Abstract
Purpose
To investigate changes in conjunctival tissue of conjunctivochalasis (CCh) patients and to determine the relationship between pathological findings and localization of loose conjunctiva.
Methods
Our study included nineteen eyes of 19 patients who were referred to Cukurova University Ophthalmology Department based on ocular surface symptoms and CCh detected in ocular examination. Amniotic membrane was applied after conjunctival excision as surgical treatment. The control group was formed with five eyes of five patients who are similar in terms of age and gender distribution with our study group. Tissue samples obtained from the study and control groups were investigated with light and electron microscopy.
Results
Results of pathological examination of conjunctival tissues revealed increased inflammation in 13 patients (68%), lymphatic ectasia in 12 patients (63%), and loss of goblet cells in 17 patients (89%). Destruction of elastic fibers was detected in all cases by staining with elastic van Gieson. After semiquantitative assessment, varying degrees of light microscopic findings were noted considering the localization of CCh. No statistically significant relationship was observed between light microscopic findings and CCh location (p > 0.05 for all). Electron microscopic investigation revealed increase in intercellular spaces, increased cytoplasmic electron density, and the presence of slight vacuolization in cell cytoplasm, and heterochromatin clumping in nuclei of cells in conjunctival samples.
Conclusions
Mechanical and inflammatory factors induce development of CCh, and signs associated with these factors can be detected with light and electron microscopy of conjunctival tissue. No relationship was observed between CCh localization and pathological changes in tissues examined in our study, and large-scale case series are required to evaluate the possible effect of CCh localization on pathological findings.
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References
Youm DJ, Kim JM, Choi CY (2010) Simple surgical approach with high-frequency radio-wave electrosurgery for conjunctivochalasis. Ophthalmology 117:2129–2133
Fernández-Hortelano A, Moreno-Montañés J, Heras-Mulero H, Sadaba-Echarri LM (2007) Amniotic membrane transplantation with fibrin glue as treatment of refractory conjunctivochalasis. Arch Soc Esp Oftalmol 82:571–574
Erdogan-Poyraz C, Mocan MC, Bozkurt B, Gariboglu S, Irkec M, Orhan M (2009) Elevated tear interleukin-6 and interleukin-8 levels in patients with conjunctivochalasis. Cornea 28:189–193
Erdogan-Poyraz C, Mocan MC, Irkec M, Orhan M (2007) Delayed tear clearance in patients with conjunctivochalasis is associated with punctal occlusion. Cornea 26:290–293
Wang Y, Dogru M, Matsumoto Y, Ward SK, Ayako I, Hu Y, Okada N, Ogawa Y, Shımazakı J, Tsubota K (2007) The impact of nasal conjunctivochalasis on tear functions and ocular surface findings. Am J Ophthalmol 144:930–937
Kheirkhah A, Casas V, Esquenazi S, Blanco G, Li W, Raju V-K, Tseng SCG (2007) New surgical approach for superior conjunctivochalasis. Cornea 26:685–691
Kheirkhah A, Casas V, Blanco G, Li W, Hayashida Y, Chen Y-T, Tseng SCG (2007) Amniotic membrane transplantation with fibrin glue for conjunctivochalasis. Am J Ophthalmol 144:311–313
Di Pascuale MA, Espana EM, Kawakita T, Tseng SCG (2004) Clinical characteristics of conjunctivochalasis with or without aqueous tear deficiency. Br J Ophthalmol 88:388–392
Meller D, Tseng SC (1998) Conjunctivochalasis: literature review and possible pathophysiology. Surv Ophthalmol 43:225–232
Watanabe A, Yokoi N, Kinoshita S, Hino Y, Tsuchihashi Y (2004) Clinicopathologic study of conjunctivochalasis. Cornea 23:294–298
Francis IC, Chan DG, Kim P, Wilcsek G, Filipic M, Yong J, Coroneo MT (2005) Case-controlled clinical and histopathological study of conjunctivochalasis. Br J Ophthalmol 89:302–305
Mimura T, Yamagami S, Usui T et al (2009) Changes of conjunctivochalasis with age in a hospital-based study. Am J Ophthalmol 147:171–177
Hirotani Y, Yokoi N, Komuro A, Kinoshita S (2003) Age-related changes in the mucocutaneous junction and the conjunctivochalasis in the lower lid margins. Nippon Ganka Gakkai Zasshi 107:363–368
Ward SK, Wakamatsu TH, Dogru M et al (2010) The role of oxidative stress and inflammation in conjunctivochalasis. Invest Ophthalmol Vis Sci 51:1994–2002
Dogru M, Tanaka M, Igarashi A et al (2005) Ocular surface and MUC5AC alterations in atopic patients with corneal shield ulcers. Curr Eye Res 30:897–908
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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Ethics Committee of the Cukurova University, Medicine Faculty, Adana, Turkey) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Harbiyeli, I.I., Erdem, E., Erdogan, S. et al. Investigation of conjunctivochalasis histopathology with light and electron microscopy in patients with conjunctivochalasis in different locations. Int Ophthalmol 39, 1491–1499 (2019). https://doi.org/10.1007/s10792-018-0963-6
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DOI: https://doi.org/10.1007/s10792-018-0963-6