The Result of Canaliculodacryocystorhinostomy with Double Probing in Common Canalicular Obstruction

PURPOSE: To evaluate the results of endoscopic canaliculodacryocystorhinostomy with double probing to resolve common canalicular obstruction. METHODS: A total of 47 patients (56 eyes) with common canalicular obstruction underwent endoscopic canaliculodacryocystorhinostomy. The double probing method was applied to 28 eyes; the remaining 28 eyes were in the control group. The success rate, degree of symptom improvement, and complication rate of the two groups were compared and analyzed. RESULTS: The postoperative success rate was 96% in the group that underwent surgery with the double probing method and 86% in the control group (P=0.160). The rate of symptom improvement without tearing was 86% in the double probing method group and 61% in the control group (P=0.038). Postoperative complication rates such as granuloma formation were 7% and 29% in the study and control groups, respectively (P=0.036). CONCLUSIONS: Endoscopic canaliculodacryocystorhinostomy with double probing to resolve common canalicular obstruction is proven to be effective in enhancing patient satisfaction and lowering complication rates, with no additional costs and risks.

A Simple New Method for Identifying the Proximal Cut End in Lower Canalicular Laceration

PURPOSE: We report a simple and effective method of identifying the medial cut end of lower canalicular laceration cases. METHODS: Twenty-seven eyes with lower canalicular lacerations as a result of trauma were involved in the study. Surgery was performed within 48 hours after injury for canalicular reconstruction. Upper canalicular probing was utilized to identify the medial cut end of deep canalicular lacerations when difficulties were encountered. Total time from the initiation of the probing procedure to the identification of the medial cut end of the lower canaliculus was measured. RESULTS: A total of 27 eyes with lower canalicular lacerations were reconstructed. In 20 eyes, the medial lacerated end was located by upper canalicular probing. The mean time from initiation of the probing procedure to identification of the medial cut end of the lacerated canaliculus was 2 minutes. CONCLUSIONS: We conclude that upper canalicular probing in patients with lower canalicular lacerations significantly reduces the time from the initiation of the operation to the identification of the medial cut end of the lower canaliculus.

Comparison of Results between Two Methods in Removal of Lacrimal Sac Medial Wall in Endoscopic Dacryocystorhinostomy

PURPOSE: To compare the surgical results between Nd: YAG laser and sickle knife, as instruments for removal of the medial wall of the lacrimal sac at the time of endoscopic dacryocystorhinostomy (DCR). METHODS: From June 2001 to January 2002, 70 patients with nasolacrimal duct obstruction were arbitrarily divided into two groups. One group underwent endoscopic DCR using sickle knife (sickle knife group) and the other group underwent endoscopic DCR using Nd: YAG laser (laser group). We evaluated the duration of wound healing, complications, and success rates. RESULTS: The duration of wound healing in the sickle knife and laser groups was 3.6 +/- 0.6 weeks and 4.0 +/- 0.3 weeks, respectively (p=0.09). Granuloma formation was statistically different between the sickle knife (45.7%, 16/35) and laser (22.9%, 8/35) groups (p=0.04). There were no significant statistical differences in the membranous obstruction rate, common canalicular obstruction rate, or synechiae formation rate between the two groups. The success rate at postoperative 1 year was 82.9% (29/35) in the sickle knife group and 88.6% (31/35) in the laser group (p=0.49). CONCLUSIONS: The laser group obtained the higher success rate and lower incidence of granuloma formation at the internal ostium than the sickle knife group. Wound healing seemed to be faster in the sickle knife group but showed higher granuloma formation in the sickle knife group. This might suggest that the instrument used in the removal of the medial wall of the lacrimal sac could influence the duration of wound healing as well as granuloma formation at the internal ostium.

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.

The Surgical Results of Balloon Catheter Dacryocystoplasty in Both Children and Adults

PURPOSE: The purpose of this study was to evaluate the surgical results of balloon catheter dacryocystoplasty (DCP) for congenital nasolacrimal duct (NLD) obstruction in children and partial NLD obstruction in adults. METHODS: The authors performed balloon catheter DCP as a secondary treatment of eight children (nine lacrimal systems) over 12 months of age who had been failed by probing, and as a primary treatment of five adults (five lacrimal systems) whose lacrimal system was partially obstructed. In children, Lacricath was inflated at the level of the valve of Hasner and 5 mm proximal to that level, three times with eight atm (bars) for 90 seconds at each level. In adults, the procedure was the same for children, but if there is any doubt of common canalicular stenosis, inflation at that level was included. RESULTS: Seven of eight children (eight of nine lacrimal systems) and three of five adults (three of five lacrimal systems) showed objective and subjective improvement at the mean follow-up period of 5.3 months and 5.0 months, respectively. CONCLUSIONS: Balloon catheter DCP was thought to be an alternative to silicone tube intubation in children with NLD obstruction who had been failed by probing and also a useful primary treatment in adults with partial NLD obstruction in the office setting.

Clinical Analysis of Glaucoma Patients Undergone Filtration Surgery

PURPOSE: We evaluated clinical aspects of the glaucoma patients who had undergone trabeculectomy. METHODS: We analyzed 211 patients' medical records who had undergone trabeculectomy in Chungbuk National University Hospital from August 1991 to December 1999 retrospectively. RESULTS: The mean age of the patients was 57.1+/-16.3 years and the 119 eyes (56.4%) had bilateral glaucoma. Among them, 57 eyes (47.9%) had primary open-angle glaucoma. Cataract was the most common cause of decreased vision in the fellow eye during the mean follow-up period of 25.4+/-22.3 months. The number of patients whose visual acuity in the fellow eyes less or equal to hand movement before surgery were 25 eyes (11.8%) and they resulted from glaucoma (18 eyes) and trauma (4 eyes). CONCLUSIONS: The fellow eyes of the glaucoma patients who had undergone trabeculectomy were easily subject to high prevalence of glaucoma that may lead to blindness. Therefore, more thorough and periodic ocular examination and appropriate treatments are mandatory to prevent further progress in these eyes with more advanced glaucoma.

4 Cases of Mdification of Scleral Fixation Using 30 G Needle for Posterior Chamber Intraocular Lens Dislocation

PURPOSE: Various methods of scleral fixation for the cases of posterior chamber intraocular lens (PCL) dislocation or subluxation into the vitreous cavity had been developed, and in the recent year a modification of internal scleral fixation using a hollow-bore needle has been introduced. The authors endeavored to evaluate clinical usefulness of the method. METHODS: The study was conducted for four cases of PCL dislocation or subluxation. A 10-0 polypropylene suture was threaded up the internal shaft of a 30 G straight needle and retrieved. The needle containing this suture was then inserted through the bed of the partial-thickness scleral flap 1.5 mm posterior to the limbus. The loop of suture was hooked with haphic of PCL. After the needle was retracted, the haptic was captured and the suture was tied to the sclera. The same maneuver was performed for the haptic in the opposite side. RESULTS: Except for pars plana vitrectomy, time taken for the above procedure was 10~15 minutes. Postoperatively induced astigmatism of all 4 cases were less than 3 diopters on the second postoperative day. No specific complication associated with this procedure was noted. IOL remained stable without tilting or rotation 18 months after procedure. CONCLUSIONS: This modified internal scleral fixation technique must be a convenient and effective procedure for repositioning posteriorly dislocated PCL.

Factors Affecting on Determination of Laser Power in Transpupillary Thermotherapy

PURPOSE: To evaluate whether the degree of melanin pigmentation of fundus or intraocular pressure would have influence on the determination of laser power for effective transpupillary thermotherapy(TTT). METHODS: TTT was performed on 6 eyes of each of the brown, yellow and white rabbits. Immediately after diode laser irradiation to posterior pole, retinal periphery, and iris with various power(2 mm, 60 or 120 sec), macular threshold power(MTP), peripheral threshold power(PTP), and iris threshold power(ITP) were defined as a maximum power not causing any ophthalmoscopic change on the respective laser site. To assess the influence of intraocular pressure, TTT was performed with the eyeballs compressed as much as retinal arterial pulsation disppeared. Three weeks after laser irradiation, funduscopic and fluorescein angiographic appearance were correlated with histopathologic findings. RESULTS: We found no difference of MTP between brown and yellow rabbit but their MTP were smaller than that of white one(P<0.05). There was positive correlation between MTP, PTP and ITP in all experimental species. ITP/MTP and PTP/MTP were 3.45+/-0.68, 1.09+/-0.10 in brown rabbit, 3.84+/-0.79, 1.12+/-0.13 in yellow rabbit and 4.13+/-0.43, 1.16+/-0.14 in white rabbit respectively. When TTT was performed with the eyeball compressed, the laser spot looks whiter in all cases than without. Microscopic examination revealed occlusion of choriocapillaris and photoreceptor degeneration in the laser spots formed by MTP. CONCLUSION: When performing TTT, one should reduce the laser power according to the amount of melanin pigmentation of fundus and intraocular pressure. Empirical laser burn to the retinal periphery will be a helpful mean to determine optimal laser power for TTT.

Sterile Corneal Peripheral Perforation after Cataract Surgery in Terrien's Marginal Degeneration

Previous reports have documented the occurrence of sterile peripheral corneal ulcer and perforation after cataract surgery in patients with systemic autoimmune vasculitic disease or Sjogren's syndrome. But the corneal complication after cataract surgery in patients with Terrien's marginal degeneration, characterized by bilateral slowly progressive thinning of peripheral cornea with opacity and superficial vascularization, have not been reported. We report a case of sterile peripheral corneal perforation following recent cataract surgery in a 77 year old woman with Terrien's marginal degeneration, treated with partial penetrating keratoplasty.