Part 2: Conjunctivochalasis (CCH) Dry Eye: The Reservoir Restoration Procedure for CCH

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In part one of a two part series, Arla Genstler, MD discussed Conjunctivochalasis (CCH) Dry Eye and how it’s diagnosed, and introduced the Reservoir Restoration Procedure for CCH. Here, she speaks in more depth about this procedure and its clinical results.

What are the keys to performing the Reservoir Restoration Procedure for CCH?

Dr. Genstler: The procedure is fairly straightforward however, one of the keys is to completely remove the abnormal Tenon’s capsule, deeply establish the fornix by getting the prolapse fat to retract, and then re-establish the deep cul-de-sac. Not using too much tissue glue and smoothing the cryopreserved amniotic membrane are also important – I typically wait a few minutes to make sure that it’s adhered adequately. The procedure is quick and easy and takes only about 20-30 minutes.

How do you set patient expectations for their post surgery experience?

Dr. Genstler: I tell patients that their eye will be patched for the first 24 hours, and that they will have a protective contact lens in place that will keep their eye comfortable. When the patch comes off, they can essentially resume their normal activities. Patients typically have some discomfort initially, but of not much significance, particularly seeing what they were already accustomed to prior to surgery.

How soon after surgery do patients typically feel relief from their symptoms?

Dr. Genstler: Pre-surgery I tell patients that this is one element of their disease and part of a comprehensive plan in which we re-establish stability to the ocular surface. Typically by one week when we take the contact lens out, patients feel relief and notice an improvement in how their eyes feel. Most patients say they have about 70 percent to 80 percent improvement in their symptoms and are grateful to no longer have episodic tearing, which is a predominant symptom of CCH.

How soon do you typically recommend patients have their second eye done?

Dr. Genstler: It depends on each individual, as sometimes patients have bad CCH on one side and not so much on the other, so the decision is made on a case-by-case basis. I usually have this discussion at the one-month follow-up. At that point I will ask them if they have gained relief and improvement, and if there is a need to conduct the procedure on the other eye, most patients move forward.

What advice would you give your colleagues about getting started with the procedure?

Dr. Genstler: This is a wonderful addition to our armamentarium that allows ocular surgeons to relieve a chronic problem that historically didn’t have very good solutions. This procedure is based on science and strong clinical data, and solves a problem ­–– it actually fixes the problem. It’s truly something that can differentiate your practice and your entire approach to dry eye.

 

"Restoration of Fornix Tear Reservoir  in Conjunctivochalasis With Fornix Reconstruction"


Arla Genstler, MD, is a cataract and refractive surgeon at Genstler Eye Center in Topeka, Kansas. She is board certified by the American Board of Ophthalmology and a Fellow of the American Society of Cataract and Refractive Surgeons. Her practice has three offices and a stand-alone surgery center, and is one of the leading refractive and cataract practices in Kansas.