Autogenous Temporalis Fascia Grafting and Conjunctival Flap Transposition in Scleromalacia after Pterygium Excision

PURPOSE: To evaluate the result and complications of autogenous temporalis fascia grafting and conjunctival flap transposition as a treatment of scleromalacia after pterygium excision. METHODS: We used autogenous temporalis fascia and conjunctival flap to treat scleromalacia of 9 patients(9 eyes) who underwent pterygium excision and checked the postoperative result and complications. RESULTS: We could keep the temporalis fascia graft without necrosis during follow-up examination. Pain, inflammation and scleral discoloration were disappeared after temporalis fascia grafting in all cases. Postoperative complications were included 2 cases of progression of cataract and 1 case of mild chamber inflammation. CONCLUSIONS: We obtained good surgical result of scleromalacia after pterygium excision by autogenous temporalis fascia grafting with conjunctival flap transposition.

Management of Complications after Conjunctivodacryocystorhinostomy with Jones Tube

PURPOSE: To analyze the surgical outcomes of conjunctivodacryocystorhinostomy(CDCR) with Jones tube on the postoperative management of complications. METHODS: We retrospectively analyzed the medical records of 87 eyes (79 patients) with at least 3 months follow-up who had undergone CDCR with Jones tube between January 1993 and December 2002. The patients were divided into several cases according to the results of postoperative management. RESULTS: Thirty eyes (34%) experienced no complications of Jones tube, over a mean follow-up period of 26.77 +/- 34.41 months. Forty-five eyes (52%) were improved by postoperative management of complications, over a mean follow-up period of 45.00 +/- 42.70 months. In these 45 eyes, the medial migration of the tube was corrected in 7 eyes after repositioning without fixed suture, in 9 eyes after repositioning with fixed suture, in 10 eyes after endonasal endoscopy-assisted repositioning with fixed suture, and in 1 eye after endonasal endoscopy-assisted tube exchange. The lateral migration of the tube was corrected in 1 eye after repositioning with fixed suture, and in 7 eyes after endonasal endoscopy-assisted tube exchange with fixed suture. The extrusion of the tube was corrected in 3 eyes after endonasal endoscopy-assisted tube reinsertion with fixed suture. Consecutive dacryocystitis improved in 1 eye after tube exchange with dacryocystectomy. The conjunctival obstruction of the tube was corrected in 6 eyes after resection of conjunctival tissue. Twelve eyes (14%) were not improved by CDCR or postoperative managements of complications, over follow-up period of 38.50 +/- 35.39 months. CONCLUSIONS: The complications of Jones tube occurred anytime during the postoperative period. If extrusion of the tube occurred reinsertion had to be done as soon as possible. Migration or obstruction of the tube was mostly improved by postoperative managements.

Silicone Intubation for Treatment of Punctal Stenosis

PURPOSE: To evaluate the surgical results and complications of silicone intubation in patients with epiphora by punctal stenosis. METHODS: We reviewed the records of 35 eyes of 23 patients who had undergone silicone intubation from 1998 to 2002 and followed more than 1 year postoperatively. RESULTS: Following 1 year postoperatively, 33 eyes (94.3%) showed no epiphora, 2 eyes (5.7%) showed intermittent epiphora. Complications after silicone intubation included prolapse of tube in 3 eyes, punctal slitting in 1 eye, itching in 6 eyes, foreign body sensation in 2 eyes, discharge from punctum in 3 eyes and intranasal discomfort in 1 eye. CONCLUSIONS: Silicone intubation seemed to be an alternative method in patient with epiphora due to punctal stenosis and also a useful method to treat upper and lower punctum.

Surgical Results of Lacrimal Surgery with or without Canalicular Stenosis

PURPOSE: To compare the surgical results of lacrimal surgery for nasolacrimal duct obstruction with and without canalicular stenosis. METHODS: We surveyed 175 eyes which underwent external dacryocystorhinostomy with silicone tube intubation from January 1996 through December 2000 retrospectively. Group 1 included 126 eyes in nasolacrimal duct obstruction without canalicular or commoon canalicular stenosis and group 2 included 47 eyes with canalicular or common canalicular stenosis. We checked the statistical significance with Chi-squre Test. RESULTS: Anatomical success rate was 96.0% (121/126) in group 1 and 85.7% (42/49) in group 2; It was statistically significant (p<0.05). And functional success rate was 91.3% (115/126) in group 1 and 73.5% (36/49) in group 2; it had statistic significance (p<0.05). The surgical success rate depending on the size of sac was not statstically significant in goup 1, but it had statstic significance in total group (p<0.05). In site of stenosis, anatomical and functional success rate ware 93.1% (27/29) and 79.37% (23/29) in common canalicular stenosis. It was higer surgical success rate than the other site, but it had no statistic significance. CONCLUSIONS: The canalicular or common canalicular stenosis is important factor in success of lacrimal surgery. Therefore it is recommendable to open the canalicular stenosis by probing prior to performing dacryocystorhinostomy.

Comparison of Surgical Result between External Dacryocystorhinostomy with Mitomycin-C and without Mitomycin-C

PURPOSE: To compare the surgical results of external dacryocystorhinostomy with intraoperative application of mitomycin-C and external dacryocystorhinostomy without application of mitomycin-C. METHODS: In 80 eyes which underwent external dacryocystorhinostomy, group 1 included 40 eyes with intraoperative mitomycin-C, and group 2 (control group) included 40 eyes without mitomycin-C. In group 1, 5 minute application with 0.4 mg/ml mitomycin-C was intraoperatively performed on the osteotom site and the incision site of posterior mucosal flap. Postoperative follow-up was done at 1-week interval for 1 month, at 2-week interval after 2 months and 1-month interval for 3 to 6 months. We determined the surgical success by the irrigation with normal saline and epiphora. By the irrigation with normal saline, no reflux was regarded as the anatomical success, no reflux with no epiphora was regarded as the functional success. We checked the statistical significance with Fisher's Exact Test. RESULTS: After 6 months, anatomical success rate was 95.0% (38/40) in group 1 and 90.0% (36/40) in group 2. It was not statistically significant (p>0.05). And functional success rate was 90.0% (36/40) in group 1 and 85.0% (34/40) in group 2; it had no statistic significance (p> 0.05). CONCLUSIONS: Authors conclude that the intraoperative use of mitomycin-C in repeated dacyo-cystorhinostomy or the poor condition of nasal mucosa is more helpful than the primary use of mitomycin-C in external dacyocystorhinostomy.

Anterior Capsular Staining with a Mixture of Indocyanine Green Dye and Viscoelastic Material

PURPOSE: The authors used a mixture of ICG dye and viscoelastic material to perform continuous curvilinear capsulorhexis (CCC) in white cataract, in order to stain the anterior capsule with the minimal contact with the corneal endothelial cells. METHODS: In 10 eyes with white cataract, CCC was performed under the anterior capsular staining with ICG dye. The ICG solution was prepared by dissolving 25 mg of ICG in 1 mlof an aqueous solvent, which was mixed in 3 ml of balanced salt solution. With a three-way connector, one way was occluded, the other was connected with 1 ml of viscoelastic material, and the third was connected with 4 ml of the prepared ICG solution. One half percent mixture of ICG and viscoelastic material was made by alternate injection. The anterior chamber was filled with viscoelastic material, and then the anterior capsule was stained by slow spread of the prepared ICG mixture between anterior capsule and viscoelastic material. The remains of ICG mixture was removed by infusion and aspiration. The anterior chamber was filled with viscoelastic material again, CCC was performed with cystotome. Corneal edema and anterior chamber reaction was evaluated with slit lamp at 1 day, 1 week and 1 month after surgery. RESULTS: In all cases, CCC was successfully completed under the anterior capsular staining of the desired area with 0.5% ICG dye mixture and there was no contact with the corneal endothelial cells. Mild corneal edema and mild anterior chamber reaction that observed on the 1st postoperative day subsided within 1 week in all cases. CONCLUSIONS: Staining the anterior capsule with 0.5% ICG dye mixture, after the anterior chamber was filled with viscoelastic material, it was helpful to perform CCC in white cataract. Using this technique, we could minimize the contact with the corneal endothelial cells and stain the desired area.

Comparison of Surgically Induced Astigmatism between a No-Stitch Frown Incision and a No-Stitch Straight Incision

PURPOSE: This investigation was performed to evaluate the surgically induced astigmatism of no-stitch frown incision with 4.0 mm chord length, which was compared with no-stitch 3.2 mm straight incision. METHODS: Sixty eyes, which could be observed for 3 months, were divided into two groups. Both groups were composed of 30 eyes. Group 1 - a semicircular frown incision with 4.0 mm chord length was made 1 mm posterior and most convex to limbus. Group 2 - a 3.2 mm straight incision was made 2 mm posterior to limbus. No-stitch was done in both groups. The corneal astigmatism was evaluated at postoperative 1st day, 1st week, 2nd week, 1st month, 2nd month and 3rd month with Bausch & Lomb keratometry, calculated by values derived from Cravy's vector method and statistically analyzed by Student t-test. RESULTS: The change of surgically induced astigmatism in group 1 was 0.52 D, 0.45 D, 0.43 D, 0.38 D, 0.40 D, and 0.39 D at 1st day, 1st week, 2nd week, 1st month, 2nd month, and 3rd month, respectively. In group 2, it was 0.83 D, 0.72 D, 0.65 D, 0.52 D, 0.50 D, and 0.49 D at the same intervals. These differences of astigmatic change were not statistically significant(p>0.05). CONCLUSION: The astigmatic change in a no-stitch frown incision with 4.0 mm chord length was not enough to comparable with that of a no-stitch 3.2 mm straight incision. We could safely use PMMA intraocular lens by no-stitch frown incision. So, this method has some advantages over small incision with foldable intraocular lens.

Autogenous Temporalis Fascia Graftin Exposure of Hydroxyapatite Implant

Hydroxyapatite recently has been used for its excellent results compared with other implant materials, but the tissue breakdown and exposure of the hydroxyapatite implant was reported due to hemorrhage or infection. Five patients with exposed hydroxyapatite implant after evisceration or enucleation were studied.The hydroxyapatite implant exposure occurred in 2 to 8 weeks (mean 4.2 weeks)after implantation.Conjunctival defects with various sizes were noted in all cases and purulent discharge in one case. An autogenous temporalis fascia patch graft was placed instead of preserved sclera or fascia lata for the intensification of the defect area.No reexposure occurred during a follow-up examination and we could keep the implant well in all cases. The temporalis fascia is advantageous over preserved sclera or fascia lata because it is firm and can be easily obtained from the same operative field as the primary surgery.Therefore, it is thought to be suitable for graft material in surgery of the exposed hydroxyapatite.No scars are visible after obtaining temporalis fascia.

Operative Results in Orbital Floor Fracture Associated with Malar Tripod Fracture

17 patients underwent operations in malar tripod fracture combined with orbital floor fracture from January 1995 to June 1998. Age distribution was from 16 to 62. Sexual distribution was 15 males and 2 females. 11 cases were due to slip or all down. All orbital floors were reconstructed with silastic sheet through subciliary incision. In case of type I and type II, one-point fixation was performed with miniplate and screws on zygomaticomaxillary suture, In type III and IV, two-point fixation was done with miniplate and screws on zygomaticomaxillary and zygomaticofroptal suture by Gillies' approach and lateral eyebrow incision. Among 9 patients with preoperative diplopia, 5 patients improved within 1 week, 2 patients within 1 month. Among 3 patients with severe preoperative diplopia, 2 patients remained with mild diplopia, but no interference with daily work was encountered. In postoperative apperance and X-ray findings, excellent results were noted in 4 cases(24%), good cases in 10 cases (59%), fair cases in 3 cases (18%), but no poor case was found. 5 cases with Preoperative mouth opening limitation improved during postoperative period. In patients with malar tripod fracture with orbital floor fracture, it can serve as a good surgical method that bony fragment reduction by Gillies' approach and fixation with miniplate and screws.

The proportional Changes of Tear Proteins in the Dry Eye Patients

It is well studied about the composition of tear and it`s function, but not about the proportion of tear proteins in the dry eye, in which tear volume is reduced and tear film is unstable. Therefore, we performed this study to determine the proportion of tear proteins. This study involved 150 subjects, 50 volunteers and 100 outpatients who visited Ophthalmologic department from January to December in 1997. Dry eye was classified into mild and severe dry eyes. Four fractions of tear protein were demonstrated by electrophoresis. The proportion of tear proteins in fraction 1 to 4 were 31.0+/-5.9%(mean+/-standard deviation), 2.9+/-1.3%, 40.8+/-5.5%, 25.2+/-5.2%, in control group, 33.4+/-7.1%, 3.4+/-3.0%, 41.6+/-7.7%, 21.5+/-4.8% in mild dry eye group, 37.5+/-11.4%, 3.2+/-2.2%, 40.3+/-9.1%, 19.5+/-5.3% in severe dry eye group respectively. With severty of the dry eye, the proportion of fraction 1 was increased and the proportion of fraction 4 was decreased, both of which were statistically significant difference(P<0.01). In proportion to the severity of dry eye, the proportion of tear proteins became unstable. For the diagnosis and management of the dry eye,we consider the supplement of the decreased portion of tear proteins.

The Complications of Silicone Tube Intubation after Lacrimal Surgery

We reviewed the complications associated with silicone tube intubation in the treatment of disorders of the lacrimal system in 68 cases from January 995 to December 1997. Complications included conjuctival and corneal irritation 7 cases, punctal erosion 6 cases, tube prolapse 5 cases, tube extrusion or breakage 4 cases, and intranasal irritation 3 cases. After silicone intubation complications occurred in 7 cases in the 1st month, 8 cases between 1 and 3 months. Among them each 3 cases had their tubes removed. Complications occurred in 4 cases between 3 and 6 months, 6 cases longer than 6 months. After 3 months, all patients with complications had their tubes removed. Operation result of patients with tube removed was good.

The Incidence of Complication and Decreased Visual Acuity in Traumatic Hyphema Patients According to the Amount of Blood Clot

We reviewed the medical records of 122 patients (122 eyes) who had been admitted for the traumatic hyphema at the Wallace memorial Baptist Hospital between January 1993 and June 1996, excluding perforating eye injury. And according to the degree of hyphema, the incidence of its complications such as early glaucoma, late glaucoma, rebleeding, or conreal staining , and decreased final visual acuity was analyzed. The degree of hyphema was graded by the amount of the anterior chamber filled with blood clot after layering of the red blood cells: Grade I was defined as less than one third of anterior chamber, Grade II as one third to one half of it, Grade III as one half to nearly total of it, or Grade IV as total of it. The early or late glaucoma was defined as intraocular pressure using Goldmann` s applanation tonometer of 21mmHg or more on admission or at about 1 month after admission. The decreased final visual acuity is defined as final corrected visual acuity using Hans chart of 0.5 or less. Of 122 eyes, there were 92 eyes(75.4%) in Grade I, 20 eyes(16.4%) in Grade II, 6 eyes(4.9%) in Grade III, or 4 eyes(12.3%) in Grade IV. According to the grade, the incidence of early glaucoma was 10.9%(10 eyes) in Grade I, 25.0%(5 eyes) in Grade II, 16.7%(1 eye) in Grade III, or 25.0%(1eye) in Grade IV; that of late glaucoma was 3.3%(3eyes) in Grade I, 5.0%(1 eye) in Grade II, zero in Grade III, or 25%(1 eye) in Grade IV; that of rebleeding was zero in Grade I, 10.0%(2 eyes) in Grade II, 50.0%(3 eyes) in Grade III, or 50.0%(2 eyes) in Grade IV; that of conreal staining was 50.0%(2 eyes) in Grade IV but zero in Grade I, Grade II or Grade III; and that of decreased final visual acuity was 8.7%(8 eyes) in Grade I, 20.0%(4 eyes) in Grade II, 33.3%(2 eyes) in Grade III or 25%(1 eye) in Grade IV. The higher the grade, the higher the incidence of its complication and decreased final visual acuity not showing the statistical significance (P>0.05). However, the incidence of rebleeding and decreased final visual acuity was higher in Grade II to IV groups showing the statistical significance in comparison with Grade I(P<0.01). Therefore, it is considered that diagnosis, treatment , and follow-up should be made correctly and attentively in Grade II to IV groups than in Grade I.

The Clinical Experience of Hydroxyapatite Implantation using Autologous Sclera and Vicryl Mesh

The hydroxyapatite implant, recetnly widely used new intraorbital implant, in light, highly biocompatible, characterized by easy fibrovascular proliferation. Thus, when inserted after evisceration, it has some beneficial effect cosmetically: it can cause less protrusion of implant or alteration of position and can have good artificial eye motion by linking to the implant. However, in case of hydroxyapatite implantation after evisceration with the cornea preserved, there is a risk of cornea melting by contact with the implant, and in case with the cornea preserved of the eyeball size being too small, hydroxyapatite implant is impossible after evisceration. Hydroxyapatite implantation is done after enucleation using donor sclera, which is not readily available in Korea. Thus we inserted hydroxyapatite implant covered with circular from of Vicryl mesh on endothelium after evisceration in 11 eyes, and inserted hydroxyapatite implant using autologous sclera with Vicryl mesh after enucleation in 3 eyes, in which 18 mm-sized implant could not be implanted after evisceration from August 195 to July 1996. Follow-up examination was done during 6 to 20 (mean 12.9) months postoperatively. Motion of extraocular muscle was very good. During follow-up examination, adverse effects such as conjunctival wound dehiscence and exposure or protrusion of hydroxyapatite implant through the conjunctiva didn`t occur. It should be considered an excellent operative method, because the hydroxyapatite implantation using autologous sclera with Vicryl mesh decreases the risk of exposure or protrusion of the implant and can be performed without the use of donor sclera.

Long-term follow-up of Conjunctivodacryocystorhinostomy

Conjunctivodacryocystorhinostomy(CDCR) with a Pyrex tube is an accepted procedure for the treatment of epiphora resulting from obstructed canaliculi. We analyzed the success rate, complications and it's treatment of 181 eyes who underwent CDCR with a Pyrex tube at Wallace Memorial Baptist Hospital between september 1986 and march 1996. Straight tubes, 18mm long(70 of 181 eyes; 38.7%) was most commonly used. Of 181 eyes, 172 eyes(95%) were successful. Complications of CDCR included submergence of Pyrex tube (13 of 181 eyes; 7.2%), tube extrusion(9 of 181 eyes; 4.9%), tube extraction(5 of 181 eyes; 8.9%). Of the 9 eyes of tube extraction, 7 eyes were 20mm in length, and the exchange of 20mm for 18mm was performed under topical anesthesia and two eyes, 18mm in length were replaced by 16mm in length. It was successful in 3 eyes but 6 eyes were dissatisfied because of residual tearing. In 13 eyes of tube submergence, tubes were sutured with 5-0 nylon to the skin of medial canthus and was successful in 10 eyes but was failed in 3 eyes. Of 181 eyes, 5 eyes(2.8%) lost their tube. 4 patients came for treatment 24 hours after tube loss and 1 patients came for treatment 72 hours after tube loss. A simple tube reinsertion was successful in all cases. Other complications were granuloma formation(16 of 181 eyes; 8.8%), conjunctival growth over the tube opening(8 of 181 eyes; 4.4%) and infection (5 of 181 eyes; 2.8%). Granuloma recurred two times in 4 eyes, three times in 2 eyes, four times in 1 eyes and was resected effectively each time under topical anesthesia. Conjunctival overgrowth was treated with conjunctival resection and tube manipulation. The infection resolved completely on consecutive treatment with topical and oral antibiotics.

Hand-held Laser Interferometric Prediction of Postoperative Visual Acuity in Cataractous Eye

The visual acuity measured preoperatively by hand-held laser interferometer was compared to the visual acuity measured postoperatively by Han s visual acuity in 86 cataractous eyes treated by phacoemulsification with posterior chamber IOL insertion in order to get the prediction of postoperatively corrected visual acuity. The follow up period was at least 4 weeks. In the 56 cases with immature cataract and normal retina, the postoperative visual acuity was predictable within 2 lines in 52 eyes (92.8%). In 20 eyes with mature cataract including nuclear sclerosis, postoperative Han's visual acuity was predictable within 2 lines in 7 eyes (35%), and one patient showed positive disparity. In 15 eyes with retinopathy, 10 eyes (66.7%) showed positive disparity and 3 eyes (20%) showed negative disparity. We concluded that the hand-held laser interferometer is a reliable method to predict the postoperative visual acuity in immature cataract with normal retina.

The Clinical Study of Branch Retinal Vein Occlusion Associated with Systemic Hypertension

Branch Retinal Vein Occlusion(BRVO) is the second most retinal vascular abnormality after diabetic retinopathy. Systemic hypertension is the most common combined disease. The author evaluated 38 patients of BRVO with hypertension regarding the clinical manifestations, viual acuity changes and the results of treatment. Medical or Laser therapy was selected according to the degree of retinal nonperfusion, macular edema and neovascularization documented by fluorescein angiography. The most common age group was sixth decade(39.5%) and the most common affected site was superior temporal branch of retinal vein(60.5%). The sequelae were macular edema(39.4%), perifoveal non perfusion, retinal neovascularization and vitreous hemorrhage. There were no significant differences in visual prognosis due to the states of blood pressure, vein occlusion site and timing of laser therapy. The better visual prognosis was observed in cases of without soft exudate or without macular edema or capillary non perfusion less than 5 disc diameter. The increased visual acuity of 2 lines or more were noted in 10(71%), 13(76%), 9(60%) cases respectively and showed stastiscal correlations(p0.05). We suggest that the medical and laser therapy should be considered according to the status of high quality fluorescein angiography of retina.

The Clinical Study of Treatment of Blowout Fracture

The orbital blowout fractures has been increasing due to trauma and traffic accidents with time. The diagnostic confirmation is easily established by CT scan, but the indication for surgical treatment, the technique for repair, and timing of repair are still controversial. We have reviewed investigated the charts of 18 cases who had blowout fracture, including the clinical manifestation, surgical indication, surgical procedures, improvement of diplopia, and its complication. The follow up was at least 6 months in the past 5 years. In cases of diplopia only in the upward gaze limitation, or small orbital fracture in orbital CT scan and less degree of enophthalmos, these 8 cases were treated conservatively for 2 weeks and diplopia improved markedly. However, in 10 cases of severe diplopia and in large fracture and tissue incarceration, these were surgically managed using Silastic sheets. In these cases, the diplopia resolved within 1 month in 7 cases(70%). Residual diplopia waS seen in 3 cases, and we retreated surgically for the two cases of them. In the other non surgical cases, diplopia resolved on 6 months follow up except in 2 cases of mild diplopia. Therefore we should pay more attention to surgical indication.

The Clinical Study of 33 Cases of Congenital Blepharoptosis

The blepharoptosis is drooping of upper eyelid in primary gaze with various causes. The most common cause of ptosis is, in known as, underdevelopment of levator muscle. We evaluated the age and sexual distribution, clinical manifestation, result of treatment and it's complication of congenital blepharoptosis. The method of surgery and amount of muscle resection was decided according to several factors that is the amount of ptosis, the preoperative levator functon, and the Margin Limbal Distance(MLD). Most of patient was second decades(48.3%). In cases of unilateral ptosis, left lid was higher incidence(60%) than right lid and 4 cases(14%) were bilateral ptosis. The amount of ptosis was between 3 and 4mm in most cases(48.5%), and over the 5mm was 12 cases(36.3%). Preoperative levator function between 4 and 7mm of the patient was in 18 cases(54.5%) and 3mm or less was 12 cases(36.3%). Between 16 and 19mm muscle resection was 10 cases(43.5%), Between 12 and 15mm resection was 7 cases(30.4%). In initially corrected visual acuity with Hans Chart. 12 cases(36%) were 0.5-1.0 and 2 cases were 0.1 or less. There is no significant visual improvement after one year surgical correcton. The most common surgical procedure was levator muscle resection(73%) through anterior skin incision and followed by frontalis suspension in 9 cases(27%). The result of operation was good for the period of six months follow-up. The most common complication was undercorrection in 2 cases of levator muscle resection and 1 case of frontalis suspension. The other complications were overcorrectopn, exposure keratitis and entropion in each case, respectively.

The Results of Pigtail Probe Canalicullar Reconstruction Surgery with Silicone Tube and Methylcellulose

We performed simple and successful canalicular reconstruction with smooth tip pigtail probe in 56 cases of inferior canalicular laceration. After general anesthesia or local anesthesia in inferior and superior canthal area, upper lacrimal sac area and lacerated inferior eyelid, methylcellulose mixed fluorescein was injected through the superior canaliculus under the surgical microscope with cobalt blue filter and simply found cutting end of the inferior canalicullus. Smooth tip pigtail probe was inserted and silicone stent was connected the superior and inferior canaliculi and the peri canalicular sheath was sutured with and to end anastomosis. Silicone tube was removed after postoperative 8 weeks and 86% of the patients(48/56 cases) was successful without epiphora. Smooth tip pigtail probe, methylcellulose mixed fluorescein, silicone stent, and end to end anastomosis of pericanalicular sheath under the surgical microscope would increase the success rate of pigtail probe canalicular reconstruction.

The Result of the Dacryocystorhinostomy on the Chronic Dacryocystitis

We performed 75 cases of daryocystorhinostomy from Jan. 1988 to Dec. 1990. A routine dacryocystography was performed prior to operation in all cases. A modified T oti's method was applied as a surgical technique "H" shaped incision was done. Both anterior and posterior flaps were sutured adequately and vaseline guaze was used as a plugging agent for 7 to 10 days Success was achieved in 72(96.0%) of 75 cases. The causes of 3-failures were organized granulation tissue and trauma.