Clinical Characteristics and Treatment of Congenital Nasolacrimal Duct Obstruction

PURPOSE: A comparison analysis of the clinical characteristics and treatment results of congenital NLD obstruction. METHODS: The present study involved 216 pediatric patients (258 eyes) diagnosed with and treated for congenital NLD obstruction. Treatment was applied step by step starting with conservative massaging, lacrimal probing, and silicone tube intubation. RESULTS: The treatment results of congenital NLD obstruction in pediatric patients under 12 months of age showed an 87.3% success rate after an average of 4.3 months of treatment in the group using lacrimal sac massage and antibiotic eye drops (conservative treatment). The group treated by correct massaging techniques showed a 93.6% success rate after an average of 3.8 months of treatment. The success rate of lacrimal probing, applied to patients not showing improvement after massage therapy was 77.8%. Pediatric patients not showing improvement after lacrimal probing underwent silicone tube intubation. All patients showed improvement except in 1 case that had an early silicone tube dislocation. DISCUSSION: A step-by-step approach is effective in treating congenital NLD obstruction patients, and correct lacrimal massage techniques improve the success rate during conservative therapy. The period of conservative treatment and number of probing times did not have a statistically significant correlation with the success rate of lacrimal silicone tube intubation. Silicone tube intubation showed a high success rate in patients sustaining the silicone tube for a minimum of 2.1 months.

Silicone Intubation and Dacryocystographic Finding in Incomplete Nasolacrimal Duct Obstruction

PURPOSE: To assess the relationship between the internal diameter of the nasolacrimal duct and the success rate of silicone tube intubation in incomplete nasolacrimal duct obstruction patients with epiphora. METHODS: Dacryocystography was performed 80 patients with symptoms of epiphora and the anteroposterior (AP) diameters and the lateral diameters of the nasolacrimal ducts were measured. These measurements were compared between the group of patients who demonstrated improvement after the operation, and the group without symptom improvement. RESULTS: The mean length of the nasolacrimal duct in the group with nasolacrimal stenosis was 11.7+/-0.1 mm, the mean lateral diameter was 1.0+/-0.2 mm, and the mean AP diameter was 1.1+/-0.1 mm. The AP diameter of the symptomatic nasolacrimal duct in the group with successful postoperative results was 1.1+/-0.1 mm, and 0.9+/-0.1 mm in the group with unsuccessful results. The group with successful postoperative results had an average of 18.1+/-7.0% stenosis in the side of the eye with nasolacrimal duct stenosis compared with the asymptomatic side, and the group with unsuccessful postoperative results had an average of 34%+/-3.6% stenosis. CONCLUSIONS: In cases with nasolacrimal duct stenosis, the success rate of silicone tube intubation was high when the AP diameter of the nasolacrimal duct was more than 1.1+/-0.1 mm and when the stenosis was less than 18.1+/-7.0% in the symptomatic side compared with the opposite side. These results are expected to help predict the success rates when preoperatively planning silicone tube intubation.

Retinal Capillary Hemangioma Treated with Verteporfin Photodynamic Therapy and Intravitreal Triamcinolone Acetonide

PURPOSE: To report a case of retinal capillary hemangioma treated with verteporfin photodynamic therapy combined with intravitreal triamcinolone acetonide. METHODS: A 15-year-old female presented with metamorphopsia in the left eye for 7 days. Examination showed peripheral endophytic retinal capillary hemangioma, macular edema, and a best-corrected visual acuity of 20/50. The hemangioma and macular edema were treated with verteporfin photodynamic therapy and intravitreal triamcinolone acetonide. RESULTS: After 5 months of follow-up, involution of the hemangioma, reduction of macular edema, decrease of the feeder and draining vessel diameter, and improvement of best-corrected visual acuity to 20/25 was seen. CONCLUSIONS: This verteporfin photodynamic therapy combined with intravitreal triamcinolone acetonide appeared to cause involution of the hemangioma with reduction in macular edema and improvement in visual acuity.