Zepto-rhexis: A new surgical technique of capsulorhexis using precision nano-pulse technology in difficult cataract cases

Several techniques are used to make a capsulorhexis in white mature cataract cases as needle cystotome, Utrata capsulorhexis forceps, microincision capsulorhexis forceps, femtosecond Laser, etc. Zepto precision nano-pulse capsulotomy device (Mynosys Cellular Devices; Fremont, CA, USA) is Food and Drug Administration approved, a disposable capsulotomy device that uses low-energy pulses to create a precise central capsulorhexis, independent of pupil size, corneal clarity, or lens density. In this article, the authors report their experience of performing anterior circular curvilinear capsulorhexis with Zepto precision nano-pulse capsulotomy device in challenging cataract cases done at our center. The Zepto handpiece device was inserted through 2.8 mm clear corneal incision. Results of our study in 3 cataract cases (intumescent cataract, morgagnian cataract, and cataract with small pupil) revealed that the precision pulse capsulotomy technology mechanically and simultaneously cleaves all 360� of the apposed capsule of without cauterizing it, creating CCC of 5.2 mm size.

Functional success evaluation of lacrimal drainage system by dacryoscintigraphy after transcanalicular diode laser dacryocystorhinostomy

Purpose: The purpose of the study was to evaluate the functional success rates using dacryoscintigraphy (DSG) after transcanalicular diode laser dacryocystorhinostomy (TDL-DCR). Methods: In this retrospective study, we investigated the records of 56 patients who underwent TDL-DCR for unilateral primary acquired nasolacrimal duct obstruction and anatomic patency was achieved. The lacrimal drainage systems of the other eyes of the patients were normal and were selected as control group. The functional success was evaluated with tear transit time (TT) on DSG and epiphora complaints' score (ECS) at postoperative 6 months. Results: Twenty-two (39%) of the patients were male and 34 (61%) were female, with a mean age of 46.6 (21�). The dacryoscintigraphic findings of the operated and healthy eyes showed that there was statistically insignificant prolongation in the tear TT at the operated side at postoperative 6th month (P > 0.05). The mean ECS of operated eyes was 0.89. Functional success was achieved in 43 (76.8%) patients when the ECS of 0 and 1 was accepted as successful. A statistically significant delay in drainage was observed in DSG in all of the cases with epiphora score of 2 and 3 (P < 0.05). The tear TT was prolonged with the age increase (P < 0.05), but there was no significant difference concerning the gender. Conclusion: DSG is an effective tool to evaluate the functional success of TDL-DCR.

Dacryoscintigraphic Findings in the Children with Tearing

PURPOSE: To investigate the diagnostic effectiveness of dacryoscintigraphy in children with tearing; to evaluate tear clearance rate as a diagnostic factor of dacryoscintigraphy in children with tearing; and to analyze the results of treatment according to dacryoscintigraphic findings in children with tearing. METHODS: Between January 2010 and April 2014, 176 eyes of 88 children with tearing (49 boys and 39 girls; mean age, 23.81 ±14.67 months; range, 12 to 72 months) were studied retrospectively. Of these, 37 of 88 children with tearing were bilateral cases, and 51 were unilateral cases. None of the patients had a history of craniofacial disorder or trauma. The chief complaint of tearing with or without eye discharge and delivery mode, past history of neonatal conjunctivitis, syringing, or probing were collected from parents, grandparents, or previous hospital data. The drainage pattern of the nasolacrimal duct was analyzed, and the clearance rate of 50 microCi 99m technetium pertechnetate was measured by dacryoscintigraphy. RESULTS: According to the dacryoscintigraphy results, 98 of 125 eyes (78.4%) with tearing showed nasolacrimal obstruction and 29 of 51 eyes (56.9%) without tearing showed patency. There was a significant difference between tearing eyes and normal eyes (p = 0.001). The clearance rate difference after 3 and 30 minutes was 16.41 ± 15.37% in tearing eyes and 23.57 ±14.15% in normal eyes. There was a significant difference between epiphoric eyes and normal eyes (p = 0.05). Based on the dacryoscintigraphic findings, nasolacrimal-duct obstruction was treated with probing or silicone-tube intubation. The majority of patients showed symptom improvement (75.2%) during the two months of follow-up. CONCLUSIONS: Dacryoscintigraphy is a non-invasive method of qualitatively and quantitatively diagnosing nasolacrimal duct obstruction in children with tearing.

Clinical utility of dacryoscintigraphy in the assessment of nasolacrimal duct obstruction

Epiphora, or pathological overflow of tear due to obstruction in the nasolacrimal drainage system, is a common problem encountered in ophthalmology. The ophthalmologist relies mainly on symptoms to guide further diagnosis and therapy. However, there appears to be a discrepancy between the degree of discomfort experienced by the patient and the severity of pathological finding. The purpose of this study was to determine the clinical utility of dacryoscintigraphy in the assessment of nasolacrimal duct (NLD) obstruction. We retrospectively reviewed the records of 27 patients who underwent dacryoscintigraphy between July-January 2007. Thirty-six eyes in these patients had epiphora. Three eyes (8%) showed partial obstruction. On the other hand, 33/36 eyes (92%) had complete obstruction in different areas of the NLD system. Patients with complete obstruction were treated by dacryocystorhinostomy and silicon tube insertion. Patients with partial nasolacrimal duct obstruction were treated medically. Dacryoscintigraphy is a simple, non-invasive, safe and non-traumatic procedure in assessing NLD obstruction. It demonstrates anatomical pathway of tear by physiological drainage. This can aid the surgeon in localizing the site of obstruction and guide him in choosing the appropriate treatment.

The Clinical Outcome of Silicone Tube Intubation According to Nasolacrimal Duct Obstruction Sites by Dacryoscintigraphy

PURPOSE: To evaluate clinical outcome of silicone tube intubation in lacrimal passage obstruction according to the lacrimal passage obstruction patterns by dacryoscintigraphy. METHODS: Fifty-nine eyes of 52 patients complaining of epiphora were divided into three groups pre-sac (group 1), intra-sac (group 2), and intra-ductal (group 3) types by dacryoscintigraphy. We confirmed the obstructive sites of lacrimal passage by probing with Bowman probe, and excluded all the cases of not passing lacrimal pathway or without the obstruction of lacrimal pathway. In the silicone intubation, a tie between both silicone tube was made at silicone silastic sheet instead of Mersilk. RESULTS: The success was defined as maintaining the patent lacrimal passage with irrigation and disappearing of epiphora for at least 3 months. The success rate of the silicone intubation was 16 eyes of 17 eyes (94.1%) in group 1, 19 eyes of 23 eyes (82.6%) in group 2, and 14 eyes in 19 eyes (73.7%) in the group 3. The highest success rate of silicone intubation was pre-sac type and the lowest success rate was intra-ductal type by dacryoscintigraphy. There is no significant difference of success rate among three groups. CONCLUSIONS: Although it's required the longer follow-up period and larger subjects to evaluate the efficacy of silicone tube intubation, it should be useful management of silicone tube intubation, especially at the cases of pre-sac obstruction by dacryoscintigraphy.

Result of Partial Nasolacrimal Duct Obstruction After Silicone Tube Intubation

PURPOSE: In a preliminary series of 36 eyes with partial nasolacrimal duct obstruction, the types of dacryoscintigraphy result were classified and the results of silicone tube intubation were analysed. METHODS: The results of dacryoscintigraphy, performed in 36 eyes of 29 patients with partial nasolacrimal duct obstruction, were classified into the following 3 types: pre-lacrimal sac type, proximal nasolacrimal duct type and distal nasolacrimal duct type. Punctoplasty accompanied by silicone tube intubation was conducted selectively. RESULTS: In dacryoscintigraphy, symptoms improved in 6 eyes among 6 in distal nasolacrimal duct type (100%), 14 eyes among 18 in proximal nasolacrimal duct type (77.8%) and 8 eyes among 12 in pre-lacrimal sac type (66.7%). CONCLUSIONS: We conclude that dacryoscintigraphy predicts the results of silicone tube intubation. Furthermore, silicone tube intubation was effective in proximal nasolacrimal duct type and distal nasolacrimal duct type, but less effective in pre-lacrimal sac type of partial nasolacrimal duct obstruction.

The Relationship between the Dacryoscintigraphy and the Satisfaction with Punctal Occlusion in Patients with Dry Eye Syndrome

PURPOSE: The purpose of this study was to assess the relationship between the result of dacryoscintigraphy and the effect of punctal occlusion in dry eye syndrome. METHODS: Dacryoscintigraphy was performed in 86 eyes with dry eye syndrome and collagen plugs were inserted into low punctum. We evaluated the relationship between the results of dacryoscintigraphy and the effect of punctal occlusion with collagen plugs. RESULTS: In 36 eyes, tear transit time was normal in dacryoscintigraphy (Group I). In 28 eyes, tear transit time was more than 20 minutes (Group II). In 18 eyes, no tear transit was seen during 60 minutes and after dripping of normal saline, tear transit was seen (Group III). In 4 eyes, there was no tear transit after dripping of normal saline (Group IV). Symptom reduction after punctal occlusion with collagen plugs was observed in 34 eyes (94%) of Group I and 22 eyes (79%) of Group II . There was no significant differences between the two groups. In Group III, symptom reduction was observed in 4 eyes (22%) and it showed significant differences between the other groups. CONCLUSIONS: According to this results, punctal occlusion in dry eye syndrome was not effective in patients who showed tear transit after 60 minutes.

Diagnosis of Functional Nasolacrimal Duct Obstruction Using Dacryoscintigraphy / 대한핵의학회잡지

PURPOSE: To evaluate the value of dacryoscintigraphy in the assessment of patients with a clinical diagnosis of functional nasolacrimal duct obstruction. MATERIALS AND METHODS: Dacryoscintigraphy was performed in symptomatic 35 lacrimal drainage systems in 18 patients (age range: 37~76, 8 males, 10 females) that were patent on syringing. RESULTS: Abnormalities were detected with dacryoscintigraphy in 75.8% of systems. The positive scintigrams were subdivided into those demonstrating prelacrimal sac delay (31.8%), delay at the lacrimal sac/junction (40.9%), or delay within the duct (27%). CONCLUSION: Dacryoscintigraphy is noninvasive useful technique in the assessment of the functional nasolacrimal duct obstruction and very sensitive at detecting abnormalities in patients with lid laxity caused by senile change and facial nerve palsy.

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.

Role of Dacryoscintigraphy in the Diagnosis and Treatment of Pediatric with Epiphora / 대한핵의학회잡지

PURPOSE: We conducted this study to evaluate the role of dacryoscintigraphy in the diagnosis and treatment of pediatric patients with epiphora. MATERIALS AND METHODS: In 58 patients aged from 2 months to 15 years (mean age 2.8+/-2.3 years), dacryoscintigraphy was performed using a gamma camera with 4 mm pinhole collimator. We correlated symptoms with dacryosicntigraphic findings in all patients. In 37 patients who underwent ophthalmologic procedures, we analyzed the agreements of dacryoscintigraphic findings with the operation. RESULTS: High rates of agreements between epiphora and obstruction on dacryoscintigraphy (69/72, 95.8%), and between scintigraphic obstructive findings and operation sites (44/47, 93.6%) were noted. Nine of fourty-four (20.5%) asymptomatic eyes showed obstructive findings on dacroscintigraphy. CONCLUSION: In pediatric patients with epiphora, dacryoscintigraphy is a useful tool not only in diagnosing nasolacrimal duct obstruction but also in making a decision for therapeutic procedures.

Efficacy of Dacryoscintigraphy in Patients with Functional Block of Lacrimal Drainage System

To evaluate the diagnostic efficacy of dacryoscintigraphy, we examined Hones dye test and dacryoscintigraphy in 24 eyes of 18 patients who were suspected to have junctional block in lacrimal drainage system. Among 18 eyes that were negative to Jones I dye test, 3 showed punctal stenosis and 6 typical pattern of lax lid and 2 partial obsturction of nasolacrimal duct on dacryoscintigraphy. In evaluation of lacrimal drainage system, physiological aspect is as important as anatomical information since lacrimal pumping action of lid and tear flow as well as the patency of lacrimal passage contribute to the lacrimal drainage. Compared to Jones dye test, dacryoscintigraphy is more useful with certain advantages : It gives less discomfort to patients, provides anatomical information and does not depend on examiner`s skills.

Dacryoscintigraphy: The Assessment of Epiphora in Children

The value of dacryoscintigraphy in the assessment of lacrimal drainage system was examined in 20 children below 34 months of age, 28 symptomatic eyes and 12 asymptomatic eyes. Of 28 symptomatic eyes, 20(71%) had abnormalities of tear drainge on dacryoscintigraphy. Of 12 asymptomatic eyes, 10 had normal tear drainage systems on dacryoscintigraphy. Because of the good natural physiological character and simplicity of this procedure and lower risk of radiation hazard. dacryoscintigraphy is a useful technique in the assessment of lacrimal drainage systems in children with symptom of epiphora.

Tear Drainage through the Upper Can,liculus in Case of Lower Canalicular ObstruCtion

Symptomatic epiphora has been rarely observed in patients jwith only one canaliculus obstruction. The authors experienced 7 cases of only lower canahculus obstruction without epiphora. Tear drainge of these eyes was assessed using dacryoscintigraphy and compared with the comtrol eyes. The measurement of T1/2 valuse, the duration of which a given amount of 99m-Tc-phytate drops to half in the conjunctival fornix was performed. The T1/2 valuse was 368.1 seconds in average in the eye with the lower canaliculus obstruction and 263.3 seconds in the control eyes(p