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

Conjunctivochalasis is defined as redundant, loose, nonedematous, inferior bulbar conjunctiva interposed between the globe and the lower eyelid [1], occurring in patients with ocular irritation, epiphora, blurred vision, dry eye, and subconjunctival hemorrhage [1-3]. First-line treatments include topical preservative-free artificial tears, steroids, and antihistamines, with surgery as necessary if symptoms do not resolve. The primary surgical method consists of crescent-shaped resection and re-approximation of redundant inferior bulbar conjunctiva [1]; several studies have demonstrated the general efficacy of this method [2,4]. However, this approach has several limitations, resulting in the development of modified surgical techniques, including amniotic membrane graft transplantation [5,6], scleral fixation of the redundant conjunctiva with stitches [7], and superficial cauterization using bipolar devices [8]. More recently, a surgical approach using a high-frequency radiowave electrosurgical unit was described [9]. This method minimizes heat dissipation and resultant cellular alteration, reducing postoperative pain and scar formation and facilitating wound healing [10,11]. These authors reported that this electrosurgical system produced successful results in conjunctivochalasis, with a shorter operative time but comparable clinical outcomes to standard surgical methods. However, in practice, these investigators often encountered complaints of early postoperative pain in electrocauterized patients who had conjunctival epithelial defects in the electrocauterized area in the early postoperative days. We hypothesized that, despite good clinical outcomes, the high temperatures generated by the electrosurgical unit may induce greater than anticipated thermal damage in the subconjunctival tissue and overlying epithelial cells, inducing an inflammatory response. Therefore, we compared postoperative inflammation in an experimental conjunctivoplasty model utilizing high frequency radiowave electrocauterization with a procedure using simple excision and suturing.