Relationship between the Extent of Peripheral Anterior Synechiae and the Severity of Visual Field Defects in Primary Angle-closure Glaucoma

We investigated the relationship between the circumferential extent of peripheral anterior synechiae (PAS) and the severity of visual field defects in primary angle-closure glaucoma (PACG). Correlations between visual field defects and the extent of PAS were analyzed in 73 eyes; 28 with and 45 without acute attacks. Spearman's correlation coefficient between the severity of visual field defects and the extent of PAS was 0.348 (P = 0.003) in all subjects (n = 73), 0.377 (P = 0.012) in the PACG eyes without acute attacks (n = 45), and 0.338 (P = 0.079) in the eyes with acute attacks (n = 28). Our results showed a statistically significant correlation between the extent of PAS and the severity of visual field damage in PACGoverall, and especially in PACG patients without a history of acute attacks.

Clinical Effect of Limited Myectomy for the Treatment of Essential Blepharospasm

PURPOSE: Limited protractor myectomy was employed through lid crease incision alone and the effect and complications of this surgery were evaluated and compared with those of the conventional method in essential blepharospasm. METHODS: Seven patients who were not responsive to botulinum toxin injection for essential blepharospasm and who were worried about large scars after protractor myectomy underwent limited myectomy through lid crease incision in the upper lid and lateral myectomy in the lower lid. The corrugator and procerus muscles were left in place. RESULTS: Blepharospasm was improved in five of the seven patients after limited myectomy and by botulinum injection in one of the remaining two patients for whom limited myectomy was not successful. Severe lymphedema seen after protractor myectomy through suprabrow incision was not encountered. Long-term lymphedema, skin necrosis, eyebrow loss, and exposure keratitis were reduced and operative time was shorter than that of conventional methods. CONCLUSIONS: Limited myectomy through lid crease incision in essential blepharospasm has less postoperative complications and shorter operative time than conventional surgery.

The Surgical Results of Transcanalicular LASER-assisted Dacryocystorhinostomy

PURPOSE: The purpose of this study is to evaluate the effectiveness of transcanalicular laser-assisted dacryocystorhinostomy(DCR) comparing with previous endonasal DCR. METHODS: The patients were divided into two groups; One is transcanalicular laser-assisted DCR, the other is endonasal DCR. 35 patients with NLD obstruction underwent transcanalicular laser-assisted DCR. The bony ostium was created using a transmitting Nd: YAG fiberoptics catheter laser through the canaliculus. On the other hand, 45 patients with NLD obstruction underwent endonasal DCR. The authors compared success rate, postoperative complication and operative time between two groups. RESULTS: The success rate of transcanalicular laser-assisted DCR group and endonasal DCR group were 88.6% (31/35) and 88.9% (40/45), respectively. There was no significant difference between two groups in success rate (p>0.99). Postoperative granuloma formation was seen in 29% (transcanalicular group) and 58% (endonasal group), respectively. The operative time for transcanalicular and endonasal DCR was needed for 28.3min, 47.7min, respectively. There were statistically significant differences in less granuloma formation and shorter operative time in transcanalicular group than in endonasal group (p<0.01). CONCLUSIONS: When patients with NLD obstruction have a thin bony portion of the lacrimal fossa, transcanalicular laser-assisted DCR with shorter operative time and less postoperative complications may be chosen as the beneficial procedure rather than endonasal DCR.

Surgical Results of Modified Dacryocystorhinostomy

PURPOSE: To evaluate the surgical results of endoscopic modified dacryocystorhinostomy (DCR). METHODS: The authors operated on patients with upper punctal and canalicular obstruction associated with nasolacrimal duct obstruction and performed endoscopic modified DCR. One end of a lacrimal tube was passed into the nasal cavity through an excision site of the caruncle and internal ostium and the other end of the tube was inserted into the nasal cavity through a patent punctum and the newly created intranasal ostium. The two ends were tied together in the nasal cavity in modified DCR. RESULTS: The primary success rate of modified DCR was 71.0%. Of the four failed cases, one underwent CDCR using Jones tube. CONCLUSIONS: The author's modified DCR may be a suitable alternative method to CDCR or DCR using monocanalicular silicone tube to relieve epiphora in patients with NLD obstruction associated with upper punctal and canalicular obstruction.