Effect of nasolacrimal duct packing combined with sodium hyaluronate gel injection in locating the nasal broken end in lacrimal canaliculus anastomosis which is difficult to find the broken end / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of nasolacrimal duct packing combined with sodium hyaluronate gel injection in locating the nasal broken end in lacrimal canaliculus anastomosis which is difficult to find the broken end.METHODS:A total of 13 patients(13 eyes)with traumatic single lacrimal canaliculus rupture were treated in our hospital. RS lacrimal duct drainage tube was inserted into the lacrimal duct from intact lacrimal canaliculus to fill the nasolacrimal duct, then sodium hyaluronate gel was injected to make sodium hyaluronate gel overflow from the nasal broken end of fractured lacrimal canaliculus, which was used to locate the nasal broken end which was difficult to find and completed the lacrimal anastomosis operation.RESULTS: Among the patients with 13 eyes who were difficult to find the broken end, the nasolacrimal duct was filled with RS lacrimal duct drainage tube. After injection of sodium hyaluronate gel, the gel overflowed from the nasal broken end under direct vision of the microscope, and the lacrimal duct drainage tube was successfully inserted, and the success rate of finding the broken end was 100%. Thirteen eyes were extubated after being placed for 3mo, and then were followed up for 6mo. Among them, 9 eyes were cured, 3 eyes were markedly effective and 1 eye was ineffective. The cure rate was 69%, and the total effective rate was 92%.CONCLUSION: A new technique for rapid location of nasal broken end is proposed for patients in which are difficult to find the broken end. This method is simple to operate and requires a relatively low clinical experience. It is suitable for patients with different degrees of single lacrimal canaliculus rupture and can complete complex lacrimal canaliculus rupture anastomosis in a short time.

Effect of endoscopic canaliculus opening operation for proximal lacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the feasibility, effect and safety of endoscopic canaliculus opening operation with lacrimal drainage tube for proximal lacrimal duct obstruction.<p>METHODS: Totally 52 patients(61 eyes)with proximal lacrimal duct obstruction were examined in the Third Affiliated Hospital of Nanchang University from June 1 2016 to June 1 2018, and all were treated by endoscopic canaliculus opening operation with lacrimal drainage tube. Lacrimal drainage tube was removed after 2-3mo. All patients were followed up from 6-12(mean 7.3±2.2)mo. The operation effect and complications were observed.<p>RESULTS: All patients were treated by endoscopic canaliculus opening operation with lacrimal drainage tube successfully. The recovery rate was 85%, improvement rate was 8%, ineffective rate was 7%, effective rate was 93%. Without serious complications occurred after operation.<p>CONCLUSION: Endoscopic canaliculus opening operation with lacrimal drainage tube for treating the proximal lacrimal duct obstruction, could locate precisely and fully open the normal lacrimal duct with high success rate, safe and feasible.

Curcumin Prevents Bile Canalicular Alterations in the Liver of Hamsters Infected with Opisthorchis viverrini

Opisthorchis viverrini infection causes inflammation and liver injury leading to periductal fibrosis. Little is known about the pathological alterations in bile canaliculi in opisthorchiasis. This study aimed to investigate bile canalicular alterations in O. viverrini-infected hamsters and to examine the chemopreventive effects of curcumin on such changes. Hamsters were infected with O. viverrini and one group of animals was fed with 1% dietary curcumin supplement. Animals were examined during the acute infection phase, days 21 and 30 post-infection (PI) and chronic infection phase (day 90 PI). Scanning electron microscopy revealed that in the infected group fed with a normal diet, bile canaliculi became slightly tortuous by 30 day PI and more tortuous at day 90 PI. Transmission electron microscopy showed a reduction in microvilli density of canaliculi starting at day 30 PI, with a marked loss of microvilli at day 90 PI. These ultrastructral changes were slightly seen at day 21 PI, which was similar to that found in infected animals fed with 1% curcumin-supplemented diet. Notably, curcumin treatment prevented the reduction of microvilli density, reduced the dilation of bile canaliculi, and decreased the tortuosity of the bile canaliculi relative to non-infected animals on a normal diet at days 30 and 90 PI. These results suggest that curcumin reduces alteration of bile canaliculi and may be a promising agent to prevent the onset of bile duct abnormalities induced by O. viverrini infection.

Frequency and Characteristic Findings of the Common Canaliculus in Koreans

PURPOSE: To investigate the different types of anatomical connection between the lacrimal sac and the canaliculi using digital subtraction dacryocystography (DCG) in Koreans. METHODS: The authors of the present study performed digital subtraction DCG in Korean patients who presented with epiphora from January 2010 until December 2010. The 248 patients (496 eyes) who achieved a satisfactory DCG image were classified as follows: 1) type I: visible common canaliculus (CC), 2) type II: no visible CC and the canaliculi entering the sac at the point where they meet on the sac wall (common opening), 3) type III: no visible CC and common opening, and each canaliculus entering the sac from different points. RESULTS: Out of a total of 496 eyes, CC was observed in 449 eyes (type I: 90.5%). In 41 eyes (8.3%), the CC was absent (type II), but the upper and lower canaliculi joined at the wall of the lacrimal sac. In 6 eyes (1.2%), the upper and lower canaliculi entered the sac separately (type III). Eighteen patients (7.3%) showed different types of lacrimal drainage system between the 2 eyes. CONCLUSIONS: The CC may not exist in all patients, and the type of anatomical connection between the lacrimal sac and the canaliculi may be different between the eyes in the same individuals. Although such patients comprise a minority, anatomical knowledge of the lacrimal drainage system could be helpful to assess and manage patients with lacrimal drainage disorder.

Factors Affecting the Long-term Outcome of Silicone Tube Intubation in Patients With Nasolacrimal Duct Obstruction

PURPOSE: To evaluate factors affecting the outcome of silicone tube intubation in patients with nasolacrimal duct obstruction. METHODS: A retrospective study of the outcome of silicone tube intubation performed from August 2001 to August 2009 in 98 patients (132 eyes) with nasolacrimal duct obstruction was conducted. Improvement was defined as the disappearance of epiphora after silicone tube intubation and success was defined as maintenance of improvement by the time of the final patient follow-up. Recurrence was also defined as appearance of epiphora after silicone tube extubation. RESULTS: The success rate was 76.5% (101 eyes), failure rate was 8.3% (11 eyes), and recurrence rate was 15.2% (20 eyes). Preoperative canaliculus irrigation test was significantly correlated with symptomatic improvement and recurrence after silicone tube intubation (p = 0.003 and 0.045, respectively). The mean time that patients experienced recurrence was 43.7 months after silicone tube intubation, according to Kaplan-Meier survival analysis. CONCLUSIONS: Preoperative canaliculus irrigation test is a simple and effective tool to estimate the outcome of silicone tube intubation. This outcome should be considered in the stage of planning treatment in nasolacrimal duct obstruction patients.

Management of Dermoid Tumor in the Medial Canthal Area

Dermoid tumors in the medial canthal area are rare, but when present they commonly adhere to the lacrimal canaliculi. Three patients presented with a mass in the medial canthal area. The authors performed excisional biopsies, and the masses were diagnosed as dermoid tumors. In two patients, canalicular lacerations were found after mass excision, which suggested that the masses had been firmly adherent to the lacrimal canaliculi. The lacerated canaliculi were repaired after bicanalicular silicone intubation. In the remaining patient, lacrimal silicone intubation was performed at the beginning of surgery, and the mass was successfully dissected from the canaliculi, leaving them intact. Excision of dermoid tumors in the medial canthal area requires careful dissection to avoid canalicular laceration. Bicanalicular silicone intubation at the beginning of surgery is helpful for the identification of the canaliculi and for the prevention of canalicular laceration during dermoid tumor excision.

Correspondence among the Canaliculus Irrigation Test, Dacryocystography and Jones Test in the Epiphora Patients

PURPOSE: The correspondence between the canaliculus irrigation test, dacryocystography, and Jones test in patients with epiphora was investigated. METHODS: The study included 494 eyes of 359 patients who complained of epiphora and underwent both canaliculus irrigation test and dacryocystography from May 2001 to March 2006. Sixty-eight eyes from 34 patients diagnosed with functional lacrimal duct obstruction took Jones tests. Factors such as age, sex, duration of epiphora, and site of obstruction were analyzed in terms of correspondence of the tests. RESULTS: Between the canaliculus irrigation test and dacryocystography, correspondent rate was 55%. Correspondence had no relation to patient age, sex, duration of epiphora, or site of obstruction. Between Jones test and dacryocystography, the correspondent rate was 47%. Factors affecting the correspondences were not significantly found. CONCLUSIONS: A canaliculus irrigation test can give useful information with high correspondence rate of dacryocystography in the case of 'not pass' or 'pass without regurgitation'. Therefore dacryocystography should be utilized in "pass with regurgitation" cases by canaliculus irrigation test.

Nursing about using the Worst lacrimal probe to repair the lacerateon of lacrimal canaliculus / 中国实用护理杂志

Objective To explore the ideal postoperative nursing methods of repair the lacerateon of lacrimal canaliculus. Methods Using pigtail probe to repair the lacerateon of lacrimal canaliculus in 49 patients, observed the postoperative nursing points in different clinical phases. Results There were 2 patients had the anstomotic stoma split, 1 patient had the canaliculitis. There were 46 patients had successful extubation. Conclusion The Worst lacrimal probe is an satisfactory and reliable method to repair the lacerateon of lacrimal canaliculus. The detailed interpretation and the skillful nursing care are the guarantee for successful operation.

A Case of Congenital Accessory Punctum and Canaliculus in a Dry Eye Patient

PURPOSE: We report a case of congenital accessory punctum and canaliculus in a patient with dry eye, which had not previously been reported in Korea. METHODS: A 56-year old woman presented with dry eye that was more pronounced in the left eye than in the right. An accessory punctum was found in the left medial canthus. Dacryocystogram showed that the accessory punctum had an independent canaliculus which was connected to a normal upper canaliculus. RESULTS: The symptoms were relieved after permanent punctal occlusion of the lower and accessory puncta. CONCLUSIONS: Severe dry eye can be induced by congenital accessory punctum and canaliculus.

A Case of Reconstruction of Punctal, Vertical Canaliculus, and Ampulla Laceration

PURPOSE: To report a case with a rare form of laceration through the upper punctum, vertical canaliculus, ampulla, and upper eyelid. A modified method of repair involving the use of a bicanalicular silicone stent in the canalicular systems was used successfully. METHODS: A 7-year-old child with laceration through the upper punctum, vertical canaliculus, ampulla, and upper eyelid visited our hospital and was treated with the repair methods. A Crawford Probe(R) (FCI Ophthalmics, Marshfield Hills, MA, U.S.A.) was intubated. No direct suture was done to the canaliculus. Two 8-0 Vicryl sutures were passed through the orbicularis around the ampulla in circular fashion and tied. The authors evaluated the effectiveness and stability of the silicone stent. RESULTS: On the 13th day after surgery, all the lid sutures were removed. One and two months after surgery, the patient had no tearing. Three and a half months after operation, the patient visited our clinic because of prolapse of the silicone stent to the ocular side. Irrigation through the lacrimal passage was normal and the stent was removed. Two months after removal, the patient was free from symptom with a patent canaliculus.

Bicanalicular Silicone Tube Intubation after Simple Probing in Common Canaliculus Obstruction

PURPOSE: To investigate the surgical outcome of silicone tube intubation after simple probing performed in obstruction of distal part of canaliculus or common canaliculus. METHODS: Silicone tube intubation was done in 24 patients with obstruction of distal part of canaliculus or common canaliculus, whose obstruction was readily opened by simple probing under mild pushing pressure and who had successful lacrimal irrigation after probing. Silicone tube was removed at about 6 months after operation and the epiphora improvement, dye disappearance test, and lacrimal irrigation test were evaluated at 2 month after the intubation and 2 months after the tube removal. RESULTS: The average of probing to perforate the obstructed canaliculus were 2.1. At 1 month after the intubation, epiphora was improved in 19 patients (79.2%), and 18 patients (75.0%) showed a grade 2+ or lower in dye disappearance test, and lacrimal irrigation was successful in 21 patients (87.5%). 2 months after the tube removal, epiphora was improved in 18 patients (75.0%), and 18 patients (75.0%) showed a grade 2+ or lower in dye disappearance test, and lacrimal irrigation was successful in 20 patients (83.3%). CONCLUSIONS: When the obstruction of distal part of canaliculus or common canaliculus is thin membranous nature, good surgical outcome can be expected by silicone tube intubation after simple probing using mild pushing pressure without other special procedure.

Comparison between Upper and Lower Canalicular Tear Flow using Dacryoscintigraphy

We evaluated the relative tear flow in the upper and lower canaliculus using dacryoscintigraphy. 22 eyes were studied in 11 persons and the upper or lower punctums of both eyes were occluded with 0.3 or 0.4 mm diameter 1.75 mm long collagen plug and 13 of Technetium-99m sulphur colloid were placed in both eyes. Dacryoscintigraphy was performed in the upright position for 12 minutes. Using Pegasys. program, time-activity curve and T1/2 of radioisotope in the palpebral aperture were measured twice and the mean T1/2 was calculated. T1/2 values with the upper and lower canaliculus occluded were compared and analyzed. Of 22 eyes studied, 12 had more rapid tear transport in the upper canaliculus and 10 through the lower. The mean T1/2 of transport in the upper canaliculus was 703.2+/-789.2 seconds and 692.3+/-450.3 seconds in the lower. Tear drainage in the lower canaliculus was more rapid but this value was not found to be statistically significant (P=0.626 ). Therefore there was no significant difference between the upper and lower canalicular tear flow but individual variabilities. Considering these results, when punctum occlusion for the treatment of dry eye and reconstruction of canalicular laceration are performed we should equally weigh on both the upper and lower canaliculus.

Clinical Experience of Monocanaliculonasal Stent in Canalicular Laceration

Repairing of canalicular laceration has some controversies on the golden timing of surgery, the suture method, the materials of stent, and the need of repairing the upper canaliculus in case of involving upper canaliculus. Until recently, reconstruction of the canaliculus with a bicanalicular silicone stent has been accepted as the most reasonable method. But the bicanalicular stent has some disadvantages including cosmetic problem and the possibility of injuries to the normal canaliculus during intubation. The authors used newly developed monocanaliculonasal stents in nine patients with traumatic canalicular laceration and it showed the absence of epiphora the cosmetically superiority, and the simplicity of intubation, compared with bicanalicualr silicone stent.

Use of Conjunctiva and Labial Mucosa for Dacryocystoplasty / 昆明医科大学学报

A new menthod for treating old laceration of Lacrimal canaliculus with dacryocystoplasty using conjunctiva or labial mucosa was recommended by the authors. Out of 14 cases,9 cases were operated on with conjunctiva.7 cases were markedly effec- tive,1 cases improved and 1 cases failed.5 cases were operated on with labial mucosa.4 cases were markdly effective and 1 cases improved. The advantages of these two kinds of transplants have been compared.Labial mucosa is better than conjunctiva,and dacryocystoplasty with labial mucosa is more handy and appli- cable.

Dacryocystorhinostomy with Silicone Tube used in the Lacrimal Drainage System

We performed 16 dacryocystorhinostomies with silicone tube for the chronic dacryocystitis with partial obstruction of the canaliculus. About 10 weeks postoperatively, the silicone tube was removed in 6 cases which had some epiphora, and the tube was retained in the canlaiculus in asymtomatic 10 cases. After 6 months follow up period, one case revealed a reobstruction of the common canaliculus but the other fifteen cases showed satisfactory results.

Dacryocystorhinostomy with Silicone Tube used in the Lacrimal Drainage System

We performed 16 dacryocystorhinostomies with silicone tube for the chronic dacryocystitis with partial obstruction of the canaliculus. About 10 weeks postoperatively, the silicone tube was removed in 6 cases which had some epiphora, and the tube was retained in the canlaiculus in asymtomatic 10 cases. After 6 months follow up period, one case revealed a reobstruction of the common canaliculus but the other fifteen cases showed satisfactory results.