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. 2023 Sep 8;13(3):366-370.
doi: 10.4103/tjo.TJO-D-23-00054. eCollection 2023 Jul-Sep.

Tenon excision with fibrin glue-assisted reattachment of conjunctiva flap (T.E.F.A.R.C) for the treatment of conjunctivochalasis

Yi-Ting Hou  1 , Bing-Jun Hsieh  1 , Jo-Hsuan Wu  2 , Wei-Lun Huang  3   4 , Wei-Li Chen  1   5   6
Affiliations

Tenon excision with fibrin glue-assisted reattachment of conjunctiva flap (T.E.F.A.R.C) for the treatment of conjunctivochalasis

Yi-Ting Hou et al. Taiwan J Ophthalmol. .

Abstract

To observe the surgical outcome of "Tenon Excision with Fibrin Glue-Assisted Reattachment of Conjunctiva Flap" (T.E.F.A.R.C.) for the treatment of symptomatic conjunctivochalasis (CCH). This is a retrospective case series of CCH patients undergoing T.E.F.A.R.C. from January 2017 to December 2020 were reviewed. Seven patients (14 eyes) with symptomatic CCH received T.E.F.A.R.C. in both eyes. The symptoms before and after the procedures were compared and surgical complication was evaluated. The mean follow-up time was 13.7 ± 2.14 months. After the operation, resolution of the symptoms was reported in 12 eyes (86%). The grade of CCH decreased from 3 to 0 in all 14 eyes, and the restoration of inferior conjunctival surface and fornix within 1 day was also observed in all eyes. Most patients had localized injection and mild chemosis after the operation, which mostly recovered within 3 weeks. No complication or recurrence of CCH was reported after 1 year of follow-up. In conclusion, T.E.F.A.R.C. is a simple and effective treatment option for CCH with less surgical complication. Future larger studies are needed to confirm its clinical applicability.

Keywords: Conjunctival flap; conjunctivochalasis; fibrin glue; fornix; tenon.

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Conflict of interest statement

Dr. Wei-Li Chen, an editorial board member at Taiwan Journal of Ophthalmology, had no role in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper.

Figures

Figure 1
Figure 1
(a) Preoperatively, redundant lower bulbar conjunctiva, degenerated Tenon, and shortage of fornix tear reservoir were found. (b) 2% lidocaine with epinephrine was injected subconjunctivally at the 4 and 8 o’clock hours and create a limbal-based conjunctival flap. (c) The conjunctival flap was lifted and the Tenon attached to the inner side of the flap and remained on the sclera was completely excised with Westcott scissors. (d) The conjunctival flap was placed back to cover the lower bare sclera down to the fornix. Fibrin glue was used to reattach the conjunctival flap firmly to the sclera and extending to the fornix and fornix tear reservoir was created
Figure 2
Figure 2
(a) Before operation, slit-lamp biomicroscopy revealed loosen and redundant lower conjunctival folds which caused increased tear film meniscus (white arrows). (b) At 1 week after operation, smooth and firmly attached lower conjunctiva with normal height of tear film meniscus was found
See this image and copyright information in PMC

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References

    1. Marmalidou A, Kheirkhah A, Dana R. Conjunctivochalasis: A systematic review. Surv Ophthalmol. 2018;63:554–64. - PubMed
    1. Cheng AM, Yin HY, Chen R, Tighe S, Sheha H, Zhao D, et al. Restoration of fornix tear reservoir in conjunctivochalasis with fornix reconstruction. Cornea. 2016;35:736–40. - PMC - PubMed
    1. Yokoi N, Komuro A, Maruyama K, Tsuzuki M, Miyajima S, Kinoshita S. New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis. Am J Ophthalmol. 2003;135:303–8. - PubMed
    1. Marmalidou A, Palioura S, Dana R, Kheirkhah A. Medical and surgical management of conjunctivochalasis. Ocul Surf. 2019;17:393–9. - PubMed
    1. Kheirkhah A, Casas V, Esquenazi S, Blanco G, Li W, Raju VK, et al. New surgical approach for superior conjunctivochalasis. Cornea. 2007;26:685–91. - PubMed