Treating Conjunctival Chalasis (CCH) with Radio Frequency (RF) Plication (CCHP) with heated - PowerPoint Presentation

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Treating Conjunctival Chalasis (CCH) with Radio Frequency (RF) Plication (CCHP) with heated expression of Obstructed Meibomian Gland Dysfunction (oMGD)

How RF benefitted two illustrative casesEdward H. Jaccoma, MDExcellent Vision Dry Eye and Rejuvenation CenterPortsmouth, NH

RF (Radiofrequency)

RF – A powerful tool for fixing eyes and eyelids

Radiofrequency has been used in medicine for almost 100 years and was designed as a surgical tool that became an aesthetic tool, that can harness the benefits of both to treat eyes and eyelids

RF (Radiofrequency)

SPEED QUESTIONNAIRE

SPEED is a validated questionnaire allowing

Patients to indicate the level of symptomsrelating to their dry eye disease. Higher numbersindicate more symptoms. This patient had 24 before her treatment and16 after treatment of both eyes .

RF (Radiofrequency) – Patient #1

My individualizedPatient Handoutindicates how much

of the dry eye problemlikely relates to lack ofwater (ATD) vs lack of(or the wrong kind of)oil (MGD)

This patient had a combination – both of which got better

With this novel treatment.

RF (Radiofrequency) Patient #1

Tear Break Up Time (TBUT) is a measure of good oil – and this computer program allows us to see dry spots “break through” the oil – as the red and orange colors indicate below. Normal is over 20 seconds but before treatment the right eye (on top left) took 2.6 to see the first dry spots and looked this red shortly after. The post treatment is top right and shows substantial improvement. The left eye shows similar improvements below.

Before

(Bad)

After

(Good)

RF (Radiofrequency)

RF (Radiofrequency) – Patient #1

Meibomian Glands (MGs) are the oil producing glands in our eyelids and are normally long, straight, skinny glands that, when compressed by strong blinks, help to dispense that oil into our tears. This patient’s glands are dysfunctional, but their anatomy is still pretty good. They tend to “clog” over time with waxy blockages that heat can help to “melt” and pressure can help express or “purge” from the glands.

Right eye lower lid

Left eye lower lid

MGs

RF (Radiofrequency)

RF (Radiofrequency) – Patient #1

Specialized tear dye can highlight the pleats and folds in the clear, thin membrane covering the whites of our eyes. Dry eyes deficient in oil will lose lubrication and cause friction to pull and drag this thin membrane loose. Pleats and folds occur between the lower lids and the eye, which displaces the tears and restricts the normal movement of these tears over the clear cornea. This problem is called “Conjunctival

Chalasis” (CCH) and is common to dry eye sufferers like this one. To the left is the Right eye before “Plication” where we smooth the membrane using heat to “iron out” these folds. To the right is the same eye after the plication.

Before

After

RF (Radiofrequency)

Lots of wrinkles

Pleats and

Folds breaking

Up the tears

Less wrinkles

Pleats and

Folds breaking

Up the tears

RF (Radiofrequency) – Patient #1

CCH Left eye Before and After treatment (Plication or CCHP)

Before – droopy lid with lots of CCH

After – less droopy lid with less CCH

RF (Radiofrequency)

RF (Radiofrequency) – Patient #1

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Initial RF for MGD Treatment Study

Pellevé™ vs

Lipiflow

™ MGD-Related Dry Eye Treatment Study: The ThermaLid™ Procedure

A Pilot Study Comparing the Efficacy of the Pellevé System to

LipiFlow

for the Treatment of Dry Eye due to Meibomian Gland Dysfunction

Article Sidebar

Published: Mar 28, 2018

DOI: https://doi.org/10.22374/jded.v1i1.2

Keywords:

Keywords: Dry eye syndrome, Meibomian gland dysfunction,

Lipiflow

Main Article Content

Edward Hall Jaccoma

Southern Maine Eye Associates and New England Dry Eye

Craig

Litherland

Andrew Jaccoma

Aseef

Ahmed

Abstract

Objective: To assess the safety and efficacy of the Pellevé Wrinkle Treatment System as compared to

LipiFlow

, for treatment of dry eye syndrome due to meibomian gland dysfunction (MGD).

https://jdryeyedisease.com/index.php/JDED/article/view/2

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Results: The function of the meibomian glands improved significantly from baseline to 3 months for both thermaLid

and Lipiflow treated eyes, with no significant difference between them, as measured by MGE grading, wax plug scoring, Standard Patient Evaluation of Eye Dryness (SPEED) and Ocular Surface Disease Index (OSDI) scoring. A significant change in conjunctival staining was found after both treatments at the 1-month time point but not the 3-month time point. thermaLid but not Lipiflow treatment, significantly decreased MARX line measurements at 3-months.

Lipiview, Non-Invasive Tear Breakup Time (NITBUT), corneal surface staining, Tear Osmolarity, and anesthetic Schirmer's testing did not show statistically significant improvement, nor differences between treatment modalities.Conclusions: thermaLid treatment of the eyelids appears to show efficacy similar to Lipiflow treatment in reducing symptoms, reducing wax plugging and improving the number of functioning MGs as well as reducing conjunctival staining in MGD related dry eye disease.

Materials and Methods: In this split face, randomized study, ten patients who met specific criteria for inclusion were followed after treatment with the Pellevé Wrinkle Reduction System (what the authors have dubbed the "thermaLid Procedure") and a standard LipiFlow

procedure performed the same day, with 1 and 3 months follow-up. Pre- and post- treatment MGD was assessed using a variety of subjective and objective measurements.

Initial RF for MGD Treatment Study

TREATMENT FOR CONJUNCTIVOCHALASIS: A COMBINED APPROACH UTILIZING RADIOFREQUENCY CAUTERIZATION AND THERMALIDTM

PROCEDURE Article SidebarpdfTreatment

VideoPublished: Feb 17, 2021

DOI:https://doi.org/10.22374/jded.v4i1.35

Keywords: Conjunctivochalasis, ThermaLidTM

, Plication, Meibomian Gland Dysfunction, Radiofrequency Cauterization

Main Article Content

Liem

Nguyen

University of New England - College of Osteopathic Medicine

Edward

Jaccoma

Abstract

Background

Dry Eye Disease (DED) and related ocular surface diseases have multiple etiologies, but two of the most prevalent are Meibomian Gland Dysfunction (MGD) and

Conjunctivochalasis

(CCH). This study examines a customizable two-step approach utilizing radiofrequency to treat these two commonly coexisting conditions and provide patients with relief from DED signs and symptoms.

**Commonly an insurance-based treatment

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TempSure

/RF CCH Plication Study

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TempSure

/RF CCH Plication Study

Study Design

An IRB approved retrospective chart review of 25 consecutively treated patients was conducted. Patients were included if they presented with DED symptoms and were treated with a combination treatment approach to improve both MGD and CCH, with pre- and post-treatment dry eye metrics outlined below. Follow-up visit information was compared to pre-treatment baseline to evaluate the efficacy and safety of treatment.

Results

Statistically significant results were observed in a decrease in symptoms as evaluated by the primary endpoints of the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and an increase in the number of Meibomian Glands Yielding Liquid Secretion (MGYLS). Tear Meniscus Height also saw statistically significant improvement while Non-invasive Tear Break-Up Time (NTBUT) and Schirmer’s saw minor progress. Clinical evaluation and ocular surface photographs showed marked improvement in CCH with minimal observed side effects during post-operative follow-up visits.

Conclusion

A two-step approach utilizing a radiofrequency device to treat dry eye symptoms provides significant clinical improvement and symptomatic relief for a broad spectrum of patients who had received a variety of prior treatments for DED.

TempSure Device Treatments Patient #2

Lids, CCHP and MGD treatments

Pre-RF Tx

Before: CCHP OULLL ignipunctureThermaLid OUPost-RF TxAfter

: CCHP OULLL ignipunctureThermaLid OU

RF/TempSure Device Patient #2

Right Eye Before

Right Eye After

Left Eye Before

Left Eye After

RF/TempSure Device Patient #2

Upper lid extra skin fold (excess skin)

Lower tear duct opening turned out

Lower lid droop (ptosis)

Upper lid droop (ptosis)

Upper lid skin fold tightened (less excess skin)

Lower tear duct opening turned in (normal)

Lower lid lifted

Upper lid lifted

Left Eye Before

Left Eye After

RF offers the unique opportunity to improve lid position, tighten lid skin, iron out the folds in a membrane that commonly aggravates the dry eye problem while also (off label by FDA standards) heating and expressing the waxy plugs common to the obstructions causing oil glands to clog and become less functional. These “Dysfunctional” glands then tend to wither and drop out, leading to “evaporative dry eye disease.”

Oil is critical to “sealing in” the moisture of a tear. With poor oil comes poor tears and dry eyes. RF has been approved by the FDA for surgical applications like these plications, and also for the purpose of reducing fine lines and wrinkles in skin. I’ve found the heat required for rejuvenating the conjunctiva and the lid’s skin, also allows me to improve the ocular surface and the tears serving that surface. We invite you to schedule an appointment and find out if this could be right for you.

RF (Radiofrequency)

Thank You!Sincerely,

Edward H. Jaccoma, MD(Dr. J)And ALL the wonderful staff of Excellent Vision’s Dry Eye and Rejuvenation Center!

RF (Radiofrequency)