Conjunctivochalasis, excision and scleral tacking
16 Jan, 2018 uploaded / 538 views
This narrated video demonstrates the excision of redundant conjunctiva (conjunctivochalasis) with scleral tacking closure sutures that can be used for refractory cases. The video reviews the technique and possible complications. Alternative techniques are shown in other videos on this website
Conjunctivochalasis excision: cut and tack technique
Tacking the conjunctiva to the sclera may be beneficial in refractory conjunctivochalasis. The surgical field is prepared with topical anaesthetic and povidone iodine.
A speculum exposes the inferior conjunctiva and by stretching the conjunctiva minimises the risk of over-zealous excision. However, it makes it harder to determine the location and degree of redundancy, which should be assessed and can be marked prior to placing the speculum.
Marking the area the redundant fold is not essential, but can help ensure a neat elipse is excised.
The procedure can be done under topical anaesthetic but a small injection of subconjunctival anaesthetic may make it more comfortable and raise the conjunctiva to be excised.
The redundant conjunctival fold is excised.
Buried 8-0 vicryl are being placed that enter from the internal surface of the superior edge and exit on the external conjunctival surface. They re-enter through the external surface of the inferior edge and exit on the inside of the incision and then a cautious bite of the sclera is taken to tack the conjunctiva down before the suture is tied with the knot buried. A spatulated needle is probably the best balance between relatively easy penetration and passage through the sclera without the increased risk of penetration of the cutting needle and even more so of the reverse cutting needle.
A couple more tacking sutures and a couple of simple conjunctiva closure sutures are placed.
The procedure does carry a risk of complications including ocular penetration, fornical shallowing, cicatricial entropion, globe restriction particularly of upgaze, granuloma formation and persistent inflammation or giant papillary conjunctivitis.