Clinical outcomes of the amniotic membrane transplantation in conjunctivochalasis, the investigation of conjunctivochalasis histopathology with light and electron microscopy

Aim: To investigate the effectivity of the conjunctival excision and amniotic membrane transplantation for conjunctivochalasis, evaluation of pathologic changes at the conjunctival tissueMaterials and Methods: The 19 eyes of 19 patients which refer to Çukurova University Ophthalmology Department with ocular surface symptoms and detected conjunctivochalasis in ocular examination between June 2009 and March 2012 included to our study. Ocular surface disease indeks scoring was calculated for all patients. Florecein and Rose ? Bengal staining was performed on the corneal ? conjunctival surface and findings were graded according to Oxford scheme. Amniotic membrane was applied with fibrin glue for 12 eyes and with suture for 7 eyes after conjunctival excision as a surgical treatment. The tissue samples which obtained during surgery were investigated with light and electron microscopy. The symptom scores, ocular surface disease indeks scores, measurements of tear break-up time, corneal ? conjunctival staining scores were calculated at the control examination which performed one month after surgery and these values were compared with the values prior to surgery.Results: 13 females (68.4%) and 6 males (30.6%) in the study, 12 patients in Group I and 7 patients in Group II, mean age was found to be 66.8 ± 6.9 years in Group I and 58.4 ± 20.5 years in Group II. When the changes in the ocular surface disease index scores at the first month after surgery were examined, a statistically significant decrease was seen in both groups (p=0.019 ve p=0.001). Corneal and conjunctival staining which were detected in different phases before surgery completely disappeared after surgical treatment in both groups. When the alterations in the ocular symptoms at the first month after surgery were observed substantially reducing was seen in both groups. Increased inflammation in 13 patients (68%), lymphatic ectasia in 12 patients (63%), loss of goblet cells in 17 patients (89%) and destruction of elastic fibers in all patients were noted as the results of pathological examination of conjunctival tissues.Conclusions: Mechanical and inflammatory factors induce development of conjunctivochalasis. Amniotic membrane transplantation by suturing or with using of fibrin glue can be considered as an effective means for conjunctival surface reconstruction during removal of conjunctivochalasis.