Eyeworld

110 | EYEWORLD | JULY 2021 C ORNEA Contact Desai: desaivision2020@gmail.com Holland: eholland@holprovision.com Hovanesian: johnhova@gmail.com Salinger: drsalinger@comcast.net Trinh: tanya.trinh@gmail.com Continued need for education Dr. Hovanesian said there's still a need for sim- ple awareness about conjunctivochalasis. "Every eyecare provider is seeing conjunc- tivochalasis and needs to be aware of it so you can optimally treat these patients because otherwise, they tend to go from doctor to doctor unhappy with their treatment and having their problem unsolved," he said. Dr. Desai said awareness about the con- dition in general is still needed, as is a better understanding of what the condition is and the right approach to its management. "We are facing an uphill battle in terms of making more surgeons aware of even looking for it, understanding what the condition is, and having the right approach to it. All three of those need a lot of work," Dr. Desai said. Dr. Desai said. For this reason (and several others), Dr. Desai uses amniotic membrane in his surgical management for conjunctivochala- sis. If one were to remove a strip of conjunctiva and not replace it with amniotic membrane or another platform, he said there might be short- term improvement, as loose conjunctiva would no longer create a foreign body sensation. Over the long term, however, Dr. Desai said it doesn't improve adherence of the conjunctiva, doesn't address prolapsed orbital fat, doesn't improve the inflammatory condition of the eye and gob- let cell deficiency, and can exacerbate a conjunc- tival deficiency. Dr. Desai said that amniotic membrane al- lows for reconstruction of the cul-de-sac, creates a barrier against prolapsed orbital fat, addresses Tenon's insufficiency, and allows for regenera- tive healing with the biologics inherent in the membrane. More from Dr. Hovanesian Dr. Hovanesian described conjunctivochalasis, its diagnosis, and management in a video (bit.ly/2SGz4Ho). Surgically, after the physician has identified where the areas of loose conjunctiva are, Dr. Hovanesian showed how to excise a small strip of conjunctiva 1 mm from the limbus so as to not disturb limbal stem cells. He then cuts dehydrated amniotic membrane to the same shape of the conjunctival defect, making it 1–2 mm larger on all sides except the corneal side. "We use dehydrated amniotic membrane because of the ease of cutting with the packaging and the ease of application directly on to the eye in its dry state," he said. From there, fibrin adhesive is applied in two layers. After applying the second adhesive, the graft is applied and placed under the surrounding conjunctiva. Postop, Dr. Hovanesian prescribes prednisolone acetate 1% QID, fluoroquinolone antibiotic QID, and a topical nonsteroidal. In before and after pictures, Dr. Hovanesian noted less inflammation and complete coverage of surface epithelium after healing. He also said a review of his patients over the course of a year identified eight patients with conjunc- tivochalasis. All patients were older than 5 years, had a history of prior eye surgery, and previous diagnosis of severe dry eye. Dr. Hovanesian said all of these patients had excision of the affected conjunctiva and placement of the dehydrated amniotic membrane, which resulted in complete resolution of the symptoms following surgery. "We encourage our colleagues to consider conjunctivochalasis in patients who have been previously diagnosed with unremitting dry eye that is associated with pain. Naturally, making every effort with nonsurgical therapy is an appropriate first step in this condition, but when conservative treatment fails, we have had very good success using the described technique," Dr. Hovanesian said in the video. continued from page 109

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