We reviewed the medical charts of 25 eyes from 19 patients who were diagnosed with CCh and received modified laser photocoagulation treatment at the Konkuk University Hospital between March 2012 and August 2019. The study followed the Declaration of Helsinki principles and was approved by the Institutional Review Board/Ethics Committee of the Konkuk University Medical Center (IRB number 2022-03-059). Informed consent was obtained from each patient before undergoing the laser procedure.
All patients had CCh-related symptoms such as epiphora, ocular irritation, or discomfort. We recommended argon laser treatment if a patient was dissatisfied with medical treatments such as artificial tears, ointments, antihistamine drops, or anti-inflammatory drops. All patients underwent a complete ophthalmic examination including visual acuity measurements, external eye examination, intraocular pressure measurements, and slit-lamp anterior segment examination to evaluate their ocular surface and CCh grade. Patients were excluded if they had a history of trichiasis, entropion, blepharitis, pterygium, pinguecula, keratoconjunctivitis sicca, Sjögren’s syndrome, prior history of ocular conjunctiva surgery, and several other systemic conditions relating to eye disease such as Graves’ diseases.
CCh grades were determined as lid-parallel conjunctival folds under slit-lamp examination, as previously described.[13 (link),15 (link)] Patients were classified as grade 0 (no persistent fold), 1 (single, small fold), 2 (more than 2 folds there were below the tear meniscus), or 3 (multiple folds that were above the tear meniscus). Patients were asked if their symptoms improved and if they thought the surgery was successful at the last follow-up. We defined surgical success as improvement in CCh grade without recurrence over 6 months and when a patient expressed subjective improvement and satisfaction during an office examination.
The overall procedure is depicted in Fig. 1 and shown in Video S1, Supplemental Digital Content, http://links.lww.com/MD/I308. The eye was initially anesthetized using 0.5% topical proparacaine. While their lower eyelid was pulled down, the patient was asked to look upward until the CCh was in the center of the slit-lamp microscope’s field of view, and a dark purple skin marker was used to apply the ink directly to the redundant conjunctival surface (Fig. 1), which increased energy absorption at the conjunctiva by the argon laser, thereby reducing the required laser power. The beam was aimed at the outer inferior conjunctiva at least 2 mm from the limbus to avoid thermal damage. This low-energy argon laser photocoagulation method was applied a mean of 80 times with a 532 nm green argon laser (VISULAS 532s, Carl Zeiss Meditec, Jena, Germany) using a 500 μm spot size for 0.5 seconds at 250 to 400 mW. The power of the laser was increased by 50 mW starting from the baseline of 250 mW until the conjunctiva became blanched shrunken and had small cavitations in response to the laser. Coagulation was considered adequate when the conjunctiva became blanched and shrunken and had small cavitations. After the treatment, 0.3% gatifloxacin and 0.1% fluorometholone were topically applied 4 times daily for a week. All these procedures were performed by H.J.S. Patients were screened at 1 week, 1 month, 3 months, and 6 months after the procedure. After the 6-month follow-up, patients were instructed to visit if they had any discomfort. Only patients who visited the hospital for more than 6 months after the procedure were included in this study.
All statistical analyses were performed using SPSS version 20.0. Paired t tests were used to analyze the pre- and postoperative CCh grades of the patients.