Combination Surgery of Silicone Tube Intubation and Conjunctival Resection in Patients with Epiphora

PURPOSE: To compare the success rates of performing only silicone tube intubation versus carrying out both conjunctival resection and silicone tube intubation. METHODS: The subjects of this study involved 62 patients (96 eyes) between October 2015 and May 2017 who were diagnosed as having punctal stricture or nasolacrimal duct stenosis. Out of 96 eyes, 47 underwent only silicone tube intubation, and 49 underwent both silicone tube intubation and conjunctival resection. Three parameters were measured at 1, 3, and 6 months after the surgery: the area of the tear meniscus using RTVue-100 anterior segment optical coherence tomography, the height of the tear meniscus using a slit lamp microscope, and the subjective satisfaction of patients as a result of improved sympotms like epiphora. The surgery was considered successful when the patients' experienced the resolution of symptoms and reduction of the area and height of the tear meniscus. RESULTS: The area of the tear meniscus, height of the tear meniscus, and subjective satisfaction of patients was superior in the group that underwent both silicone tube intubation and conjunctival resection compared silicone tube intubation only. Based on these results, the success rate of the surgery was 68.9% in the group that underwent only silicone tube intubation and 78.7% in the group that underwent both silicone tube intubation and conjunctival resection. CONCLUSIONS: The resection of relaxed plica semilunares seems to increase the success rate of silicone tube intubation through the reduction of the area and height of the tear meniscus. Therefore, after determining the degree of conjunctivochalasis, if it was found to be severe, a combination with conjunctival resection was expected to increase the success rate of the surgery.

Eyelid Contour Analysis Following Müller's Muscle-conjunctival Resection and Levator Aponeurosis Advancement in Mild to Moderate Belpharoptosis

PURPOSE: To analyze both the effects and the eyelid contour of Müller's muscle-conjunctival resection and levator aponeurosis advancement in patients with mild to moderate belpharoptosis. METHODS: We conducted a retrospective cross-sectional study including 20 eyes of 16 patients who underwent Müller's muscle-conjunctival resection and 25 eyes of 17 patients who underwent levator aponeurosis advancement from January 2012 to December 2015, where each patient was followed up for at least 6 months. Surgical success was defined as either a marginal reflex distance 1 (MRD₁) elevation greater than 2.5 mm postoperatively or a bilateral MRD₁ difference less than 0.5 mm. Both the conventional and 12 oblique mid-pupil lid distances were measured every 15 degrees using custom software developed in the MATLAB program (MathWorks, Natick, MA, USA). RESULTS: The average correction of Müller's muscle-conjunctival resection was 1.1 mm, while that of levator aponeurosis advancement was 0.9 mm. There was no significant difference in MRD₁, MRD₂, function of levator palpebrae muscle, or lid contour in the preoperative status between the Müller's muscle-conjunctival resection group and the levator aponeurosis advancement group. The surgical success rate was 85% in the Müller's muscle-conjunctival resection group and 84% in the levator aponeurosis advancement group, but this difference was not significant. The postoperative lid contour (superomedial side, 15°) was more effective in the Müller's muscle-conjunctival resection group (p < 0.05). CONCLUSIONS: Overall, both types of blepharoptosis surgery were effective at correcting mild to moderate blepharoptosis. The correction of mild to moderate blepharoptosis using Müller's muscle-conjunctival resection is an effective technique for elevating the eyelid and normalizing the eyelid contour.

Conjunctival Flap Surgery Using Calcium Plaque Scissors for Calcified Scleromalacia after Cosmetic Conjunctivectomy

PURPOSE: To research the advantage of using calcium plaque scissors in conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. METHODS: We analyzed 55 eyes that had undergone conjunctival flap surgery for calcified scleromalacia occurring after cosmetic conjunctivectomy. Surgical blade was used in 30 eyes (Group 1) and calcium plaque scissors in 25 eyes (Group 2). Time after conjunctivectomy, plaque size, operation time and visual acuity before and after the flap surgery were analyzed and compared. Additionally, necessity of additional scleral surgery was evaluated. Optical coherence tomography (OCT) of the sclera was performed both pre- and postoperatively and the results were compared. RESULTS: An average of 3.9 +/- 1.0 years elapsed until conjunctival flap surgery and follow-up time was 5.2 +/- 3.8 months. Post conjunctivectomy time and plaque size were similar in both groups (p = 0.87 and 0.49, respectively). The surgery time in Group 2 was shorter than in Group 1 (17.5 +/- 6.3 minutes and 21.9 +/- 8.5 minutes, respectively, p = 0.20). Uncorrected visual acuity was similar in both groups before and after conjunctival flap surgery (p = 0.53 and p = 0.20, respectively). In Group 1, one sclera transplantation and three Ologen(TM) insertion surgeries were performed as an additional scleral surgery. Based on OCT, calcium plaque scissors were confirmed as a new surgical tool for calcium plaque removal with minimal scleral damage. CONCLUSIONS: Using calcium plaque scissors when performing conjunctival flap surgery for calcium plaque removal that occurred after cosmetic conjunctivectomy reduces the necessity of an additional scleral surgery and surgery time.

The Efficacy of Fibrin Glue in Surgical Treatment of Conjunctivochalasis With Epiphora

PURPOSE: To investigate the efficacy of fibrin glue used in conjunctival resection for conjunctivochalasis with epiphora. METHODS: Twenty-three patients (42 eyes) with conjunctivochalasis without nasolacrimal duct obstruction underwent conjunctival resection using either absorbable sutures (11 patients, 20 eyes, Group 1) or fibrin glue (12 patients, 22 eyes, Group 2) to attach the conjunctiva to the sclera. Outcomes recorded were improvement of epiphora, postoperative discomfort, and operation time. Postoperative discomfort was analyzed only in one eye (right eye) in case that the both eyes were operated. RESULTS: Epiphora completely improved in 6 eyes (30%) in Group 1 and 8 eyes (36.4%) in Group 2, partially improved in 9 eyes (45%) and 8 eyes (36.4%), and did not improved in 5 eyes (25%) and 6 eyes (27.2%), respectively (p=1.000). On the first day postoperatively, postoperative eye discomfort developedin 7 eyes (63.6%) in Group 1 and 5 eyes (41.7%) in Group 2 (p=0.414). Throughout the following week, the discomfort lasted in 6 eyes (54.5%) in Group 1 and 1 eye (13.6%) in Group 2 (p=0.027). The mean operation time was 25.0 (+/-2.6) minutes in Group 1 and 12.0 (+/-2.4) minutes in Group 2 (p<0.001). CONCLUSIONS: The success rates were similar in the two groups. However, the use of fibrin glue significantly reduces the postoperative discomfort and the operation time. Therefore, the use of fibrin glue in conjunctival resection of conjunctivochalasis seems to be an effective method.