The Efficacy of the Combined Procedure in Involutional Entropion Surgery: A Comparative Study

PURPOSE: To evaluate the efficacy of the combined procedure in the management of involutional entropion. METHODS: In this study, we reviewed 45 eyes of 36 patients who underwent the combined procedure (lateral tarsal strip, retractor tightening, and everting sutures) for the management of involutional lower eyelid entropion and compared the results with 31 eyes of 25 patients who underwent the Wies procedure. Exclusion criteria included previous lower eyelid surgery and follow-up of less than 6 months. RESULTS: No patients demonstrated entropion on the first postoperative day. The mean follow-up period was 18.4 months (6 to 52 months) in the Wies group and 22.6 months (6 to 59 months) in the combined procedure group. During the follow-up period, 9 of 31 eyes in the Wies group presented with recurrence and only 1 of 45 eyes in the combined procedure group presented with recurrence (p = 0.001). The average time of recurrence was 4.8 months in the Wies group. Recurrence occurred at 2 months postoperatively in the patient in the combined procedure group. Six of the 9 recurrences in the Wies group were managed by the combined procedure. None of these patients had further recurrence after correction. Three patients complained about a visible incision line after the Wies procedure. CONCLUSIONS: The combined procedure seems to be more effective than the Wies procedure in the management of involutional entropion. The combined procedure addresses the three major causative factors in involutional entropion and makes it possible to perform the surgery using a small incision.

Visual outcome of pars plana vitrectomy with intraocular foreign body removal through sclerocorneal tunnel and sulcus-fixated intraocular lens implantation as a single procedure, in cases of metallic intraocular foreign body with traumatic cataract.

Aim: To evaluate visual outcome following pars plana vitrectomy (PPV) and intraocular foreign body (IOFB) removal through the sclerocorneal tunnel combined with simultaneous cataract extraction and sulcus-fixated intraocular lens (IOL) implantation as a single procedure in penetrating ocular trauma with IOFB and traumatic cataract. Materials and Methods: Eighteen cases of penetrating ocular trauma with retained IOFB and traumatic cataract who underwent PPV, IOFB body removal and cataract extraction with posterior chamber IOL (PCIOL) implantation in the same sitting, between June '04 and December '05 were retrospectively analyzed. All the foreign bodies were removed through the sclerocorneal tunnel. Result: All the 18 patients were young males, with an average follow-up period of 12 months. In 12 cases the foreign body was intravitreal and in six cases it was intraretinal but extramacular. Thirteen cases had a best corrected visual acuity ranging from 20/20 to 20/60 at their last follow-up. Five cases developed retinal detachment due to proliferative vitreoretinopathy (PVR) changes postoperatively and were subsequently managed by surgery. Conclusion: Primary IOL implantation with combined cataract and vitreo-retinal surgery is a safe option reducing the need for two separate surgeries in selected patients with retained IOFB and traumatic cataract. This combined procedure provides good visual outcome with early rehabilitation in young working patients.

Surgical Effect of Canaliculodacryocystorhinostomy in Patients with Failed Conjunctivodacryocystorhinostomy

PURPOSE: To analyze outcomes of the canaliculodacryocystorhinostomy and the combined procedure of canaliculodacryocystorhinostomy and Jones tube reinsertion, in patients who had complications of conjunctivodacryocystorhinostomy, which required other surgical procedures. METHODS: We retrospectively analyzed the outcomes of 18 eyes (16 patients) who visited the Department of Ophthalmology, Yeungnam University Hospital for functional failures and complications of conjunctivodacryocystorhinostomy, and who underwent either the canaliculodacryocystorhinostomy or the combined procedure between February 1994 and October 2003. These patients had submerged, prolapsed, lost, or obstructed Jones tubes, with a length of patent canaliculi from the puncta of more than 7mm, identified with probing, irrigation and dacryocystography. RESULTS: Complete or significant improvement of epiphora was achieved in 83.3% (15 of 18 eyes) after a follow-up period ranging 6 to 70 months (average 28.5 months). CONCLUSIONS: Canaliculodacryocystorhinostomy and the combined procedure can be expected to achieve functional success in patients who suffer from complications of the Jones tube. We recommend these procedures in cases of common canalicular obstruction and upper and lower canalicular obstruction with a length of patency greater than 7mm.

Results of Combined Procedures versus Two-Stage Operation using Small Incision in Patients with Cataract and Glaucoma

To compare the result of small-incision combined procedure with that of two-stage procedure, the authors retrospec- tively reviewed 21 patients (23 eyes) who underwent small-incision combined cataract and glaucoma surgery (group 1) and 21 patients (23 eyes) who underwent small-incision cataract surgery after trabeculectomy (group 2). Intraocular pressure (IOP), visual acuity, bleb status, antiglaucoma medications and complications were analyzed.The mean follow-up period was 12.9 (2.3~30.1) months in group 1 and 13.9 (2.1~35.9) months in group 2. The mean preoperative IOP was 21.1 +/-6.6mmHg in group 1 and 26.6 +/-9 .3 mmHg in group 2. The mean postoperative IOP was 14.3 +/-3 .7 mmHg and 15.8 +/-3.1 mmHg in group 1 and 2, respectively. At last visit,13 eyes (56.5%) in group 1 and 12 eyes (52.2%)in group 2 had functioning blebs, and 21 eyes (91.3%) in group 1 and 17 eyes (73.9%) in group 2 had well controlled postoperative IOP without antiglaucoma medications.Rupture of posterior capsule,bleb site leakage, hypotony occurred in both groups; button hole (1 eye in group 1) and hyphema (2 eyes in group 2) were observed. These results indicate that the small-incisioncombined cataract and glaucoma surgery may be as safe and effective as the two-stage procedure.

Results of Combined Cataract and Glaucoma Surgery with Mitomycin C

To evaluate the results for intraocular pressure (IOP), visual acuity and postoperative complications, we conducted a retrospective review of the records of 29 consecutive cases who had combined cataract and glaucoma surgery with mitomycin C (0.2mg/ml) in patients with coexisting cataract and glaucoma. The mean follow-up period was 6.8 +/- 1.8 months. The mean preoperative lOP was 26.3 +/- 9.1mmHg(range, 11-44mmHg), which decreased by mean 12.1mmHg to a mean postoperative IOP of 14.2 +/- 3.4mmHg(range,7-22mmHg) as measured at the last follow-up. At the last follow-up, 21 eyes(72.4%) had IOPs of 21mmHg or less without glaucoma medications as complete sucess. The mean preoperative number of antiglaucoma medication was 2.4 +/- 1.0 (range, 1-4), which decrease to a mean number of antiglaucoma medication of 0.4 +/- 0.7 (range, 0-2) at the last follow-up. All patients were using fewer medications at last follow-up than preoperatively. Twenty two eyes (75.9%) had a best-corrected visual acuity of 0.5 or better at the last follow-up. Last follow-up best-corrected visual acuity was better than the preoperative best-corrected visual acuity for all patients. Six eyes (20.7%) had fibrinous uveitis as the most common postoperative complication, and other complications were hyphema, wound leak and cystoid macular edema etc. The glaucoma triple procedure with adjunctive mitomycin C(0.2mg/ml) appears to be a safe and effective surgical technique for treating patients with coexisting cataract and glaucoma.

Efficacy of Intraocular Pressure Control in Glaucoma Combined Procedure (Extracapsular Cataract Extraction with Trabeculectomy)

We reviewed 21 cases of extracapsular cataract extraction with trabeculectomy (combined procedure) and 21 cases of trabeculectomy in glaucoma patients in order to evaluate any differences in the efficacy of the intraocular pressure (IOP) control between the two groups. The long-term IOP control effects were not diferent statistically between the two groups. During 2 weeks after operation, however, average IOP of combined procedure group was higher than that of trabeculectomy group. Visual acuity was improved in 71% of the combined procedure group. and the rest of them were not improved in vision because of extensive preoperative optic nerve damage. The complications were increased anterior chamber reaction and posterior synechia in combined procedure group and cataract progression as a late one in trabeculectomy group.

Combined Procedure of Open Reduction and Shortening of the Femur in Treatment of Congenital Dislocation of the Hips in Older Children / 대한정형외과학회잡지

Combined procedue of open reduction and shortening of femur for treatment of congenital hip dislocation in the older child is known to minmize the incidence of avascular necrosis, redislocation and stiffness. Thirty six hips in thirty three children were operated upon in the past six years with combined procedue of open reduction and shortening of femur. And twenty eight hips in twenty five children who were followed up more than one year were analysed. By the results, we obtained excellent in twenty nine percent, good in fifty three percent, fair in fourteen percent and poor in four percent.