Is dacryocystectomy effective in reducing epiphora?

Purpose: To study the efficacy of dacryocystectomy (DCT) in reducing epiphora in cases of primary acquired nasolacrimal duct obstruction. Methods: This was a prospective, nonrandomized, interventional study conducted over a period of 12 months. All cases who either opted or satisfied our criteria for DCT in primary acquired nasolacrimal duct obstruction (age above 70 years) were included in the study. Patients with secondary nasolacrimal duct obstruction and those undergoing revision surgeries were excluded. Patients were asked to report the percentage improvement in postoperative watering subjectively. Munk score and fluorescein dye disappearance test (FDDT) were recorded pre? and postoperatively. Wilcoxon signed ranked test was used for analysis. Results: Eighty?two eyes of 65 patients were included. Most of the patients (46, 70.8%) were females. The mean age was 68.46 ± 5.7 years (range: 60–85 years). The mean subjective improvement in watering was 86.8%. The P value for preoperative and postoperative difference in Munk score and FDDT score was highly significant (P = 0.00001). Conclusion: Apart from providing relief from ocular discharge, DCT also provides significant improvement in watering. Patients can be preoperatively counseled regarding chances of reduction in epiphora following surgery

The devil is coming: Feeding behavior of juvenile Munk's devil rays (Mobula munkiana) in very shallow waters of Punta Descartes, Costa Rica / El diablo se aproxima: comportamiento de alimentación de juveniles de mantas diablo (Mobula munkiana) en aguas poco profundas de Punta Descartes, Costa Rica

Introduction: Identifying critical habitats for vulnerable elasmobranch species is crucial for effective conservation measures. The Munk's devil ray (Mobula munkiana) is endemic to the Eastern Pacific, but yet little is known about its biology, ecology, and habitat use. As filter feeders, it is assumed that this species concentrates at high-productive upwelling regions, such as the Costa Rican Dome. Like many elasmobranchs, its populations are highly depleted and require urgent information to inform better conservation measures. Objective: The study was conducted to gain information on a unique behavior observed in juvenile M. munkiana, so further information can be provided on early life stages of this vulnerable species. Methods: From June to September 2017 and in August 2018, the feeding behavior of juvenile Mobula munkiana was observed in two shallow bays located at Punta Descartes, North Pacific Costa Rica. Individuals were captured using a non-lethal method to obtain data on size, weight, and sex distribution. Plankton samples (n = 100) were taken at both bays throughout the months to infer diet composition. Results: Munk's devil rays showed a repetitive swimming movement parallel to the beach, feeding exclusively in the shallow breaking zone of the low tide waves at depth <50cm. A total of 12 M. munkiana (11 live and one found dead) indicated a juvenile feeding aggregation ranging from 490 - 610mm in disk width and 1400 - 2300gr in weight. The sex ratio (males to females) was 3:1. Zooplankton of the order Mysidacae was found in the highest abundance in the breaking zone. Conclusions: The specific behavior and seasonal occurrence of juvenile Munk's devil rays in this area seem to be driven by prey abundance. More research is needed to conclude the presence of reproductive adults at deeper depths and the year-round habitat use of Punta Descartes. The area is threatened by unsustainable development and requires realistic management strategies to guarantee the survival of vulnerable species and their critical habitats.

Introducción: La identificación de hábitats críticos para especies vulnerables de elasmobranquios es crucial para tomar medidas de conservación efectivas. La manta diablo o raya de Munk (Mobula munkiana) es endémica del Pacífico Oriental y se sabe poco sobre su biología, ecología y uso de hábitat. Como filtradores, se asume que se concentran en regiones de afloramiento con alta productividad; sus poblaciones se consideran en disminución y requieren información urgente para fundamentar medidas de conservación. Objetivo: El estudio se realizó para obtener información sobre un comportamiento de alimentación observado en juveniles de M. munkiana, con el fin de proporcionar más información sobre las primeras etapas de vida de esta especie considerada vulnerable a la extinción. Métodos: De junio a setiembre de 2017 y en agosto de 2018, se observó el comportamiento de alimentación de los juveniles de M. munkiana en dos bahías poco profundas de Punta Descartes, en el Pacífico norte de Costa Rica. Los individuos fueron capturados utilizando un método no letal para obtener datos sobre el tamaño, peso y sexo. Se tomaron 100 muestras de plancton en las bahías para inferir la composición de la dieta. Resultados: Las rayas mostraron un comportamiento de natación repetitivo paralelo a la playa, alimentándose exclusivamente en la zona de rompimiento de las olas en marea baja, a menos de 50 cm de profundidad. Un total de 12 rayas M. munkiana (11 vivas y una encontrada muerta) indicaron una agregación de juveniles para alimentarse. Los anchos de disco variaron de 490 a 610 mm y el peso entre 1400 a 2300 g. La proporción sexual (machos: hembras) fue de 3:1. En la zona donde rompían las olas se encontró principalmente el orden Mysidaceae. Conclusiones: El comportamiento específico y la ocurrencia estacional de M. munkiana en la zona de estudio parecen estar impulsados por la abundancia de presas. Se necesita más investigación para concluir la presencia de adultos reproductivos a mayor profundidad y sobre el uso de hábitat en los alrededores de Punta Descartes durante todo el año. Esta área se encuentra amenazada por un desarrollo insostenible y requiere estrategias de manejo realistas para garantizar la supervivencia de especies vulnerables y sus hábitats críticos.

Haim Munk syndrome: Report of two siblings of Northern India treated with acitretin.

Haim Munk Syndrome (HMS) is the allelic mutation of exon 6 codon in cathepsin C gene. Here, we present two cases of same family with HMS having all the cardinal features of HMS which includes palmo plantar keratoderma and periodontitis along with arachnodactyly, acroosteolysis, onychogryphosis, and marked osteopenia on hand wrist radiographs. Both the siblings were treated with cotrimoxazole, acetretin and topical keratolytics and followed up over a period of one year, showed remarkable improvement in palmo plantar keratoderma and periodontitis.

The Effectiveness of Lacrimal Trephination for the Treatment of Canalicular Obstruction

PURPOSE: To determine the effectiveness of lacrimal trephination to treat canalicular obstruction. METHODS: Silicone intubation following lacrimal trephination was performed in 38 eyes of 29 patients with epiphora due to canalicular obstruction between December 2005 and October 2009. Medical records were retrospectively reviewed and telephone interviews were performed. The severity of epiphora was graded by Munk's scale, and anatomical improvement was evaluated by postoperative probing and syringing. RESULTS: The procedure was successful in 73.7% of the cases (grade 0 or 1), and 68.4% of the eyes had complete resolution of epiphora (grade 0). The anatomical success rate was 81.6%. CONCLUSIONS: Lacrimal trephination is a simple and effective treatment for canalicular obstructions. Therefore, lacrimal trephination could be performed prior to attempting an invasive conjunctivodacryocystorhinostomy.