Conjunctivochalsis surgery performed at The Gulani Vision Institute

[Jen72]

Thanks for the info Richard, its always good to be more informed. Hopefully I wont need to see another specialist but now I know I have options in the area. I am glad that everything went well for you.

[Rebecca Petris]

Francesco's comments are well-intended. The truth is that many of us old-timers have read excited posts from people who had recently undergone amniotic membrane transplanation for conjunctivochalasis - only to find that, six months or a year later, the same patient had no lasting benefit. In some of those cases there was a very high cost involved, and the patients had to move on to other treatments, some successfully, some not. I myself as many of you know have tended to be skeptical or conjunctivochalasis surgery primarily because of the rarity of any long-term positive reports posted in our community. However, I suspect this is in large part due to the difficulty of identifying the right pain source to treat when there are multiple ocular surface diseases/conditions going on.

So I am sympathetic to your concern Francesco. Just to add some useful context to the situation though - Richard's been a member of the post-refractive community for a very long time and is a trustworthy information source. Dr. Gulani is a highly reputed corneal specialist and surgeon and I have indeed known some of his patients. I have been in touch with him recently and am attempting to learn more myself about conjunctivochalasis to get a better feel for where it fits in the scheme of things with ocular surface disease. If I have a take-home message about this, it's that the surgery Richard underwent is not a "dry eye" treatment. It's a conjunctivochasis treatment. Conjunctivochalasis occurs relatively commonly in varying degrees, and by no means all patients with this condition need to do something about it. Richard's treatment was unique to his specific needs, and I hope that he receives the maximum possible long-term benefits from it.

[Francesco]

Thank you Rebecca..anyway you are totally right about conjunctivochalasis (also in the other thread I started about it)......i was almost sure I needed a surgery but after visiting Dr. Tseng he said that it is very mild and does not need a surgery.....

I'm not gonna write about the visit and what he told me because I dont know how much people are interested in it, but I can only say that after visiting some "Top" Dry Eye Dr.s in cities like New York, Houston etc (you all know the name of these Dr.s) the only one who really told me exactly what is going on in my eyes was Tseng, instead of "try this it might help". Ok the visit was 800$ but at least I have some hope now...

Francesco

[Richard Esser]

Thank You Rebecca

Francesco's comments are well-intended. The truth is that many of us old-timers have read excited posts from people who had recently undergone amniotic membrane transplanation for conjunctivochalasis - only to find that, six months or a year later, the same patient had no lasting benefit. In some of those cases there was a very high cost involved, and the patients had to move on to other treatments, some successfully, some not. I myself as many of you know have tended to be skeptical or conjunctivochalasis surgery primarily because of the rarity of any long-term positive reports posted in our community. However, I suspect this is in large part due to the difficulty of identifying the right pain source to treat when there are multiple ocular surface diseases/conditions going on.

So I am sympathetic to your concern Francesco. Just to add some useful context to the situation though - Richard's been a member of the post-refractive community for a very long time and is a trustworthy information source. Dr. Gulani is a highly reputed corneal specialist and surgeon and I have indeed known some of his patients. I have been in touch with him recently and am attempting to learn more myself about conjunctivochalasis to get a better feel for where it fits in the scheme of things with ocular surface disease. If I have a take-home message about this, it's that the surgery Richard underwent is not a "dry eye" treatment. It's a conjunctivochasis treatment. Conjunctivochalasis occurs relatively commonly in varying degrees, and by no means all patients with this condition need to do something about it. Richard's treatment was unique to his specific needs, and I hope that he receives the maximum possible long-term benefits from it.

I do understand why people are skeptical and as you and I discussed if the physician is guessing that conjunctovochalasis is the problem and performs surgery the procedure will not work. Dr. Gulani ran many tests and also just looking at the eye the redundant conjunctiva was red and inflammed and elevated from the membrane it attached to. I am glad you pointed out this is not a procedure to correct dry eye, however, the fact that this procedure if done correctly improves the tear film some patients do see an improvement in their dry eye, however, I do not want people to think if their eyes are dry they need to have this procedure performed. Most dry eye patients need to follow the good advise on this Board and they will improve.
I will keep posting regarding my progress. If in six months my improvement is 80% your members will know this, if in six months it is only 50% this fact will be precisely stated.

Thank you for this wonderful Board and the work you do.

Richard

[Lucy]

Rebecca, Richard and Francesco must have been reading my mind. When I read Francesco's remarks to Mr. Esser, I understood why Francesco had this attitude. Then, Mr. Esser's long time problem going back ten years and more, puts him in more than a flash in the pan type of post.

Rebecca brought it together nicely. Francesco, I understand how it is to spend big bucks traipsing around the country looking for a fix. I understand how spending $800 for "an answer" (even if it isn't a fix) is better than words that don't really mean anything.

Mr. Esser, your posts are very articulate and easy to understand. I hope you will keep posting about your experience. I really, really hope this does much to help you. It puts the readers (like me) in the position of thinking 'maybe this could help me.' I will be in Florida during the winter and who knows, maybe I'll have a checkup with Dr. Guliani. Thanks to all for this interesting thread. Lucy

[Richard Esser]

Reply to Lucy

Rebecca, Richard and Francesco must have been reading my mind. When I read Francesco's remarks to Mr. Esser, I understood why Francesco had this attitude. Then, Mr. Esser's long time problem going back ten years and more, puts him in more than a flash in the pan type of post.

Rebecca brought it together nicely. Francesco, I understand how it is to spend big bucks traipsing around the country looking for a fix. I understand how spending $800 for "an answer" (even if it isn't a fix) is better than words that don't really mean anything.

Mr. Esser, your posts are very articulate and easy to understand. I hope you will keep posting about your experience. I really, really hope this does much to help you. It puts the readers (like me) in the position of thinking 'maybe this could help me.' I will be in Florida during the winter and who knows, maybe I'll have a checkup with Dr. Guliani. Thanks to all for this interesting thread. Lucy

I am happy to keep posting. I wish there was more published information on conjunctivochalasis. If know if the conjunctiva of any individual over 60 years of age is examined closely enough there will be evidence of this pathology simply because of the aging process. Physicians like Dr. Tseng, ******, and Gulani know how to diagnose and treat this condition. I wish there were more like them out there. In the Chicago area where I am from I was only able to locate one physician with any surgical experience treating this condition and because of previous refractive surgery he was afraid to touch my eye.

Richard

[dnew85]

Gentle Superficial Cauterization???

I haven't posted in a while but visit almost daily. Things have improved some but are far from great. This is very interesting to me because the nasal side of my right eye is still red and uncomfortable at best and painful at the worst. It always feels like there is something it it and I can see extra wrinkling of the conjunctiva when I roll my eye inward. I am in the process of scheduling an AMT procedure consultation but I was wondering if anyone has heard of the following. I would be very interested in trying this befor the AMT. Any feedback is much appreciated.

d

AIM:
We report here a simple surgical approach to reduce moderate conjunctivochalasis.

PATIENTS AND METHODS:
A non-comparative prospective interventional case series study of fifteen consecutive patients with moderate conjunctivochalasis was carried out. On the inferior bulbar conjunctiva 10 to 20 superficial burns were performed with an electrical bipolar cauter to reduce moderate conjunctivochalasis. Before and around a mean time of six months after surgery digital photographs of the conjunctivochalasis were taken at the slit lamp. The maximal height of the conjunctivochalasis above the lower eyelid margin measured before surgery was compared with the height of the conjunctivochalasis measured after surgery around the same location (one eye per patient).

RESULTS:
In each patient, gentle and superficial cauterization induced contraction of the bulbar conjunctiva and reduction of the conjunctivochalasis. No complications were noted during or after the procedure. Mean (+/- SD) maximal conjunctivochalasis height above the lower eyelid margin was higher before (2.3 +/- 0.9 mm) than after surgery (0.8 +/- 0.6 mm). Preoperative values of conjunctivochalasis height were significantly (p < 0.001) different from the postoperative ones (Wilcoxon rank signed test).

CONCLUSIONS:
Gentle superficial cauterization of the inferior bulbar conjunctiva can induced significant reduction of a moderate conjunctivochalasis.

[Richard Esser]

Reply re: Superficial cauterization

I haven't posted in a while but visit almost daily. Things have improved some but are far from great. This is very interesting to me because the nasal side of my right eye is still red and uncomfortable at best and painful at the worst. It always feels like there is something it it and I can see extra wrinkling of the conjunctiva when I roll my eye inward. I am in the process of scheduling an AMT procedure consultation but I was wondering if anyone has heard of the following. I would be very interested in trying this befor the AMT. Any feedback is much appreciated.

d

AIM:
We report here a simple surgical approach to reduce moderate conjunctivochalasis.

PATIENTS AND METHODS:
A non-comparative prospective interventional case series study of fifteen consecutive patients with moderate conjunctivochalasis was carried out. On the inferior bulbar conjunctiva 10 to 20 superficial burns were performed with an electrical bipolar cauter to reduce moderate conjunctivochalasis. Before and around a mean time of six months after surgery digital photographs of the conjunctivochalasis were taken at the slit lamp. The maximal height of the conjunctivochalasis above the lower eyelid margin measured before surgery was compared with the height of the conjunctivochalasis measured after surgery around the same location (one eye per patient).

RESULTS:
In each patient, gentle and superficial cauterization induced contraction of the bulbar conjunctiva and reduction of the conjunctivochalasis. No complications were noted during or after the procedure. Mean (+/- SD) maximal conjunctivochalasis height above the lower eyelid margin was higher before (2.3 +/- 0.9 mm) than after surgery (0.8 +/- 0.6 mm). Preoperative values of conjunctivochalasis height were significantly (p < 0.001) different from the postoperative ones (Wilcoxon rank signed test).

CONCLUSIONS:
Gentle superficial cauterization of the inferior bulbar conjunctiva can induced significant reduction of a moderate conjunctivochalasis.

This sounds very interesting. In all my research I never came across this. It sounds simple and less invasive. I am wondering if the results are immediate or if it takes time to see improvement. I noticed following my chalasis repair improvement was immediate because the conjunctiva had been tightened and in the process some of the red and inflamed tissue was removed.

Richard

[Richard Esser]

Update on chalasis surgery of 10/28/08 by Dr. Gulani

I am about two and one half weeks post op. Eye is still red but improving. Tear film is more stable than before surgery. I would say by about 50%. I am on two drops of Omnipred daily and use one drop of Systane every 1-2 hours. The appearance of the conjuctiva is better despite the redness. Much smoother in appearance. I will need to remain on drops for a total of four weeks. With a two quadrant chalasis repair I am looking at about six weeks for full healing. If I was asked to rate my improvement from this surgery I would say around 50% in terms of dryness, burning, and blurred vision. I will be starting autologous serum eyedrops next week at a high concentration of 50%. Some eye doctors believe these eye drops should be used in conjunction with chalasis surgery. Will keep everyone updated.

Richard

[NYer]

after visiting some "Top" Dry Eye Dr.s in cities like New York, Houston etc (you all know the name of these Dr.s) the only one who really told me exactly what is going on in my eyes was Tseng, instead of "try this it might help".

Francisco, you really said a mouthful. I've been so annoyed, particularly for the last few days. Out of no where, my eyes started acting up two days ago and are really sore and dry - in fact just sitting here at the PC is making me nuts with my eyes burning. And this is after a year of seeing a "top dry eye doctor" in New York....who has thrown a number of drops at me, none of which helped, most of which irritated my eyes. And at my last visit, actually told me how much better my eyes looked....and this is even after I was lax in doing the warm compresses, etc. Yeah, right, they looked better...my heiney. They are actually worse than before I started seeing him. So, he's full of baloney, just like the others.

I'm really glad for you that you found someone who was actually helpful - perhaps not in fixing you but at least in helping you know what's going on.