Evaluation of Subconjunctival Remnant Particles after High-frequency Radio-wave Electrosurgery for Conjunctivochalasis

PURPOSE: To investigate the clinical manifestations and properties of remnant particles in the subconjunctival space after high-frequency radio-wave electrosurgery for conjunctivochalasis. METHODS: We performed a retrospective, observational case series with in vitro experimental imaging in nine eyes from eight patients who presented with small dark-gray lesions during follow-up after high-frequency radio-wave electrosurgery for conjunctivochalasis. General examination including slit-lamp examination and visual acuity testing was performed preoperatively and postoperatively. During follow-up, we evaluated remnant particles and any other complications including granuloma or conjunctival injection with slit-lamp photography and anterior optical coherence tomography. Coagulation tips were investigated with scanning electron microscope and energy dispersive X-ray spectroscopy to analyze the insulating electrode and assess changes to tips after repeated use. RESULTS: None of the patients included in this study experienced any change in visual acuity or major complications postoperatively. Small dark-gray lesions (0.3 to 0.5 mm in size) were observed in the inferior bulbar sub-conjunctival space in the location where high-frequency radio-wave electrosurgery had been performed. Cirrus high-definition optical coherence tomography images revealed focal hyper-reflection with a posterior shadow, suggesting foreign particles. Scanning electron microscopy and energy dispersive X-ray spectroscopy imaging analysis revealed peaks of carbon and fluorine complexes, consistent with the polytetrafluoroethylene coating on the electrode. CONCLUSIONS: There were no instances of inflammatory reaction, particle migration, or major complications due to particles. Physicians should be aware of the possibility of remnant polytetrafluoroethylene particles in subconjunctival tissue when using insulated coagulation tips subjected to repeat sterilization.

Removal of Eyelid Epidermal Cyst Using High-Frequency Radio-Wave Electrosurgery

PURPOSE: To introduce an effective new surgical approach with high-frequency radio-wave electrosurgery to remove eyelid epidermal cysts. METHODS: Thirteen patients (13 eyes) with eyelid epidermal cysts were enrolled in the present study. All patients underwent high-frequency radio-wave electrosurgery (Ellman surgitron(R)) to remove the epidermal cyst. The results were analyzed retrospectively, after a follow-up of more than 6 months. RESULTS: At 6 months postoperatively, all eyes showed no recurrence of epidermal cyst. Additionally, no complications were reported by any patient. CONCLUSIONS: High-frequency radio-wave electrosurgery is an effective procedure to remove eyelid epidermal cyst without recurrence.

Effect of Electrocauterization on the Inflammation of the Conjunctiva in Experimental Animal Model

PURPOSE: Recently, conjunctivochalasis repair surgery using electrocauterization has been gaining popularity. However, patients with electrocauterized conjunctivoplasty tend to complain of more postoperative pain than patients undergoing simple excision with suturing. Therefore, we investigated the effects of electrocauterization on inflammation of the conjunctiva using an experimental animal model and compared these with the effects of simple excision with suturing. METHODS: Ten New Zealand white rabbits underwent cauterization in the right eyes and excision and suturing in the left eyes. For each eye, we excised or electrocauterized the inferior bulbar conjunctiva, 1 mm in width and 6 mm in length, 2 mm from the limbus. A fine-needle electrode was inserted subconjunctivally, and electrocauterization was performed. In the contralateral eye, the corresponding area was excised and re-approximated with 10-0 nylon sutures. Sutures were removed after 14 days. Tissue samples were obtained at 21 days post-procedure, and inflammatory cells were counted in five randomly selected fields (x200) on hematoxylin-eosin stained slides. Tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta concentrations in tears were measured using enzyme linked immunosorbent assays. RESULTS: All cauterized eyes demonstrated smooth surface healing without scarring after 5 days, whereas sutured eyes presented with mild edema with some scarring until the suture was removed. The number of inflammatory cells was significantly greater in sutured eyes compared with cauterized eyes (p = 0.035, Mann-Whitney U-test) at 21 days post-procedure. Tear TNF-alpha and IL-1beta concentrations at 21 days were similar in both groups. CONCLUSIONS: Electrocauterization for conjunctivoplasty seems to be advantageous in terms of inflammation compared with simple suturing and excision.

The Effect of Conjunctivochalasis Surgery Using a High-Frequency Radio-Wave Electrosurgical Unit

PURPOSE: To evaluate the effects of conjunctivochalasis surgery using a high-frequency radio-wave electrosurgical unit. METHODS: Twenty-seven eyes of 14 patients with conjuctivochalasis who received surgeries with shrinkage of the inferior bulbar conjunctiva using a high-frequency radio-wave electrosurgical unit (Ellman surgitron(R)) were evaluated. Conjuctivochalasis grade, the ocular symptoms, Ocular Surface Disease Index (OSDI), tear film break-up time (BUT), Schirmer test, and corneal staining with fluorescein were measured preoperatively, at 3 months postoperatively, and analyzed prospectively. RESULTS: Three months after the surgery, all patients' conjunctivochalasis became grade 0, and the ocular symptoms, OSDI score, BUT, and corneal staining with fluorerscein were also improved. Additionally, there were no specific complications during the follow-up period. CONCLUSIONS: Conjunctivochalasis surgery using a high-frequency radio-wave electrosurgical unit produced an effective improvement in conjuctivochalasis grade and symptoms and appeared to be a simple and safe procedure.