Effectiveness of Combined Surgery Simultaneously Correcting 3 Main Causes of Involutional Entropion

PURPOSE: To evaluate the long-term effectiveness of inferior retractor tightening combined with lateral tarsal strip surgery and anterior lamellar resection for simultaneously correcting the 3 main causes of involutional entropion. METHODS: In this retrospective study we reviewed 80 patients diagnosed with involutional entropion between April 2004 and February 2014 at the Korea University Guro Hospital and Cheonan Chungmu Hospital. The patients were evaluated for the 3 major causes of involutional entropion and were confirmed to have all components. Lateral canthal tendon laxity test and anterior lamellar redundancy test were performed to grade the involutional entropion patients. The patients received inferior retractor tightening, lateral tarsal strip operation and anterior lamellar resection procedure simultaneously. RESULTS: Eighty involutional entropion patients were included in the present study. The patients consisted of 35 males and 45 females with an average age of 71.1 ± 9.3 years. In the lateral canthal tendon laxity test, 52 (61.2%) eyes were grade II, 33 (38.8%) eyes were grade III. In the anterior lamellar redundancy test, 17 (20%) eyes were grade I, 57 (67.1%) eyes were grade II and; 11 (12.9%) eyes were grade III. Among the 80 patients, 85 eyelids received combined surgery, 84 had successful outcomes and 1 case recurred at 5 months following the primary surgery with an average follow up of 26.5 ± 4.6 months. Lateral canthal deformity was observed in 2 eyelids which were corrected successfully. CONCLUSIONS: Simultaneous correction of the 3 main causes of involutional entropion through inferior retractor tightening, lateral tarsal strip surgery and anterior lamellar resection procedure is effective in correcting involutional entropion and safe in avoiding overcorrection.

Clinical Characteristics of Benign Eyelid Tumors

PURPOSE: To report the relative frequency and clinical characteristics of patients with benign eyelid tumors. METHODS: A retrospective study of 192 consecutive patients admitted to Korea University Ansan Hospital with benign eyelid tumor between January 2009 and December 2014 was undertaken, and clinical records including age, sex, involved site, and pathology of tumors were reviewed retrospectively. All eyelid tumors were confirmed histopathologically. RESULTS: The sexual distribution revealed 87 males and 105 females with benign eyelid tumors. The mean age at diagnosis was 42.6 +/- 19.2 years. Molluscum contagiosum (5.5 +/- 3.5 years) and pilomatrixoma (14.0 +/- 15.6 years) were generally found in younger individuals, while seborrheic keratosis (60.2 +/- 15.8 years) and squamous cell papilloma (50.5 +/- 13.4 years) occurred predominantly in elderly patients. Tumors were most common on the upper lid (63.0%). The four most frequent subtypes were melanocytic nevus (37.5%), epidermal cyst (8.3%), squamous cell papilloma (5.7%), and seborrheic keratosis (5.2%). CONCLUSIONS: The most common histopathological diagnosis of benign eyelid tumors was melanocytic nevus. The results of this study provide epidemiological information that will be useful for diagnosis and therapy of such tumors.

Therapeutic Effect of Squeezing the Punctum and Lacrimal Canaliculus in Canaliculitis Patients

PURPOSE: To report the therapeutic effect of squeezing the punctum and lacrimal canaliculus using Q-tips in canaliculitis patients. METHODS: From March 2004 to February 2014, 42 eyes of 42 patients diagnosed with canaliculitis at our clinic were retrospectively analyzed. To remove the discharge and concretions, the punctum and lacrimal canaliculus were squeezed using Q-tips without invasive procedures. RESULTS: The mean patient age was 56.39 years and mean follow-up period was 10.6 months. No statistical significance was observed in terms of rate of disease occurrence and mean age between males and females. Among the eyes analyzed, 30 (71.4%) were cured with only 1 squeezing procedure, 12 eyes (28.6%) required more than 2 procedures; 1 eye (2.3%) recurred and the period until recurrence was 3.8 months. CONCLUSIONS: Most studies support surgical management as the definitive therapy for canaliculitis to remove concretions that serve as a reservoir for bacteria. The gold standard treatments are curettage or canaliculotomy; however, these are not safe procedures and may result in epiphora in post-procedure patients due to the risk of lacrimal pump dysfunctioning or scarring of the canalicular system following invasive procedure. Squeezing punctum and lacrimal canaliculus only using Q-tips is effective in removing the canalicular concretions and without causing complications in the canalicular system.

Clinical Effectiveness of the Lateral Tarsal Strip Procedure

PURPOSE: To evaluate the clinical indications and efficacy of the lateral tarsal strip procedure. METHODS: The medical records of patients who underwent the lateral tarsal strip procedure between September 2008 and February 2014 were retrospectively reviewed. We examined age, gender, diagnosis, procedures simultaneously performed with the lateral tarsal strip, duration of observation, postoperative complications and cases requiring revision surgery. Patients without recurrence or undercorrection of eyelid/lateral canthal area lesions, surgical complication and not requiring revision surgery until final visit were considered as successful cases. RESULTS: One hundred eighty-three eyes of 129 patients were included in this study. The mean patient age was 61.6 years and average follow-up duration was 9.2 months. Diagnoses of eyes were lower lid laxity (39.9%), involutional entropion (24.0%), lower lid retraction (14.8%), cicatricial ectropion (6.6%), lateral canthal deformity (5.5%), involutional ectropion (3.8%) and paralytic ectropion (2.7%). Surgical procedures simultaneously conducted with lateral tarsal strip in 167 eyes of 183 eyes were endoscopic dacryocystorhinostomy (30.5%), lower retractor tightening (19.2%), medial spindle procedure (13.8%), mid-lamellar lengthening (12.6%), lower blepharoplasty (10.8%), Quickert suture (4.2%) and Hotz's operation (3.0%). Successful results were obtained in 116 of 129 patients (89.9%). CONCLUSIONS: The lateral tarsal strip procedure can successfully correct lower lid laxity and be used in various clinical indications with or without other surgical procedures.

Anatomical Location and Distribution of Supraorbital Notch and Foramen Evaluations Using Facial 3D Computed Tomography

PURPOSE: To evaluate anatomical locations and distributions of supraorbital notch and foramen using facial 3D computed tomography in the Korean adult population. METHODS: The study sample was composed of 87 adult patients with no history of trauma or ocular disease. The horizontal position of the supraorbital foramen or notch was recorded in relation to a vertical line defined by a reproducible hypothetical point, such as the nasion and mid-maxilla and the midpoint of the horizontal supraorbital plane. The distance and angle for each supraorbital foramen and notch were calculated from the defined vertical line. Furthermore, vertical distance from supraorbital plane, which was established using the highest points of both supraorbital rims, was obtained from the supraorbital foramen. RESULTS: The mean age of the 87 patients was 45.44 +/- 8.34 years (range, 30-59 years). There were 66 eyes in the supraorbital notch and 108 eyes in the supraorbital foramen. There were no distributional differences between the 2 sides. The mean horizontal distance of both types was 23.95 +/- 3.93 mm (range, 16.41-38.94 mm). The horizontal distance of male patients was longer than the female patients (25.18 +/- 4.16 mm vs. 22.63 +/- 3.19 mm, p < 0.001, based on independent t-test) and the horizontal distance of supraorbital notch was shorter than the supraorbital foramen (22.59 +/- 3.18 mm vs. 26.18 +/- 4.04 mm, respectively, p < 0.001, based on independent t-test). The mean vertical distance and mean angles of the supraorbital foramen were 3.02 +/- 1.119 mm and 6.81 +/- 2.31 degrees (degrees), respectively. CONCLUSIONS: The present study described the anatomical location of each supraorbital opening type in Korean adults. According to horizontal distance, a surgeon can avoid iatrogenic injury of the supraorbital neurovascular complex, especially during brow surgery. In addition, the anatomy can aid in targeting supraorbital neurovascular complex in cases of nerve block.

Analysis of Upper Eyelid Fat Pad Changes with Aging and Body Mass Index in Korean

PURPOSE: To evaluate differential changes in the central and nasal fat pads of the upper eyelid associated with aging and the effect of body mass index in Koreans. METHODS: Using a standardized scale, the volume grade of the central and nasal fat pads was graded from 0 to 3 (0 for depressed, 1 for flat, 2 for mildly protruded, and 3 for markedly protruded) in normal adults, consisting of 20 males and 20 females from 30 years of age to 80 years of age. The body mass index was calculated for every patient through interviews using their height and weight. Statistical evaluations correlating age and body mass index with central and nasal fat pad changes were performed. Statistical evaluations correlating age with fat pad changes except for the effect of body mass index were performed. RESULTS: Except for the effect of body mass index, the central fat pad increased (r = -0.176, p = 0.007) and nasal fat pad decreased (r = 0.252, p < 0.001) with aging, which was statistically significant. CONCLUSIONS: With aging, the central fat pad increases and nasal fat pad decreases in the upper eyelid. Clinically, this finding has implications in cosmetic and functional upper eyelid blepharoplasty. In addition, the results may be useful to determine whether to conserve or remove the fat as well as the amount of fat removal during upper blepharoplasty.

Monocanalicular and Bicanalicular Intubation with Sequential Probing for Congenital Nasolacrimal Duct Obstruction in Patients Over the Age of 24 Months

PURPOSE: The clinical effectiveness of monocanalicular or bicanalicular intubation with sequential probing was evaluated in patients over the age of 24 months with congenital nasolacrimal duct obstruction. METHODS: Patients over 24 months of age with congenital nasolacrimal duct obstruction who underwent monocanalicular intubation with sequential probing (19 patients, 20 eyes) or bicanalicular intubation with sequential probing (22 patients, 22 eyes) were studied. Success rates and complications were evaluated. Silicone tube was removed 6 months after surgery. Success was defined as no epiphora and no retention on fluorescein dye disappearance test. RESULTS: The success rate was 95.0% (19 eyes / 20 eyes) in the monocanalicular intubation group and complications included 7 cases of early tube dislodgement, which achieved successful outcome. The success rate was 82.6% (19 eyes / 22 eyes) in the bicanalicular intubation group and complications included 4 cases of punctal slitting, and 3 cases of tube extrusion. The success and complication rates were not significantly different between the 2 groups (p = 0.608, p = 1.000, respectively). CONCLUSIONS: In congenital nasolacrimal duct obstruction, the monocanalicular tube intubation group had similar success and complication rates to the bicanalicular tube intubation group. Silicone tube maintenance for 2 months in the monocanalicular group and for 3 months in the bicanalicular group was sufficient.

Punctoplasty Using a Radiofrequency Surgical Unit for Punctal Stenosis

PURPOSE: To introduce and assess the results of punctoplasty using a radiofrequency surgical unit for punctal stenosis. METHODS: Patients who complained of epiphora, had an intact lacrimal pathway below puncti, and underwent punctoplasty with the Ellman Surgitron F.F.P.F were evaluated in the present study. RESULTS: A total of 19 patients (31 eyes) were included in the study. The average age was 55 years (+/-15.7 years). At the last follow-up visit, 27 eyes (87%) had patent puncti, 1 eye became stenotic again, and 3 eyes were completely obstructed. Twenty-two eyes (71%) showed almost complete disappearance of dye on the fluorescein dye-disappearance test (FDDT). Twenty-five eyes (81%) had symptomatic improvement. No significant complication was reported postoperatively. CONCLUSIONS: Punctoplasty with a radiofrequency surgical unit is a simple and effective method for punctal stenosis.

The Effects of Transcanalicular Diode Laser-Assisted Revision Surgery for Failed Dacryocystorhinostomy

PURPOSE: To determine the intranasal causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted revision surgery. METHODS: Twenty-four patients (29 eyes) who underwent revision surgery for a failed DCR at the Department of Ophthalmology, Ansan Hospital, Korea University between March 2009 and February 2011 were included in the present retrospective study. The intranasal causes of failed DCR, the time of symptoms such as epiphora and discharge after DCR, success rates of revision surgeries and follow-up periods were evaluated. RESULTS: Membranous obstruction was found in 25 eyes (86.2%) and was accompanied with granuloma in 10 eyes; these were the most common causes of failed DCR. The mean time for symptom development after DCR was 14.6 months, the success rate of the first revision surgery was 82.1% and good results were obtained in 5 eyes after the second revision surgery. Recurrence developed in 2 eyes, but symptoms improved after the lateral tarsal strip procedure. CONCLUSIONS: Membranous obstruction was the most common intranasal cause of failed DCR and transcanalicular diode laser-assisted revision surgery produced good results. Additionally, in patients with persistent epiphora following anatomically-patent revisional surgery, lacrimal pump failure due to lower eyelid laxity should be considered and corrected.

Clinical Outcomes of Initial and Repeated Nasolacrimal Duct Office-Based Probing for Congenital Nasolacrimal Duct Obstruction

PURPOSE: To characterize the outcomes of initial and repeated office-based probing as a primary treatment for congenital nasolacrimal duct obstruction (CNLDO) in children. METHODS: The medical records of patients who underwent nasolacrimal duct office-based probing for CNLDO between March 2004 and January 2008 were reviewed retrospectively. Nasolacrimal duct probing was performed on 244 eyes from 229 consecutive patients with CNLDO. Patients who were refractory to the first probing underwent a second probing 4 to 8 weeks later. RESULTS: Based on exclusion criteria, 244 eyes from 229 patients (117 males and 112 females), aged 6 to 71 months (mean, 12.4 +/- 8.36) were included. The success rate of the initial probing was 80% (196 of 244) for all patients, 82% (111 of 136) in the 6 to 12 month age group, 79% (64 of 81) in the 13 to 18 months age group, and 78% (21 of 27) among individuals older than 19 months (p = 0.868, Pearson chi-square test). The success rate of the second probing was 61% (25 of 41) for all patients, 74% (17 of 23) in the 6 to 12 months age group, 58% (7 of 12) in the 13 to 18 months age group, and 17% (1 of 6) among individuals older than 19 months (p = 0.043, Fisher's exact test). CONCLUSIONS: While the success rate of initial nasolacrimal duct probing is not affected by age, the rate of success rate with a second probing was significantly lower in patients older than 19 months. Based on the results, authors recommend further surgical interventions, such as silicone tube intubation or balloon dacryocystoplasty, instead of repeated office probing for patients older than 19 months, if an initial office probing has failed.

The Results of Revisional Surgery for the Failed Endonasal DCR

PURPOSE: This large case study evaluated the success rate of revisional surgery and the causes of failed endonasal dacryocystorhinostomy (DCR) with long-term follow-ups. METHODS: One hundred nine patients (114 eyes) who underwent revisional surgery for a failed endonasal DCR at the Department of Ophthalmology, Guro Hospital, Korea University between January 1995 and January 2005 were included in this retrospective study. We evaluated the causes of failed endonasal DCR and their success rates of revisional surgeries. RESULTS: The causes of surgical failure were membranous obstruction (83 eyes), granuloma (22 eyes), synechia (11 eyes), common canalicular obstruction (11 eyes), functional block (7 eyes), and canalicular obstruction (1 eye). The revisional surgeries were silicone tube intubation after granuloma removal, synechiolysis and membranectomy using Nd:YAG laser and trephination of canalicular obstruction, and endonasal conjunctivodacryocystorhinostomy (CDCR) for the parts of functional block and the canalicular obstruction. The overall success rates of the revisional surgeries were 83.3% (95/114 eyes). The mean follow-ups period was 18.97 months (range, 9~113 months). CONCLUSIONS: This is the first large case study in Korea on revisional surgery with long-term follow-ups, as far as we know. The overall success rates of endonasal DCR after receiving simple revisional surgery were comparable to those of the standard external DCR.

The Results of Revisional Surgery for the Failed Endonasal DCR

PURPOSE: This large case study evaluated the success rate of revisional surgery and the causes of failed endonasal dacryocystorhinostomy (DCR) with long-term follow-ups. METHODS: One hundred nine patients (114 eyes) who underwent revisional surgery for a failed endonasal DCR at the Department of Ophthalmology, Guro Hospital, Korea University between January 1995 and January 2005 were included in this retrospective study. We evaluated the causes of failed endonasal DCR and their success rates of revisional surgeries. RESULTS: The causes of surgical failure were membranous obstruction (83 eyes), granuloma (22 eyes), synechia (11 eyes), common canalicular obstruction (11 eyes), functional block (7 eyes), and canalicular obstruction (1 eye). The revisional surgeries were silicone tube intubation after granuloma removal, synechiolysis and membranectomy using Nd:YAG laser and trephination of canalicular obstruction, and endonasal conjunctivodacryocystorhinostomy (CDCR) for the parts of functional block and the canalicular obstruction. The overall success rates of the revisional surgeries were 83.3% (95/114 eyes). The mean follow-ups period was 18.97 months (range, 9~113 months). CONCLUSIONS: This is the first large case study in Korea on revisional surgery with long-term follow-ups, as far as we know. The overall success rates of endonasal DCR after receiving simple revisional surgery were comparable to those of the standard external DCR.

The Effect of Transconjunctival Lower Blepharoplasty Combined with Pinch Skin Excision Technique

PURPOSE: The aim of this study was to analyze the effects of transconjunctival lower blepharoplasty combined with the pinch skin excision technique. METHODS: This study followed 15 patients over a six-month period who had undergone transconjunctival lower blepharoplasty combined with the pinch skin excision technique. The follow-up period exceeded 6 months. After subconjunctival injection of local anesthetic, incisions of the conjunctiva and lower lid retractors were made. The exposed fat pads were excised by clamping, excising, and cauterizing the base of the pad. The conjunctiva was closed with a continuous 6-0 Vicryl suture. If there was mild skin excess, a pinch skin excision technique was used. RESULTS: There were no complications (i.e., lower eyelid retraction, ectropion, etc.). All 15 patients were satisfied with the final result. CONCLUSIONS: The transconjunctival lower blepharoplasty combined with the pinch skin excision technique in middle-aged patients with prominent lower eyelid fat and skin excess had lower complication rates and higher patient satisfaction than the transcutaneous approach.

The Comparision of Surgical Results of Endonasal Dacryocystorhinostomy in Childen and Adults

PURPOSE: This study evaluated the success and complication rates of endonasal dacryocystorhinostomy (DCR) in children and adults. METHODS: Fifty-six children (57 eyes) and 843 adults (870 eyes) who underwent endonasal DCR to treat nasolacrimal duct obstruction (NLDO) at the Department of Ophthalmology between April 1994 and March 2004 were included in this retrospective study. RESULTS: The mean age of patients was 7.7+/-2.83 years (2~15 years) in children and 51.8+/-14.10 years (16~81 years) in adults, with mean follow-up periods of 28.4+/-23.62 months (10~91 months) and 14.7+/-11.08 months (9~120 months), respectively. The primary success rate in children (94.7%) was significantly higher than that in adults (86.0%). Significantly more synechia formation was found in children (26.3%) than in adults (10.4%). However, granuloma and membranous obstruction in children (respectively 21% and 7.1%) were significantly less than in adults (respectively 37.9% and 15%). CONCLUSIONS: Although endonasal DCR in children has problems such as technical difficulty due to a narrower nasal cavity, postoperative care difficulties and higher rates of synechia formation, endonasal DCR is a safe and effective means of treating NLDO in children, with higher success rates than those in adults.

The Effect of Nonincisional Double Fold Formation Using Three Small Incisions, Two-stitch Method

PURPOSE: The aim of this study was to analyze the effects of using the nonincisional, double fold formation method with three small incisions and two-stitches. METHODS: This study included 39 patients who underwent double eyelid operation by a nonincisional technique and who were followed up for more than 6 months. On the desired double eyelid line, three points 6 mm apart were marked and three stab incisions made. A small amount of subcutaneous tissue was removed through the incisions, and orbital fat was removed through the lateral wound site-if necessary. Using double-armed 7-0 nylon or prolene, two buried sutures of 6 mm width were made. Sixteen patients also underwent surgery for epiblepharon, and three patients with unilateral double eyelid due to trauma had a contralateral eyelid operation for asymmetry correction. Five patients also had epicanthoplasty. RESULTS: Two patients lost their folds completely and reoperations were performed. Two patients showed cysts due to suture material and so the suture knots were removed; the double fold remained afterwards, so no other procedures were needed. In one case, the suture was seen subcutaneously, so suture removal and reoperation were performed. CONCLUSIONS: To minimize double fold loss, which is a disadvantage of the nonincisional double fold formation technique, we removed a portion of pretarsal tissue, muscle, and/or orbital fat and made two wide slings. Also, we corrected asymmetry due to traumatic unilateral double eyelid and epicanthal fold. In conclusion, we expect that our method could extend the applicability of nonincisional double fold formation.

A Case of Intramuscular Hemangioma Presenting with Large-angle Hypertropia

PURPOSE: To report the case of a patient with large-angle hypertropia of an intramuscular hemangioma of the right superior rectus muscle (SR). METHODS: A 63-year-old man with progressive vertical deviation of the right eye for the past 6 months visited our strabismus department; his condition was not painful. An examination indicated that he had 60PD of right hypertropia at distance and near in primary gaze. Additionally, a significant limitation of his downgaze was noted. The right eye appeared mildly proptotic, and the upper and lower eyelids were slightly edematous. Corrected vision was 20/20 in both eyes. RESULTS: Orbital magnetic resonance imaging (MRI) studies revealed fusiform enlargement of the right superior rectus muscle, with prominent but irregular enhancement following gadolinium administration. Incisional biopsy revealed an intramuscular hemangioma in the superior rectus muscle with cavernous-type vessels. CONCLUSIONS: This case demonstrates that intramuscular hemangioma should be considered in the differential diagnosis of isolated extraocular muscle enlargement and unusual strabismus.

The Effect of Nonincisional Double Fold Formation Using Three Small Incisions, Two-stitch Method

PURPOSE: The aim of this study was to analyze the effects of using the nonincisional, double fold formation method with three small incisions and two-stitches. METHODS: This study included 39 patients who underwent double eyelid operation by a nonincisional technique and who were followed up for more than 6 months. On the desired double eyelid line, three points 6 mm apart were marked and three stab incisions made. A small amount of subcutaneous tissue was removed through the incisions, and orbital fat was removed through the lateral wound site-if necessary. Using double-armed 7-0 nylon or prolene, two buried sutures of 6 mm width were made. Sixteen patients also underwent surgery for epiblepharon, and three patients with unilateral double eyelid due to trauma had a contralateral eyelid operation for asymmetry correction. Five patients also had epicanthoplasty. RESULTS: Two patients lost their folds completely and reoperations were performed. Two patients showed cysts due to suture material and so the suture knots were removed; the double fold remained afterwards, so no other procedures were needed. In one case, the suture was seen subcutaneously, so suture removal and reoperation were performed. CONCLUSIONS: To minimize double fold loss, which is a disadvantage of the nonincisional double fold formation technique, we removed a portion of pretarsal tissue, muscle, and/or orbital fat and made two wide slings. Also, we corrected asymmetry due to traumatic unilateral double eyelid and epicanthal fold. In conclusion, we expect that our method could extend the applicability of nonincisional double fold formation.

The Frontalis Sling Operation Using Preserved Fascia Lata: Modified Crawford Technique

PURPOSE: For the correction of ptosis with very poor levator function, frontalis sling operation with various materials has been used. The purpose of this study was to evaluate the effect of the modified Crawford technique using preserved fascia lata. METHODS: The photographs and charts of 46 patients who underwent frontalis sling operation using preserved fascia lata from June 2001 to February 2004 at our hospital were retrospectively reviewed. The eyelid crease approach was used with the suturing of the sling material directly to the tarsus. RESULTS: The patients were 27 males and 19 females. There were 20 (44%) unilateral cases and 26 (56%) bilateral cases. The age of the patients ranged from 1 to 65 years at the time of surgery, with an average age of 8.3 years. The success rate was 93% (43/46 patients) for a mean postoperative follow-up of 9 months (range 4~26 months). The complications consisted of one case of overcorrection and 2 cases of undercorrection. Knot exposure occurred in 2 cases. CONCLUSIONS: The modified Crawford technique using preserved fascia lata appears to be an effective treatment for severe ptosis. The lid crease formation provides good cosmetic results and the direct suturing of the preserved fascia lata to the tarsus prevents its migration.

Clinical Evaluation of Endoscopic Endonasal Conjunctivodacryocystorhinostomy (CDCR) with Jones Tube Placement

PURPOSE: To evaluate the efficacy of endoscopic endonasal primary conjunctivodacryocysto-rhinostomy (CDCR) and revision CDCR after primary CDCR. METHODS: Twenty patients who had undergone endoscopic endonasal CDCR with Jones tube and who were followed for over 6 months at our hospital were reviewed retrospectively. Our analysis included success rate, operation time and causes of failure. RESULTS: The indications for revision CDCR were prolapse of Jones tube and inadequate tube length. The initial success rate in the primary and revision groups was 78.6% (11/14) and 100% (6/6), respectively. Two initial failures in the primary group were later successful after revision. The mean operation time in the groups was 23.9 minutes ( +/- 6.3) and 21.7 minutes ( +/- 6.1), respectively. The main causes of failure included inaccurate tube length and abnormal tube position. CONCLUSIONS: Endoscopic endonasal CDCR appears to be a reasonable approach for revision, as well as primary, because of accurate measurement of Jones tube length during surgery and the shortened operation time.

The Effect of Single Suture Inferior Retractor Tightening for Senile Entropion

PURPOSE: To evaluate the clinical efficacy of a simplified single suture inferior retractor tightening technique in senile entropion. METHODS: Twenty patients (26 eyes) showing no severe horizontal lid laxity underwent an operation for senile entropion between April 2001 and July 2003. After a subciliary incision, the inferior retractor was identified, and repaired by reattaching the superior edge of the inferior retractor to the inferior edge of the lower tarsus using a single 5-0 Prolene suture. RESULTS: The patients were followed up for an average of 2.8 months after surgery. Five patients showed complications: two overcorrections and three recurrences of entropion. The others all showed good cosmetic and functional results. The recurred cases underwent further operation with good results. CONCLUSIONS: The simplified single suture inferior retractor tightening gave good results in patients with senile entropion without severe horizontal lid laxity. Moreover, this procedure has short operation and recovery times. In unilateral cases, more symmetric appearances were obtained compared with combined surgeries.