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

Abstract

PurposeTo investigate the clinical manifestations and properties of remnant particles in the subconjunctival space after high-frequency radio-wave electrosurgery for conjunctivochalasis.MethodsWe 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.ResultsNone 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.ConclusionsThere 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.

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“…In the postoperative period, the patients reported significant relief of symptoms and a significant reduction in the OSDI score, but severe intraoperative subconjunctival hemorrhage occurred in 1 eye and chemosis in 1 eye of the patients. In a study conducted by Kim et al, 26 small, dark gray lesions consisting of remnant polytetrafluoroethylene particles were observed in the inferior subconjunctival space in the postoperative period in patients whose conjunctivochalasis was treated using high-frequency radio-wave electrosurgery. The authors underlined that attention should be exercised considering polytetrafluoroethylene migration and possible systemic side effects (eg, liver toxicity, developmental delay, behavioral changes, hormonal changes, immune system, and cell-cycle effects).…”

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“…These remnant polytetrafluoroethylene (PTFE) particles may have been detached from the electrode coating of the needle. 26 Such particles may have the potential to cause inflammation or other systemic side effects. Sixth, the plasma does not create necrotic tissue compared to the proposed methods using lasers.…”