Yokoi Norihiko, Komuro Aoi, Maruyama Kunio, Tsuzuki Masakatsu, Miyajima Seiya, Kinoshita Shigeru
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Am J Ophthalmol. 2003 Mar;135(3):303-8. doi: 10.1016/s0002-9394(02)01975-x.
To introduce a new surgical procedure for treating superior limbic keratoconjunctivitis (SLK) and to suggest the association of SLK with conjunctivochalasis.
Interventional case series.
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.
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.
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.
介绍一种治疗上睑缘角结膜炎（SLK）的新手术方法，并提示SLK与结膜松弛症的关联。
介入性病例系列。
对5例长期存在严重眼部刺激症状且对局部类固醇和人工泪液治疗无反应的患者的6只眼采用我们的新手术方法进行手术。该技术包括以下四个步骤：（1）用孟加拉玫瑰红（RB）染色定位异常结膜区域；（2）在RB染色区域相邻及远端从2点至10点位置做弧形结膜切口；（3）以弧形切口为基底切除结膜形成新月形；切除大小根据去除结膜下结缔组织后结膜冗余情况确定；（4）用间断缝线关闭新月形结膜开口。在2只眼中，新手术方法与下睑结膜松弛症手术同时进行。
所有手术眼在术后第二周结束时RB染色消失；治疗后1个月记录到症状缓解和炎症消退。随访时间最长的病例（14个月），术后3个月有杯状细胞恢复的细胞学证据。另一例结膜细胞核/质比恢复正常但无杯状细胞出现。
我们的治疗非常有效地缓解了与SLK相关的症状，即使是对常规眼药水治疗无反应的眼睛。鉴于我们未处理结膜的病变部分而是处理了相邻的结膜冗余，我们提出上睑结膜松弛症参与了SLK的发病机制。
