How Plasma Spots Affect Cytokines In Tear And Serum Samples Of Patients Treated With The Panis Method

This study aimed to evaluate the safety and efficacy of Atmospheric Low-Temperature Plasma (ALTP) after plasma assisted noninvasive surgery (PANIS) treatment of symptomatic Conjunctivochalasis (CCh). Specifically, we assessed whether ALTP treatment induces inflammatory responses, their stability, and the time required for cytokine levels to return to baseline.

A prospective interventional study was conducted at Vision health research clinic, a tertiary ophthalmology center specializing in anterior segment disorders. The study adhered to the tenets of the Declaration of Helsinki and was approved by the ethical committee of Semnan university of medical sciences (Identifier: IRCT20181229042160N3.

Twenty patients with clinically confirmed CCh (grade 3 or 4) were enrolled. After topical anesthesia, plasma spots were applied on conjunctiva as a minimally invasive procedure using the white handpiece of the PLEXR PLUS device (GMV Srl, Rome, Italy) by targeting ~15-40 spots of the lower conjunctiva to remove CCh at a distance of 4 mm from the inferior limbus. Postoperative clinical assessments were performed using slit-lamp biomicroscopy and digital imaging. Tear and serum samples were collected at baseline and at 1-week, 1-month, and 3-month follow-ups. The concentrations of pro-inflammatory cytokines (IL-2, IL-6, IL-17A, IFN-γ, TNF-α) and anti-inflammatory cytokines (IL-4, IL-10) were quantified via flow cytometry.

Following PANIS treatment, CCh severity was significantly reduced, with grade 3 cases improving to grade 1 and grade 4 cases to grade 2. No postoperative complications were reported, and the Ocular Surface Disease Index (OSDI) scores demonstrated a marked improvement. Notably, cytokine analyses revealed no significant fluctuations in inflammatory markers across preoperative and postoperative time points, suggesting the absence of ALTP-induced inflammatory responses.

This study highlights PANIS as a promising, noninvasive surgical modality for CCh management. The technique demonstrated clinical efficacy in symptom alleviation while maintaining ocular surface homeostasis without triggering an inflammatory cascade. PANIS method may serve as a viable alternative to conventional surgical interventions for CCh.