Outcomes of Anterior-Side Rectangular 4-Snip Punctoplasty for Patients with Punctal Stenosis

PURPOSE: To evaluate the efficacy of anterior-side rectangular 4-snip punctoplasty, a modification of posterior ampullectomy that is currently used in patients with punctal stenosis. METHODS: We performed a retrospective chart review of patients with punctal stenosis who underwent anterior-side rectangular 4-snip punctoplasty at our hospital. Fluorescein dye disappearance test (FDT) and questionnaire on tearing symptoms and tear meniscus height (TMH) based on spectral-domain optical coherence tomography (SD-OCT) were evaluated in preoperative and postoperative follow-up examinations of the patients. Anatomical success was defined as punctum without re-stenosis at last visit; functional success was defined as FDT grade of 0 or 1, or tearing symptom score of 2 or less. RESULTS: A total of 44 anterior-side 4-snip punctoplasty procedures were performed in 27 patients. The average age of all subjects was 56.0 +/- 11.0 years (range, 39 to 82 years). The mean follow-up period was 9.4 months (range, 6 to 20 months). FDT, tearing symptom score (p < 0.01, Wilcoxon signed-rank test), and TMH (p < 0.01, paired t-test) were significantly decreased after surgery. Anatomical success was 40/44 cases (90.9%) and functional success was 38/44 cases (86.4%). There were no complications such as skin defect or cosmetic problems. CONCLUSIONS: Anterior-side rectangular 4-snip punctoplasty is an effective surgical procedure for patients with punctal stenosis, maintaining functions of the lacrimal drainage system without re-stenosis of punctum.

The Effects of Intralesional Steroid Injection for Chalazion According to the Concentrations of Triamcinolone Acetonide

PURPOSE: To compare the efficacy of an intralesional steroid injection in the treatment of chalazion according to triamcinolone acetonide (TA) concentrations. METHODS: A total of 108 patients with 120 chalazia received an intralesional injection of TA. Patients were divided into 3 groups according to the concentrations of TA: 5 mg/ml, 10 mg/ml, and 40 mg/ml. A regular follow-up was performed and the size of lesion and recurrence were evaluated. RESULTS: Success was defined as a minimum of 80% decrease in size with no recurrence. The success rate was 78.1% in the 5 mg/ml group, 76.2% in the 10 mg/ml group, and 78.4% in the 40 mg/ml group. These results were not statistically significant (p = 0.999, Fisher's exact test). Yellow deposits developed in 4 out of 37 lesions in the 40mg/ml group, and in 1 out of 42 lesions in the 10 mg/ml group. Skin depigmentation was observed in 1 case in the 5 mg/ml group. CONCLUSIONS: Intralesional TA injection is an effective treatment for chalazion. There is no significant difference in success rates according to the concentrations of TA. However, caution is advised in cases of high injection concentrations of TA to prevent yellow deposits.

Scleral Allografting and Amniotic Membrane Transplantation With Fibrin Glue in the Management of Scleromalacia

PURPOSE: To examine the effects, complications, and safeties of sclera allograft and amniotic membrane transplantation with fibrin glue as surgical treatment methods for scleromalacia. METHODS: The study included 14 eyes of 14 scleromalacia patients who needed surgical treatment. Among them, seven eyes of seven patients whose scleral defect was small (6 mm) were operated on using fibrin glue and minimum suturing. Amniotic membrane transplantation was performed at the site of the conjunctival defect. RESULTS: In all of the cases, the results of grafting were successful throughout the follow-up period, which was 14.6+/-4.4 months, on average (ranging from 12 to 27 months). No particular complication was observed during the follow-up period after using fibrin glue. CONCLUSIONS: For scleromalacia patients, sclera allograft and amniotic membrane transplantation were performed using fibrin glue. The grafted sclera survived successfully, allowing this treatment modality to be considered an effective and safe option without complications.

Conjunctivolimbal Autograft Using a Fibrin Adhesive in Pterygium Surgery

PURPOSE: To evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium. METHODS: Thirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations. RESULTS: The mean patient age was 57.9+/-10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05+/-5.78 weeks. The mean surgery time was 18.04+/-5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive. CONCLUSIONS: The use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms . Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.

Comparison of Surgical Results between Bilateral Recession and Unilateral Recession-Resection in 25 PD Intermittent Exotropia

PURPOSE: It is the purpose of this paper to study the long-term results of surgically treated intermittent exotropia of 25 prism diopters (PD) of preoperative deviation. METHODS: We analyzed and compared 364 patients (376 cases) with at least 6 months of postoperative follow-up. Two surgical methods were done : 6 mm bilateral recession of lateral rectus muscle in 190 patients (190 cases) and unilateral 4 mm recession of lateral rectus muscle combined with 3 mm resection of medial rectus muscle in 174 patients (186 cases). RESULTS: The average age of operation was 6.2 years, ranging from 3 to 16 years, and the follow-up period after surgery ranged 6 to 128 months (mean 27.3 months). The satisfactory surgical result defined as orthophoria and deviation between 5 PD esodeviation and 10 PD exodeviation. The final success rates were 75.3% in bilateral recession group and 64.5% in unilateral recession-resection group. This difference in success rates between the two groups was statistically significant (P=0.023), and the age at operation did not influence the surgical results. Those cases who were over-corrected 6 to 10 PD had a higher success rate and there was a statistically significant relationship between alignment immediately after surgery and on the final postoperative day in the two surgical groups (P=0.0001). CONCLUSIONS: The outcome of the bilateral recession is better than that of the unilateral recession-resection for correction of 25 PD intermittent exotropia in any age group.

Surgical Efficacy of Probing with Silicone Intubation for Lacrimal Apparatus Obstruction in Children

PURPOSE: The surgical efficacy of probing with silicone tube intubation for congenital and acquired lacrimal obstruction was investigated. METHODS: Medical records of 51 children (55 eyes) with lacrimal obstruction were reviewed. Twentyfive children (28 eyes) had congenital obstruction and 26 children (27 eyes) had acquired lacrimal obstruction. Age ranged from 13 to 78 months (mean 29.8 months). All of the children were examined preoperatively by dacryocystography and treated with probing and silicone tube intubation with or without inferior turbinate fracture. RESULTS: After the follow-up period of 6~41 months (mean 13.2 months), primary success rate of probing and silicone tube intubation was 88.1% (30/37 cases) : 88.9% (16/18 cases) in congenital obstruction and 73.3% (14/19 cases) in acquired obstruction. After combined inferior turbinate fracture and silicone tube intubation, success rate noted 100% in both congenital and acquired cases. The success rates showed 100% in the cases with maintenance period of silicone intubation over 16 weeks and 65.0% in the cases with maintenance period of silicone intubation under 16 weeks. The success rates revealed no statistical significance in etiology, age, obstruction site and lacrimal sac size. CONCLUSIONS: For congenital and acquired lacrimal apparatus obstruction in children, dacryocystography, probing, internal fracture of the inferior turbinate and silicone intubation should be maintained more than 16 weeks.