin-3 (PTX3) in cultured CCh fibroblasts. Methods Conjunctival fibroblasts were isolated and cultured from CCh-derived and cataract-derived human conjunctiva explants.The cells were treated using 20 ng/ml PBS, TNF-α or IL-1β for 4 hours, respectively.The expression levels of MMP-1, MMP-3, TSG-6 and PTX3 genes and proteins were detected by quantitative real time PCR and Western blot assay, respectively. Results The second-generation cells showed a long and fusiform shape with ovoid nucleus and radial agreement, and the cell processors connected each other.The differences of the relative expression levels of MMP-1, MMP-3, TSG-6 and PTX3 mRNA in the cells were significantly different between CCh group and cataract group after being treated by PBS, TNF-α and IL-1β (MMP-1 mRNA: Fgroup=2.611, P=0.116; Fintervene=161.564, P=0.000; MMP-3 mRNA: Fgroup =5.201, P=0.029; Fintervene =211.021, P=0.000; TSG-6 mRNA: Fgroup =47.209, P=0.000; Fintervene =119.340, P=0.000; PTX3 mRNA: Fgroup =40.512, P=0.000; Fintervene =93.935, P=0.000). Compared with the cataract group with PBS treatment, the expression levels of MMP-1, MMP-3, TSG-6 and PTX3 mRNA were significantly elevated in the CCh group with PBS treatment or the cataract group with TNF-α and IL-1β treatment (all at P<0.05). Compared with the CCh group with PBS treatment, the expression levels of MMP-1, MMP-3, TSG-6 and PTX3 mRNA were significantly elevated in the CCh group with TNF-α and IL-1β treatment (all at P<0.05). The differences of the relative expression levels of MMP-1, MMP-3, TSG-6 and PTX3 proteins in the cells were significantly different between CCh group and cataract group after being treated by PBS, TNF-α and IL-1β (MMP-1: Fgroup=84.702, P=0.000; Fintervene=48.900, P=0.000; MMP-3: Fgroup=112.818, P=0.000; Fintervene=194.980, P=0.000; TSG-6: Fgroup=56.867, P=0.000; Fintervene=70.356, P=0.000; PTX3: Fgroup=1.488, P=0.231; Fintervene=89.872, P=0.000), and the expression changes of MMP-1, MMP-3, TSG-6 and PTX3 proteins were coincident with the genes among the groups with various treatments. Conclusions The expressions of MMP-1, MMP-3, TSG-6 and PTX3 in conjunctival fibroblasts are upregulated in CCh eyes.The interaction of TNF-α and IL-1β with MMPs is probably involved with the pathogenesis and development MMPs probably. Key words: Conjunctivochalasis; Inflammation; Inflammatory cytokines; Matrix metalloproteinases; Tumor necrosis factor-stimulated gene-6; Pentraxin-3; Cells cultured; Humans

Imbalance expression of cell proliferation and apoptosis protein in tissue excised from conjunctivochalasis

Objective To investigate the expression and function of cell proliferation and apoptosis protein in conjunctival tissue excised from conjunctivochalasis(CCh). Methods Thirty speciments of conjunctival tissue excised from CCh and 15 normal conjunctival tissues were collected. The expression of Bax 、caspase-3、Bcl-2 and PCNA in each group was detected by immunofluorescence. Results The positive cells area of Bcl-2 in conjunctival tissue of CCh was (741.30±63.24) μm2, and that was (728.70±71.66) μm2 in normal tissue. The positive cells area of Bax in conjunctival tissue of CCh was (859.20±81.16) μm2, and that was (722.60±70.51) μm2 in normal tissue. The positive cells area of PCNA in conjunctival tissue of CCh was (457.60±94.64) μm2, and that was (411.20±81.25) μm2 in normal tissue. The positive cells area of caspase-3 in conjunctival tissue of CCh was (881.70±41.38) μm2, and that was (698.90±56.66) μm2 in normal tissue. The average fluorescent intensities of Bax and caspase-3 in the conjunctival tissue of CCh were significantly higher than those in normal tissue (P 0.05). Conclusion The enhancement of apoptosis protein expression in conjunctival tissue of CCh suggests that apoptosis may be an important part in the process of the occurrence of conjunctivochalasis. Key words: Cell apoptosis; Cell proliferation; Conjunctivochalasis; Immunofluorescence

Research on the expression of TSG-6 and PTX3 and on apoptosis in conjunctival resection tissue in conjunctivochalasis

Objective To investigate the expression of TSG-6 and PTX3 as well as the apoptosis in conjunctival tissue of conjunctivochalasis (CCh). Methods Conjunctival tissue from the conjunctival resection tissue of CCh patients and simple cataract patients were collected and then the frozen sections of conjunctival tissue were prepared. The expressions of TSG-6 and PTX3 were detected by immunofluorescence and the apoptosis was detected by Tunel assay. Results The expression of TSG-6 was strongly positive in conjunctival epithelium of the CCh group. The average fluorescent intensity (AFI) was (76.67±26.87)which was significantly higher than that in normal control group (22.53±7.21)and the difference was statistically significant (t=8.460, P<0.001). TSG-6 was expressed in the conjunctival stroma and Tenon capsule of the CCh group (AFI 39.25±13.24) which was higher than that in normal control group (AFI 13.81±9.60) and the difference was statistically significant (t=7.440, P<0.001). PTX3 in conjunctival epithelium (AFI 52.41±11.61), matrix and Tenon's capsule (AFI 35.96±10.91) of the CCh group were both positive which were significantly higher than those (AFI 13.88±5.42 and 4.47±2.49) in normal control group (t=13.887, P<0.001; t=12.658, P<0.001 ). No statistically significant difference was found in the apoptosis rate between CCh (8.64±0.13%) and normal (8.33±0.11%) conjunctival epithelium (t=1.810, P=0.072). The apoptosis rate was significantly increased in CCh stroma and Tenon's capsule (40.42±0.24%) compared with that of normal control group (10.87±0.25%) (t=90.171, P<0.001). Conclusion The expressions of TSG-6 and PTX3, as well as cell apoptosis, increase significantly in conjunctival tissue of conjunctivohalsis, which indicates that inflammation and apoptosis involve in the pathogenesis of conjunctivochalasis. Key words: Conjunctivochalasis; Conjunctival resection tissue; TSG-6; PTX3; Apoptosis

Expression of several kinases in operative resection specimens of conjunctivochalasis

Objective To investigate the expression of extracellular regulated protein kinase (ERK), c-jun N-terminal kinase (JNK) and P38 mitogen-activated protein kinase (MAPK) in operative resection specimens of variously severe conjunctivochalasis. Methods Thirty conjunctival specimens of the conjunctivochalasis were divided into level II group including 10 cases, level III group including 12 cases and level IV group including 8 cases. 10 cases were collected from normal persons as control group. The expression of ERK, JNK and P38 MAPK in each group were determined by immunohistochemistry. Results The optical density (OD) value of ERK in the conjunctivochalasis group was 62.68±15.92 which was higher than that in normal control group 27.25±6.43 and the difference was statistically significant (F=93.287, P 0.05), but there was statistically significant difference between level II group and level IV group, or between level III and level IV group (P<0.01) which suggested the activity of MAPK was enhanced with the increase of conjunctivochalasis degree. Conclusion With the aggravation of conjunctivochalasis, the expression of ERK, JNK and P38 MAPK increases significantly. The mitogen-activated protein kinase (MAPK) may play certain roles in the occurrence and development of the conjunctivochalasis. Key words: Conjunctivochalasis; Extracellular regulated protein kinase (ERK); C-jun N-terminal kinase (JNK); P38 mitogen-activated protein kinase (P38 MAPK)

Expressions of pentraxin-3 and tumor necrosis factor-α stimulated gene-6 proteins in fibroblasts of conjunctivochalasis patients

Background Conjunctivochalasis is an age-related inflammatory ocular surface disease manifesting redundant, loose conjunctiva folds.Studies showed that conjunctivochalasis often accompanies with inflammatory response, indicating that a variety of inflammatory cytokines are involved in pathogenesis of conjunctivochalasis. Objective This study attempted to investigate the expressions of pentraxin-3 (PTX-3) and tumor necrosis factor-α stimulated gene-6(TSG-6) proteins in fibroblasts of conjunctivochalasis. Methods The protocol was approved by Ethic Committee of Putuo Hospital affiliated Shanghai University of Traditional Chinese Medicine.Thirteen eyes of 13 patients with conjunctivochalasis, 16 eyes of 16 patients with age-related cataract and 16 eyes of 15 patients with pterygium were included in Putuo Hospital Affiliated to Shanghai University of Traditional Medicine from January, 2011 to June, 2012.The samples of conjunctival tissue were collected in the patients during surgery under the informed consent, and fibroblasts were cultured and passaged by explant culture method.Content of PTX-3 and TSG-6 proteins in cell supernatant was detected by ELISA. Results Translucent poor, dark black area was around the cell overflow.Cultured cells of third generation showed long shuttle type, uniform size, radiated out in all directions, and oval nuclei was sited in the cytoplasm, surrounded by varying the length of cross-linking of cell processes.The concentrations of PTX-3 protein in cell supernatant were (2 182.33±738.68)pg/ml in the conjunctivochalasis group, which were higher than (738.32±335.00)pg/ml in the age-related cataract group and (981.37±416.04)pg/ml in the pterygium group, showing a significant difference among the three groups (F=6.474, P=0.032). The contents of TSG-6 proteins in cell supernatant were (59.10±6.52)pg/ml, (53.99±11.16)pg/ml and (35.01±5.33)pg/ml in the conjunctivochalasis group, pterygium group and age-related cataract group, with a significant difference among the three groups (F=7.421, P=0.024), and contents of TSG-6 proteins in the age-related cataract group was lowest, however, no significant difference was found in the TSG-6 contents between the conjunctivochalasis group and the pterygium group (P>0.05). Conclusions Inflammatory reaction participates in the pathogenesis and development of conjunctivochalasis, up-regulation of PTX-3 and TSG-6 expression in fibroblasts might partakes in the pathogenesis of conjunctivochalasis. Key words: Conjunctival diseases; Fibroblasts; Tenon capsule; Cells, cultured; Enzyme-linked immunosorbent assay; Conjunctivochalasis; Anti-inflammatory agents

Epidemiologic study of conjunctivochalasis in population 50 years old or more in Binhu district of Wuxi City, China

Background Conjunctivochalasis (CCh) is one of the common age-related diseases,and its morbidity rate increases with age.So to investigate the prevalence of CCh and its related factors is of great significance to the prevention and treatment of CCh in China.Objective This survey was to investigate the morbidity rate of CCh in 50 years old or more population in Binhu district of Wuxi city,and to analyze the influence factors of CCh.Methods A cross-sectional study was carried out in the population aged 50 years or more from June to December in 2010 at Binhu district of Wuxi city by cluster random sampling method.The examinations included questionnaire,height and body weight measurement,and ophthalmologic examinations included visual acuity,refraction,and ophthalmoscope.Eyelid,conjunctiva,cornea status and position of CCh,place of inferior palpebral margin,eyelid edge tension,tear river status,anterior chamber,pupil and lens were examined under the slit lamp microscope.CCh was graded based on the criteria of Li Qingsong.Epi info procedure was used to establish database for the collection of data.Logistic multivariate regression analysis was performed for the analysis of risk factors of CCh using SPSS 17.0 software.Informed consent was obtained from each subject before any medical examination.Results Total 6 150 subjects were examined in 6 722 fifty years old or more persons,with the response rate of 91.50％.CCh was diagnosed in 1 667 eyes of 856 individuals,and the prevalence rate was 13.92％.The prevalence rate of CCh increased with aging(x2 =174.39,P＜0.01).In 1 667 eyes with CCh,987 eyes were grade Ⅰ (59.21％),468 eyes were in grade Ⅱ (28.07％),202 eyes were in grade Ⅲ (12.12％) and 10 eyes were in grade Ⅳ (0.60％).The CCh mainly manifested dry,epiphora and blurred vision,with the occurrences of 22.63％,20.75％ and 15.64％,respectively.Relaxed conjunctivas accumulated at temporal side+nasal side,nasal side or nasal+center+temporal side of the lower eyelid,with the proportion of 43.37％ (723/1667),31.19％ (520/1667) or 14.40％ (240/1667).Superior corneal limbus type CCh was examined in 980 eyes,accounting for 58.79％ of the affected eyes.Normal inferior lid margin tension was seen in 1 378 eyes,accounting for 82.66％ in the affected eye,and the proportion with entroion and introversion type was 11.64％,which was higher than that of extroversion and ectropion type(5.76％).Abnormal tear fiver was found in 87.69％ of CCh eyes,however,tear river was abnormal in all the grade Ⅲ and Ⅳ of CCh eyes.Significant differences were found in gender,educational level,history of hypertension and diabetes and body mass index between CCh patients and non-CCh patients(all at P＜0.05).Conclusions CCh is a kind of common eye diseases among old population The prevalence rate of CCh is low in the population more than 50 years old in Binhu district of Wuxi city.The majority of CCh patients are grade Ⅰ and grade Ⅱ stage.The location and tension of inferior eyelid margin may be risk factors of CCh.Gender,culture degree,hypertension history,diabetes history,body mass index are possibly associated factors of CCh. Key words: Conjunctivochalasis; Epidemiology; Prevalence; Risk factor; Cross-sectional study

The clinical observation of epiphora treatment with lacrimal passage laser and improved conjunctivochalasis correction

Objective To evaluate the efficacy of lacrimal passage laser and improved conjunctivochalasis correction in treatment of epiphora caused by lacrimal passage obstruction and conjunctivochalasis.Methods 42 eyes of 28 cases treated by lacrimal passage laser and improved conjunctivochalasis correction from October 2011 to October 2012 in Tianjin Aier Eye Hospital were collected.The clinical effects,complications and key points of the surgery were analysed,and they were compared with staging operation.Results Six eyes recovered,25 eyes were improved markedly,10 eyes were improved and 1 eye was invalid.Total effective rate was 97.6％.The lacrimal passage obstruction recurred in 15 eyes,however the epiphora in 14 eyes of them was improved.Two eyes of recovered cases were complicated with mild dry eye symptom.And there was no difference between the effect of one-stage surgery and that of staging operations.Conclusion The lacrimal passage laser and improved conjunctivochalasis correction is a safe,effective,easy procedure for epiphora.The key points of improved conjunctivochalasis correction are the management of Tenon's capsule and its fixation on superficial sclera. Key words: Laser, lacrimal passage; Conjunctivochalasis; Epiphora; Obstruction, lacrimal passage

Effects of qijingmingmu soup on the expression of matrix metalloproteinases in the conjuntival fibroblasts of conjunctivochalasis

Background Our previous study determined that expressions of matrix metalloproteinases (MMPs) and tissue matrix metalloproteinase inhibitors (TIMPs)change in the conjuntival fibroblasts of conjunctivochalasis in vitro.To seek a suitable drug is very important in the prevention and treatment of conjunctivochalasis.Objective This study was to explore the effect of qijingmingmu soup on the expressions of MMPs and TIMPs in human conjunctival fibroblasts of conjunctivochalasis.Methods Twenty-four SD rats were randomized into two groups.Qijingmingmu soup was administration gastrically for consecutive 3 days,and normal saline solution was given in the same way in the control group.The blood was collected from aortaventralis and drug serum was prepared.Human conjunctival samples were obtained during the surgery of conjunctivochalasis relaxation and cultured in the DMEM containing 10％ fetal bovine serum,20％,15％,10％,5％ of drug serum and 8 ml/L epidermal growth factor(EGF) was added into the medium respectively.Enzyme-linked immunosorbent assay(ELISA)was used to detect the expressions of MMP1,MMP3,TIMP1 and TIMP3in conjunctival fibroblasts.Results Cultured cells grew well with the fusiform shape and showed the positive response for vimentin.The expression value of MMP1 (A value)in the cells was declined after administration of qijingmingmu soup.A significant difference was found in the expression of MMP1 among the control group,20％,15％,10％,5％ drug serum groups and EGF group(F=466.664,P＜0.05),and that in the 10％ ([9.92±0.14] mg/L) and 20％ ([11.87 ±0.11] mg/L) drug serum groups was significantly lowed in comparison with the control group([16.31±0.10] mg/L)(t=99.974,87.394,P＜0.05).The expression value of the MMP3in the cells in the various drug serum groups,EGF group and the control group was significantly different(F=158.168,P＜0.05),with a lower value in the 20％ drug serum group compared with the control group ([3.50±0.03] mg/L vs.[4.44 ± 0.11] mg/L) (t =21.991,P ＜ 0.05).Also,the significantly different expressing value of TIMP1 was seen among all the groups (F=183.508,P＜0.05),and expressing value of TIMP1 in the 15％ drug serum group was(1.88±0.06)mg/L,which was lower than(3.20±0.32) mg/L of the control group(t=10.353,P＜0.05).Furthermore,the expressing value of the TIMP3 in the cells was significantly different among the various groups(F=54.503,P＜0.05),and that of the 20％ drug serum group was (1.743±0.065)mg/L and it was significantly higher than (1.54 ± 0.05) mg/L of the control group (t =5.046,P =0.004).However,the expressing value of TIMP3of the 15％,10％ and 5％ drug serum groups was lower than that of the control group,respectively all at(P＜0.05).Conclusions Qijingmingmu soup drug serum at the concentration of 20％ can down-regulate the expressions of MMP1,MMP3,TIMP1 and up-regulate the expression of TIMP3 in human conjunctivochalasis bulbar conjunctival fibroblastsin vitro,which probably plays preventive and therapeutic effects on conjunctivochalasis. Key words: Conjunctivochalasis; Fibroblast; Chinese tranditional medicine/qijingmingmu soup; Matrix metalloproteinase

Clinical observation of lymphangiectasis in conjunctivochalasis cases

To investigate the relationship between the occurrence and development of conjunctivochalasis and bulbar conjunctival lymphangiectasia. Case control study. One hundred cases with conjunctivochalasis treated from January to March 2012 were selected to study, and 100 cases with no conjunctivochalasis as the control group at the same time. To observe bulbar conjunctiva lymphatic duct dilatation using slit lamp microscope, analysis bulbar conjunctiva and fascia images by OCT scanning, and ablate lymphatic of conjunctival tissue for pathologic examine. Twenty-nine eyes of the bulbar conjunctiva lymphangiectasia associated with 100 cases (183 eyes) conjunctivochalasis patients, accounting for 15.84%; 8 eyes of the ball conjunctival lymphatic dilation in control group of 100 cases ( 200 eyes), accounting for 4.00%. The difference between the two groups was statistically significant (χ(2) = 15.36, P < 0.001). OCT scanning showed that lymphangiectasia of the conjunctiva is at the subcutaneous mainly, some in the conjunctival lamina propria. They are border-clear, full-filled fluid, single-lumen or multi lumens, not involving the fascia. The histopathological examination showed that the lamina propria of the bulbar conjunctiva mildly chronic inflammatory changes accompanied by a large number of lymphangiectasia. Bulbar conjunctival lymphangiectasia may be one of the reasons for the conjunctivochalasis.

Simultaneous Treatment of Pterygium and Temporal Conjunctivochalasis

Pterygium and conjunctivochalasis are common diseases in elderly people and are not uncommonly observed together. However, there have been few reports of the simultaneous treatment of pterygium and conjunctivochalasis. We report such a surgical method and describe the results of two cases. Two patients presented with pterygium accompanied by temporal conjunctivochalasis. We decided to perform simultaneous pterygium excision and free conjunctival autograft transfer using the excess conjunctiva from the conjunctivochalasis surgery. The free graft was obtained from the bulbar conjunctiva from the 6 to 8 o'clock position in the conjunctivochalasis. To reduce the temporal conjunctivochalasis, the conjunctiva was extended and sutured to the perilimbal conjunctiva and episclera at the 6 o'clock position using 8-0 polyglactin suture. Tear meniscus break-up induced by pterygium and by conjunctival laxity was reduced, and the patients' symptoms had been significantly reduced by several days postoperatively.

Clinical observation of conjunctivochalasis surgery

Objective To observe surgical effect of conjunctival resection and partial suture for conjunctivochalasis.Methods 18 cases(36 eyes)of conjunctivochalasis were treated by conjunctival resection and partial suture under topic anesthesia.The surgical effect was evaluted.Results 32 eyes(88.89％)were clinically cured after the operation,and 34 eyes(94.44％)were improved.No complications were observed during the follow-up for 6 to 24 months.Conclusion Conjunctival resection and partial suture for conjunctivochalasis has good surgical effect with no sever complications. Key words: Conjunctivochalasis; Conjunctival resection and part suture; Effect

Ultrastructure change of conjunctiva and fascia tissue of conjunctivochalasis

Background Bulbar conjunctiva tissue appears to be thinning,elasticity declined,tension reduced and fascia atrophied in conjunctivochalasis.Histopathological examination of conjunctivochalasis shows decrease of elastic fibers and melt of collagen fibers.But there are fewer studies on the ultrastructure of conjunctiva of conjunctivochalasis up to now.Objective This study was to investigate the ultrastructure change of conjunctiva tissue in conjunctivochalasis.Methods Five loose conjunctiva samples of conjunctivochalasis and 5 normal conjunctival tissue samples were collected and ultra-microstructure changes of these samples were observed under the transmission electron microscope.Results The number of fibroblasts in conjunctivochalasis lamina was progressively decreased.The shape of fibroblasts was long and fusiform.Somatic synapse was slim.Nucleus-cytoplasm ratio was increased.Disorder,scattered and broken of the collagen fibril were seen,and some areas were dissolved or lacunae.Normal conjunctival fibroblasts were oval or polygonal,with wieners and long somatic synapse,and intercellular matrix was full of collagen fibril and dense arranged fibers.Fibroblasts in fascia of eonjunctivochalasis were linear,and collagen fibril was seriously defected.Fascia fibroblasts of normal bulbar conjunctiva were spindleshaped and bigger than conjunctivochalasis fibroblasts.There were full of collagen fibrils in intercellular matrix.Conclusions The collagen fibril is decreased and fibroblast cells are degenerated in lamina and fascia of conjunctivochalasis. Key words: Conjunctivochalasis; Loose conjunctiva; Ultra-microstructure

The clinical observation of conjunctivochalasis crescent conjunctival resection with bipolar coagulation

To seek safe, effective, economical, simple treatment conjunctivochalasis surgical methods, optimize treatment, evaluation conjunctivochalasis surgical treatment. A prospective randomized control study, 60 patients (60 eyes) conjunctivochalasis surgery patients were randomly divided into two groups, one line of bipolar coagulation therapy, another group of crescent conjunctival resection. After comparing the two surgical methods ocular surface disease index (OSDI) points, the degree of relaxation conjunctiva, tear meniscus height, BUT, surgical complications, the operation time to evaluate the two kinds of surgical methods of clinical efficacy. Bipolar coagulation therapy with crescent conjunctival resection in 8 weeks after the OSDI points, loose conjunctiva residual points, tear meniscus, BUT the difference was not statistically significant. 8 weeks after bipolar coagulation complications points lower than the crescent conjunctival resection is low, the difference was statistically significant (t = 4.67, P = 0.029); bipolar coagulation operating time (9.53 ± 3.15) min crescent than conjunctival resection time (18.59 ± 7.68) min short, the difference was statistically significant (t = 13.26, P > 0.01). Conjunctivochalasis line bipolar coagulation and removal of loose conjunctiva crescent with considerable effect, bipolar coagulation was significantly shorter operative time, a significant reduction in postoperative complications, surgical procedures easier.

Thermocautery for Inferior Conjunctivochalasis

To describe a thermocautery technique to treat symptomatic inferior conjunctivochalasis. Thirty-nine eyes of 23 patients with symptomatic inferior conjunctivochalasis were treated with thermocautery. The mean age of the patients was 78.6 ± 5.4 years (±SD) with a range of 69-89 years. Patients with symptomatic inferior conjunctivochalasis were initially treated with topical medication, and the eyes that were unresponsive underwent a ligation test. We treated those eyes in which symptoms improved or disappeared during the ligation test. The redundant bulbar conjunctival tissue was grasped with smooth forceps and cauterized with the OPTEMP variable low temperature cauterizer until the redundant conjunctival tissue was gone. The mean follow-up period was 469.5 ± 234.6 days (range, 101-823 days). After the thermocautery, the symptoms disappeared in 36 of 39 eyes (92.3%) and improved in the remaining 3 eyes (7.7%). The conjunctival laxity disappeared in 36 of 39 eyes (92.3%) and improved in 3 eyes (7.7%). There were no recurrences of the conjunctival laxity during the follow-up period. Thermocautery is a simple and effective treatment for symptomatic inferior conjunctivochalasis.

Analysis of tear proteins from conjunctivochalasis patients by liquid chip time-of-flight mass spectrometry

目的 应用液体芯片-飞行时间质谱系统分析结膜松弛症患者的泪液蛋白质表达谱,寻找潜在具有结膜松弛症诊断意义的生物学标志物.方法 收集10例结膜松弛症患者和9例正常对照的泪液,利用毛细管法每眼收集15 μL泪液.经ClinProt磁珠纯化、基质辅助激光解析电离飞行时间质谱(MALDI-TOF-MS)分析及ClinProTools生物信息学软件研究其泪液蛋白表达谱,比较2组人群泪液蛋白质谱表达的差异.结果 2组共检测发现了77个蛋白质峰,其中13个蛋白质峰差异有统计学意义(P＜0.05).其中质荷比(m/z)为1 632.48和3 401.87者为差异蛋白质,能较好地鉴别结膜松弛症组和正常对照组.结论 液体芯片-飞行时间质谱系统可高效、精确地筛查泪液蛋白质.结膜松弛症组与正常对照组泪液蛋白存在差异,值得进一步研究,可能对发现结膜松弛症的发病机制和寻求有效的防治手段有指导作用。

The Role of Oxidative Stress and Inflammation in Conjunctivochalasis

Purpose. To investigate the status of oxidative stress and histopathologic alterations in patients with conjunctivochalasis and compare the findings with those in healthy control subjects. Methods. Eleven patients (n = 20 eyes) with Yokoi grade 3 conjunctivochalasis and 11 health control subjects (n = 22 eyes) were prospectively recruited. ELISA for tear hexanoyl-lysine (HEL) and inflammatory cytokines, tear film break-up time tests, Schirmer test measurements, and fluorescein and rose bengal vital staining were performed. Conjunctival specimens obtained during surgery for conjunctivochalasis and cataract underwent immunohistochemical staining for HEL+8-OHdG, MMP-3, and MMP-9, and positively stained cells were counted. Transmission electron microscopy was also performed, with staining for elastic fibers in the conjunctival stroma. Results. The mean tear stability and vital staining scores were significantly worse in the conjunctivochalasis patients than in the control subjects. The tear HEL and tear cytokine levels showed significantly higher values in eyes with conjunctivochalasis. IL-1beta and IL-6 levels showed a significant correlation with corneal epithelial damage. IL-1beta and TNFalpha showed a significant correlation with 8-OHdG-stained cell counts. Specimens from patients with conjunctivochalasis revealed a significantly higher number of cells positively stained for HEL, 8-OHdG, MMP-3, and MMP-9 than did specimens from age- and sex-matched control subjects. Transmission electron microscopy showed decreased intercellular cohesiveness, with the conjunctival stroma showing an accumulation of elastic fibers. Conclusions. Lipid and DNA oxidative stress were present in the conjunctiva. Increased tear inflammation seemed to coexist with loss of conjunctival epithelial cohesiveness and increased collagenolytic activity, which may explain the conjunctival laxity observed in patients with conjunctivochalasis.

Epidemiologic study of conjunctivochalasis in populations equal or over 60 years old in Caoyangxincun community of Shanghai, China

To investigate the prevalence and relative factors of conjunctivochalasis among people over 60 years old in Caoyangxincun community of Shanghai. A cross-sectional study based on local residents in this community was carried out from September 2008 to October 2008. Cluster sampling was used in randomly selecting individuals aged > or = 60 years. Slit-lamp ophthalmoscope was used for eye examination and diagnosis. The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out. A database was set using SPSS 10.0 software, Chi-square test was used for data analysis. 2110 residents took part in this study, with the response rate 94.85%. 930 cases (1762 eyes) were confirmed as conjunctivochalasis, so the prevalence rate is 44.08%. The prevalence of conjunctivochalasis was increasing with age (chi(2) = 10.44, P < 0.01). 556 cases (943 eyes) were confirmed as degree I, 246 cases (647 eyes) as degree II, 120 cases (162 eyes) as degree III and the rest 8 cases (10 eyes) as degree IV. Several symptoms, such as blurred vision, asthenopia and eye pain were more frequent in patient group than in the normal ones (chi(2) value was 15.44, 20.54 and 19.74, respectively, P < 0.01). In the disease eyes, the conjunctiva usually piled up on the nasal and temporal side (944 eyes, 53.58%), the location of inferior lid margin was usually above corneal limbus (2589 eyes, 61.35%) and inferior lid margin entropion and introversion were always found (7.04% and 6.63%). Abnormal lacrimal river was found in 87.23% of the diseased eyes, more than the non-conjunctivochalasis eyes (chi(2) = 1615.81, P < 0.01). Conjunctivochalasis is a common eye disease in aged population, with obvious signs and symptoms of ocular surface and lacrimal river impairment. In the local residents, most patients were classified as minimal or moderate degree. The location of inferior lid margin and the tension of inferior lid may be related factor of conjunctivochalasis.

Impression Cytology in corneal and ocular surface pathology

Abstract Purpose: Impression cytology (IC) refers to the application of a cellulose acetate filter to the ocular surface to remove the superficial layers of the ocular surface epithelium. The SIS presentation describes the technique and uses of IC. Methods: These cells can be subjected to histological, immunohistological, or molecular analysis. Periodic acid Schiff (PAS), Papanicolaou or haematoxylin stains are commonly employed to delineate goblet cells and epithelial cell morphology. Cells harvested by IC can also be released as a cell suspension and subjected to FACS (fluorescein activated cell sorting) analysis. Proper technique is essential as the number of cells sampled can vary considerably. Results: Generally two to three layers of cells are removed in one application but deeper cells can be accessed by repeat application over the same site. Applications for IC include diagnosing a wide range of ocular surface disorders, documenting sequential changes in the conjunctival and corneal surface over time, staging conjunctival squamous metaplasia, and monitoring effects of treatment. It is also a useful investigational tool for analysing ocular surface disease with immunostaining and DNA analysis. It is non‐invasive, relatively easy to perform, and yields reliable information about the area sampled with minimal discomfort to the patient. Complications such as removal of a full thickness sheet of corneal epithelium; subconjunctival haemorrhage due to rupture of vessels in patients with conjunctival laxity, or subconjunctival emphysema due to a tear in the conjunctiva have been encountered. Conclusions: Major ophthalmic centres should introduce this technique into routine clinical practice. A team approach should include the ophthalmologist, pathologist, microbiologist and immunologist.