Evaluation of Subconjunctival Remnant Particles after High-frequency Radio-wave Electrosurgery for Conjunctivochalasis
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Purpose: To investigate the clinical manifestations and properties of remnant particles in the subconjunctivalspace after high-frequency radio-wave electrosurgery for conjunctivochalasis. Methods: We performed a retrospective, observational case series with in vitro experimental imaging in nineeyes 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 visualacuity testing was performed preoperatively and postoperatively. During follow-up, we evaluated remnantparticles and any other complications including granuloma or conjunctival injection with slit-lamp photographyand anterior optical coherence tomography. Coagulation tips were investigated with scanning electron microscopeand energy dispersive X-ray spectroscopy to analyze the insulating electrode and assess changes totips after repeated use. Results: None of the patients included in this study experienced any change in visual acuity or major complicationspostoperatively. Small dark-gray lesions (0.3 to 0.5 mm in size) were observed in the inferior bulbarsub-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 posteriorshadow, suggesting foreign particles. Scanning electron microscopy and energy dispersive X-ray spectroscopyimaging analysis revealed peaks of carbon and fluorine complexes, consistent with the polytetrafluoroethylenecoating on the electrode. Conclusions: There were no instances of inflammatory reaction, particle migration, or major complicationsdue to particles. Physicians should be aware of the possibility of remnant polytetrafluoroethylene particlesin subconjunctival tissue when using insulated coagulation tips subjected to repeat sterilization.
Abstract
Purpose: To investigate the clinical manifestations and properties of remnant particles in the subconjunctivalspace after high-frequency radio-wave electrosurgery for conjunctivochalasis. Methods: We performed a retrospective, observational case series with in vitro experimental imaging in nineeyes 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 visualacuity testing was performed preoperatively and postoperatively. During follow-up, we evaluated remnantparticles and any other complications including granuloma or conjunctival injection with slit-lamp photographyand anterior optical coherence tomography. Coagulation tips were investigated with scanning electron microscopeand energy dispersive X-ray spectroscopy to analyze the insulating electrode and assess changes totips after repeated use. Results: None of the patients included in this study experienced any change in visual acuity or major complicationspostoperatively. Small dark-gray lesions (0.3 to 0.5 mm in size) were observed in the inferior bulbarsub-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 posteriorshadow, suggesting foreign particles. Scanning electron microscopy and energy dispersive X-ray spectroscopyimaging analysis revealed peaks of carbon and fluorine complexes, consistent with the polytetrafluoroethylenecoating on the electrode. Conclusions: There were no instances of inflammatory reaction, particle migration, or major complicationsdue to particles. Physicians should be aware of the possibility of remnant polytetrafluoroethylene particlesin subconjunctival tissue when using insulated coagulation tips subjected to repeat sterilization.
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