Clinical Implications of Suspended Scattering Particles in Motion Observed by Optical Coherence Tomography Angiography.

The objective of this study was to investigate the relationship between suspended scattering particles in motion (SSPiM) in optical coherence tomography angiography (OCTA) and treatment response in diabetic macular edema (DME). We retrospectively reviewed the medical records of patients diagnosed with DME who had undergone intravitreal injection. The optical density ratio (ODR) of the intraretinal cyst and the numbers of hyperreflective foci from OCT images and SSPiM from OCTA images were compared, and their association with treatment response was analyzed. Forty-five eyes from 45 patients were included in this study. Twenty-four patients were treated with anti-vascular endothelial growth factor, and 21 patients were treated with a steroid. Binary logistic regression model showed that SSPiM in OCTA images was associated with hyperreflective foci numbers (P = 0.038) and mean ODR of the intraretinal cyst (P = 0.006). Linear regression model showed that SSPiM in the inner nuclear layer was related to treatment response (P = 0.006). SSPiM on OCTA images is related to the poor structural response to treatment in DME.

Inter-relationship between retinal and choroidal vasculatures using optical coherence tomography angiography in normal eyes.

PURPOSE: To quantify vascular and structural macular variables in healthy eyes and to investigate correlations between these variables and age using optical coherence tomography angiography. MATERIALS AND METHODS: A total of 261 eyes of 261 subjects with normal fundus were included. Central macular thickness, ganglion cell layer to inner plexiform layer thickness, outer retina layer thickness, subfoveal choroidal thickness, and choroidal vascularity index were measured using optical coherence tomography. Foveal avascular zone area, vascular density, and flow void area were measured using optical coherence tomography angiography. RESULTS: Vascular density in the superficial capillary plexus was correlated with central macular thickness, ganglion cell layer to inner plexiform layer thickness, and outer retina layer thickness (P < 0.001, P = 0.004, and P < 0.001, respectively). Vascular density in the deep capillary plexus was correlated with central macular thickness and outer retina layer thickness (P = 0.003 and P = 0.001, respectively). Vascular density of choriocapillaris was correlated with vascular density of superficial capillary plexus and deep capillary plexus (P < 0.001 and P = 0.001, respectively). CONCLUSION: Vascular density of choriocapillaris varies with retinal vascular density rather than the structure of choroid using optical coherence tomography angiography. In contrast, retinal vascular density changes as the retinal structure. Our results provide more information about the relationship between retina and choroid.

Comparison of Retinal Layer Thickness and Vascular Density between Acute and Chronic Branch Retinal Vein Occlusion.

PURPOSE: To compare retinal layer thickness and chorioretinal vascular density (VD) between acute and chronic branch retinal vein occlusion (BRVO). METHODS: This study included patients with BRVO. The VD of the superficial capillary plexus (VDs), the VD of the deep capillary plexus (VDd), and VD of the choriocapillaris were obtained using optical coherence tomography angiography. Acute and chronic BRVO data were compared to assess differences between the involved and uninvolved areas. RESULTS: We included 17 eyes with acute BRVO and 23 eyes with chronic BRVO. The VDs in the involved area were not significantly different between the involved area and in the uninvolved area in acute BRVO (p = 0.551). However, the difference was significant in chronic BRVO (p = 0.013). The VDd in the involved area was lower than in the uninvolved area in both acute and chronic BRVO (p = 0.020, p = 0.003, respectively). In addition, the VD of the choriocapillaris values did not differ significantly between acute and chronic BRVO, or between involved and uninvolved areas. The VDs in the involved area in chronic BRVO were lower than in acute BRVO (p = 0.047), and the VDd did not differ between acute and chronic BRVO in all areas. CONCLUSIONS: Vascular impaired patterns in the retinal layer differed between acute and chronic BRVO. These results may suggest that vascular change and remodeling develops differently in acute and chronic phases in BRVO.

Variation of Retinal and Choroidal Vasculatures in Patients With Age-Related Macular Degeneration.

Purpose: To investigate variations in chorioretinal vasculatures in fellow eyes of patients with unilateral neovascular age-related macular degeneration (nAMD). Methods: We included fellow eyes of consecutive patients with unilateral nAMD from swept source optical coherence tomography (SS-OCT) angiography database. Vascular and nonvascular indices were determined based on SS-OCT and SS-OCT angiography images. Variation of the vascular or nonvascular index was compared between fellow eyes with and without early AMD. Results: In 146 fellow eyes, 88 (60.3%) had early AMD and 58 (39.7%) had a normal fundus. Vascular density (VD) values of the superficial and deep retinal capillary plexus and choriocapillaris were smaller in eyes with early AMD than in those without (P < 0.001, P = 0.001, P = 0.006, respectively). Flow void area in choriocapillaris was greater in eyes with early AMD than those without (P = 0.015). In 88 fellow eyes with early AMD, vascular indices of the retina were correlated with those of choroid while nonvascular indices were not. Fellow eyes of patients with classic exudative AMD had greater foveal avascular zone area and smaller VD values of the deep retinal capillary plexus than those with polypoidal choroidal vasculopathy (P < 0.001, P = 0.004). Conclusions: In addition to vascular insufficiency in the choroid or choriocapillaris, retinal vascular alteration was apparent in eyes with early AMD. It may suggest that retinal vessels were involved in the pathogenesis of AMD even while changes in nonvascular components of the retina were not yet apparent.

Choriocapillaris layer imaging with swept-source optical coherence tomography angiography in lamellar and full-thickness macular hole.

PURPOSE: To present characteristics of choriocapillaris layer imaging with swept-source optical coherence tomography angiography (SS-OCTA) in eyes with macular hole (MH). METHODS: Patients with MH were included. Vascular density of choriocapillaris (VDC) and central flow void areas were obtained using SS-OCTA. Data were compared with age- and gender-matched normal controls. RESULTS: Fifty-one patients with MH and 51 controls were included. Among the 51 patients with MH, 19 had lamellar MH (LMH) and 32 had full-thickness MH (FTMH). While VDC in LMH (79.26 ± 4.06%) was not significantly different from that seen in fellow eyes (79.88 ± 4.28%, P = 0.729) and normal controls (80.53 ± 4.21%, P = 1.000), VDC in surgically closed FTMH (74.60 ± 7.37%) was similar to that of fellow eyes (75.45 ± 7.39%, P = 0.400) but lower than that of controls (78.37 ± 7.13%, P = 0.011). On univariate analysis of 32 patients with unilateral sealed FTMH, VDC was not correlated with basal hole area (P = 0.797) or preoperative area of disrupted ellipsoid zone (P = 0.863). Central flow void was detected in 32 eyes. Mean central flow void area was 0.82 ± 0.84 mm2, which correlated with preoperative area of disrupted ellipsoid zone (P = 0.001). CONCLUSIONS: Choriocapillaris layer imaging using SS-OCTA showed that choriocapillaris in both eyes of patients with unilateral FTMH had different characteristics from eyes with LMH or normal controls. These results suggest that variation in choriocapillaris layer flow is involved in the pathogenesis of MH.

Effects of a high level of illumination before sleep at night on chorioretinal thickness and ocular biometry.

The choroid is affected by many factors. One of the factors, change in illumination has been suggested to influence choroidal thickness. However, the effects of bright light before sleep at night on the human eye are not well established. The purpose of this study was to investigate the effects of a high level of illumination in the evening on ocular measurements. Twenty-seven men with myopia spent seven consecutive nights in the sleep laboratory. During the first two nights, subjects were exposed to light at 150 lux between 20:00 and midnight. Then, for five consecutive nights, they were exposed to ambient light at 1000 lux between 20:00 and midnight. Ocular parameters and their diurnal variations were compared between the two periods and the effects of a high level of illumination were analyzed. After subjects were exposed to 1000 lux of illumination, axial length increased with borderline significance (p = 0.064). Macular volume and retinal thickness did not change. However, subfoveal choroidal thickness after exposure to 1000 lux of illumination (245.37 ± 52.84 µm) was significantly lower than that after 150 lux of illumination (268.00 ± 57.10 µm), (p < 0.001). Significant diurnal variations were found in mean keratometry (p = 0.039), intraocular pressure (IOP, p = 0.003), ocular perfusion pressure (OPP, p < 0.0001), macular volume (p = 0.019), and subfoveal choroidal thickness (p < 0.0001). A high level of illumination had significant effects on only IOP and OPP (p = 0.027 and 0.017, respectively). Bright light exposure before sleep at an intensity as high as 1000 lux reduced subfoveal choroidal thickness in healthy young men. In conclusion, diurnal variation in choroidal thickness can be affected by bright light exposure before sleep.

Characteristics of retinal vessels in surgically closed macular hole: an optical coherence tomography angiography study.

PURPOSE: The purpose of our study was to investigate characteristics of retinal vessels in eyes with surgically closed macular holes (MH). METHODS: We included patients who underwent surgery for idiopathic MH and a follow-up examination using optical coherence tomography angiography (OCTA). The area of the foveal avascular zone (FAZ) and retinal vascular densities of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were calculated on the postoperative OCTA images and compared with those of age-matched normal controls. RESULTS: Twenty-eight patients with MH and 28 controls were included. Mean postoperative FAZ areas of SCP and DCP (0.317 ± 0.129 mm2 and 0.500 ± 0.174 mm2) were smaller than those of normal controls (0.406 ± 0.131 mm2 and 0.687 ± 0.147 mm2) (P = 0.013 and P < 0.001, respectively). Retinal vascular densities of SCP and DCP in the MH group (32.23 ± 1.45% and 31.85 ± 1.28%) were lower than those of the control group (33.26 ± 1.71% and 33.18 ± 1.89%) (P = 0.019 and P = 0.003, respectively). The retinal vascular densities of SCP and DCP were associated with postoperative mean ganglion cell-inner plexiform layer (GC-IPL) thickness (P = 0.033 and P = 0.035, respectively). The vascular densities were horizontally asymmetric and related to asymmetric distribution of GC-IPL thickness in the MH group. CONCLUSIONS: Surgically closed MH eyes had remodeled retinal vascular patterns, which were related to morphologic changes in the inner retinal layer. The healing process after MH surgery may be involved in asymmetric change in anatomy and hemodynamics of the inner retina.

Risk factors of recurrence of macular oedema associated with branch retinal vein occlusion after intravitreal bevacizumab injection.

BACKGROUND/AIMS: To identify risk factors of recurrence of macular oedema in branch retinal vein occlusion (BRVO) after intravitreal bevacizumab (IVB) injection. METHODS: The records of 63 patients who underwent IVB injection for macular oedema secondary to BRVO with at least 6 months of follow-up were reviewed. Patients were evaluated at baseline with fluorescein angiography (FA), optical coherence tomography (OCT) and ultra-wide-field fundus photography (WFP). During follow-up, OCT and WFP were repeated. The area of retinal haemorrhage, central retinal thickness (CRT), area (mm2) of capillary non-perfusion within the 1 mm (NPA1), 1-3 mm and 6 mm zones of the ETDRS circle, foveal capillary filling time, degree (°) of foveal capillary network destruction and FA pattern were analysed. RESULTS: Macular oedema recurred in 41 of 63 (65.1%) eyes after initial IVB injection. A binary logistic regression model showed that NPA1 (OR=434.97; 95% CI=5.52 to 34262.12, p=0.006) and initial CRT (OR=1.004; 95% CI=1.000 to 1.008, p=0.015) were significantly associated with the recurrence of macular oedema. Receiver operating characteristic curve analysis identified an NPA1 of 0.36 mm2 (AUC: 0.735, sensitivity: 70.7%; specificity: 63.6%) and an initial CRT of 570 µm (AUC: 0.745, sensitivity: 63.4%; specificity: 77.3%) as cut-off values for predicting recurrence of macular oedema. CONCLUSIONS: Patients with BRVO with non-perfusion of more than half of the 1 mm zone of the ETDRS circle or with an initial CRT >570 µm should be closely monitored for macular oedema recurrence within 6 months of IVB injection.

Infective Endocarditis Presenting as Endogenous Endophthalmitis Secondary to Streptococcus agalactiae in a Healthy Adult: Case Reports and Literature Review.

Endogenous endophthalmitis secondary to group B Streptococcus (GBS) is extremely rare, particularly in healthy adults. However, the visual prognosis is poor. We report the first South Korean case of GBS infective endocarditis presenting as endogenous endophthalmitis and skin and soft tissue infection. Cultures of blood, vitreous humor, and pus from skin aspirates yielded a penicillin-susceptible serotype V strain of Streptococcus agalactiae. After 6 weeks, the patient completely recovered from GBS infective endocarditis. However, despite early antibiotic treatment and early surgical intervention, the patient's right eye developed phthisis bulbi and was a candidate for evisceration.

Visual Discomfort While Viewing Three-dimensional Television as a Screening Tool for Pediatric Eye Diseases in Children.

PURPOSE: To investigate the efficacy of evaluating 3D asthenopia and 3D perception difficulty for screening of binocular vision abnormalities in children. METHODS: Patients aged 6-12 years with abnormal binocularity, including strabismus, amblyopia, and anisometropia, were included. Age-matched normal subjects without any ophthalmologic abnormality other than a refractive error were also recruited. The best-corrected visual acuity, refractive error, angle of strabismus, and stereopsis were measured. Presenting visual acuity (PVA) was measured as the uncorrected visual acuity for subjects without glasses and spectacle-corrected visual acuity for those with glasses. After watching 3D TV for 30 min, a survey was administered to evaluate the 3D perception and 3D asthenopia. Receiver operation characteristic (ROC) curve analysis was conducted to evaluate the efficacy of the survey for detecting abnormal binocularity and poor PVA. RESULTS: One hundred subjects were enrolled in this study. Among them, 59 had abnormal binocularity (strabismus, anisometropia, or amblyopia), and 41 were normal control. Among the entire subjects, the number of subjects with a PVA of 20/40 or worse in one or both eyes was 24 (7 from the normal control and 17 with abnormal binocularity). ROC curve analysis revealed that the survey did not effectively detect strabismus, anisometropia, or amblyopia. However, for detection of PVA 20/40 or worse in the subjects with abnormal binocularity, the total score of the survey yielded an area of 0.714 under the ROC curve (p = 0.010). The sensitivity was 88.2% and specificity was 61.9% with a cutoff at 0.50. CONCLUSION: The degree of 3D asthenopia and 3D perception while watching 3D TV were not effective for screening of abnormal binocularity. However, evaluation of the severity of 3D asthenopia and the quality of 3D perception can help screen of decrease in PVA that requires correction.

Ocular Perfusion Pressure and Choroidal Thickness in Early Age-Related Macular Degeneration Patients With Reticular Pseudodrusen.

Purpose: The purpose of this study was to investigate the relationship between the ocular perfusion pressure (OPP) and subfoveal choroidal thickness (CT) in eyes with early age-related macular degeneration (AMD) with or without reticular pseudodrusen (RPD). Methods: We evaluated the clinical history, blood pressure parameters, fundus photography, and optical coherence tomography images of consecutive patients with early AMD. We calculated the mean OPP from blood pressure and intraocular pressure. Results: We included 103 eyes from 103 patients, classifying 45 as the RPD group and 58 as the non-RPD group. The mean OPP of the RPD group (46.1 ± 6.5 mm Hg) did not differ from that of the non-RPD group (45.1 ± 5.1 mm Hg, P = 0.325), but the RPD group showed a thinner mean subfoveal CT (158.3 ± 73.0 µm) than the non-RPD group (220.9 ± 67.0 µm, P < 0.001). Among 64 patients who underwent follow-up examination, the rate of change in subfoveal CT in the RPD group (-4.74 ± 0.86 µm/y) was greater than that in the non-RPD group (-2.46 ± 0.75 µm/y, P = 0.028). In the RPD group, a history of systemic hypertension and lower baseline OPP were associated with a higher rate of change in subfoveal CT (P = 0.019 and P = 0.010, respectively). Conclusions: Subfoveal CT was thinner in early AMD patients with RPD than in those without RPD. Lower baseline mean OPP and a history of systemic hypertension could be risk factors associated with the progression of choroidal thinning in early AMD patients with RPD.

Relationship between cantho-limbal distance and degree of head turn in a Korean population.

OBJECTIVE: To evaluate the relationship between cantho-limbal distance and the degree of head turn in Koreans. DESIGN: Prospective cross-sectional study. PARTICIPANTS: Thirty patients without strabismus or nystagmus who had visited an ophthalmic clinic at a single medical center were included in the study. METHODS: The distance between the lateral canthus and lateral corneal limbus was measured using a 5 mm scale. The degree of head turn was measured with a goniometer when the cantho-limbal distances were 0, 5, and 10 mm. The degree of head turn was measured 3 times, and the mean value was used as the degree of head turn. RESULTS: When the cantho-limbal distances were 0, 5, and 10 mm, the degree of head turn values were 42.33, 30.47, and 2.53 degrees, respectively. The shorter the cantho-limbal distance, the higher the degree of head turn (r = -0.945, p < 0.01). The relationship was expressed as: Degree of head turn = -2.98 × cantho-limbal distance + 35.07. CONCLUSIONS: Cantho-limbal distance can be used to estimate the degree of head turn. This method may be simpler and easier in a clinical situation than checking the degree of head turn with a goniometer.

Comparison of intravitreal aflibercept and ranibizumab injections on subfoveal and peripapillary choroidal thickness in eyes with neovascular age-related macular degeneration.

PURPOSE: We aimed to compare changes in subfoveal and peripapillary choroidal thickness (CT) after intravitreal aflibercept or ranibizumab injections for neovascular age-related macular degeneration (AMD). METHODS: Medical records of 54 treatment-naïve, consecutive patients (54 eyes) who were diagnosed with neovascular AMD and received three monthly injections of aflibercept (21 eyes) or ranibizumab (33 eyes) were reviewed. Subfoveal and peripapillary CT were measured with images obtained using spectral domain optical coherence tomography at baseline and at three months. RESULTS: Subfoveal CT decreased from 232.2 ± 94.4 µm at baseline to 207.1 ± 89.3 µm at three months in the aflibercept group (p < 0.001) and from 231.5 ± 102.9 µm to 220.0 ± 98.0 µm in the ranibizumab group (p = 0.006). The reduction was greater in the aflibercept group than in the ranibizumab group (p = 0.024). Peripapillary CT decreased from 157.2 ± 62.2 µm at baseline to 147.4 ± 62.2 µm at three months in the aflibercept group (p < 0.001). However, the change in peripapillary CT from 154.9 ± 46.5 µm at baseline to 152.3 ± 50.0 µm at three months was not significant in the ranibizumab group (p = 0.123). CONCLUSIONS: Intravitreally injected aflibercept significantly decreased subfoveal CT more than ranibizumab. Choroidal thinning after aflibercept injection was not limited to the subfoveal area, but extended beyond the macula as well.

The use of a 20-gauge valved cannula during pars plana phacofragmentation with a 23-gauge ultrasonic fragmatome.

BACKGROUND AND OBJECTIVE: To evaluate the usefulness of a 20-gauge cannula to maintain a self-sealing sclerotomy wound after 23-gauge phacofragmentation. PATIENTS AND METHODS: This retrospective study compared the suture rates after 23-gauge phacofragmentation when the 23-gauge cannula was temporarily replaced with a 20-gauge valved metal cannula versus when the 23-gauge fragmatome was inserted at the sclerotomy site without a cannula. RESULTS: Whereas a sclerotomy was sutured in all 31 eyes in the without-cannula group, only one eye of 14 in the cannula group required a sclerotomy suture (P < .0001). However, there was one case of fragmatome tip fracture during fragmentation in the cannula group. CONCLUSION: A self-sealing sclerotomy wound can be maintained without suturing by using a 20-gauge metal cannula, but fragmatome tip fracture can occur during fragmentation.

Comparison of cornea endothelial cell counts after combined phacovitrectomy versus pars plana vitrectomy with fragmentation.

BACKGROUND: To compare postoperative cornea endothelial cell loss between combined phacovitrectomy and pars plana vitrectomy (PPV) with fragmentation. METHODS: Eighty-eight consecutive patients (92 eyes) who underwent combined phacovitrectomy (53 eyes from 50 patients) or PPV with fragmentation (39 eyes from 38 patients) were enrolled in this retrospective study. Endothelial cell density (ECD) was calculated with specular microscopy at 1 and 3 months after surgery. RESULTS: At 3 months after surgery, the mean ECD decreased significantly from 2,646 ± 296 cells/mm(2) to 2,422 ± 347 cells/mm(2) in the combined phacovitrectomy group (P < 0.001). However, the PPV with fragmentation group did not show any significant changes in ECD during the same period (from 2,123 ± 628 cells/mm(2) to 2,073 ± 574 cells/mm(2)). The mean endothelial cell loss in the combined phacovitrectomy group (7.9 and 9.5 %) was significantly higher than that in the PPV with fragmentation group (0.7 and 2.4 %) both at 1 and 3 months postoperatively (P = 0.001 and P = 0.001 respectively). CONCLUSION: In this study, corneal endothelial cell loss during the early postoperative period was significantly higher after combined phacovitrectomy than after PPV with fragmentation.

Effectiveness of primary monocanalicularnasal intubation with Monoka tubes and nasal endoscopic findings for congenital nasolacrimal duct obstruction with enlarged lacrimal sac and chronic dacryocystitis.

BACKGROUNDS: We report successful outcomes of monocanalicularnasal intubation with Monoka tubes and endoscopic findings for Hasner valve area. This method is presented as a primary treatment modality in congenital nasolacrimal duct obstruction (CNLDO) with an enlarged lacrimal sac and chronic dacryocystitis. METHODS: In a prospective noncomparative consecutive case series, 23 eyes of 18 patients with CNLDO with an enlarged lacrimal sac and chronic dacryocystitis underwent endoscopic probing and monocanalicularnasal intubation under general anesthesia. Demographic information, including age, sex, duration of preoperative symptoms, operative endoscopic findings, timing of silicone tube removal, follow-up periods, complications, and outcomes, was analyzed. RESULTS: The study included 23 eyes of 18 patients. Mean (SD) age was 19.7 (12.2) months (range, 9-48 mo). Under nasal endoscopic view, the probe tip protruded through a balloon-like nasal mucosa around the Hasner valve. In all cases, tubes were removed in an office setting under topical anesthesia. Mean follow-up period was 24.6 (5.4) weeks. Complications, such as punctal slitting and corneal abrasion, were not observed. All patients showed successful results until the final follow-up. CONCLUSIONS: In cases of CNLDO with an enlarged lacrimal sac and chronic dacryocystitis, monocanalicular intubation is recommended rather than simple probing. Monoka tube intubation has the advantages of technical ease of insertion and tube removal. Moreover, the tubing does not threaten the unprobed part of the lacrimal drainage system. Endoscopic findings revealed that the probe tip protruded through a balloon-like nasal mucosa with pus around the Hasner valve.

Clinical characteristics and treatment of blow-out fracture accompanied by canalicular laceration.

BACKGROUNDS: Blow-out fracture and canalicular laceration can occur simultaneously as a result of the same trauma. Despite its importance, little research has been conducted to identify clinical characteristics or surgical techniques for repair of a blow-out fracture accompanied by canalicular laceration. The aim of this study was to evaluate the clinical characteristics, the surgical approach, and the outcomes. METHODS: Thirty-four eyes of 34 patients who underwent simultaneous repair of canalicular laceration using silicone tube intubation and reconstruction of blow-out fracture were included. Medical records were retrospectively reviewed for patient demographics, nature of injury, affected canaliculus, location, and severity of blow-out fracture, associated facial bone fracture, ophthalmic diagnosis, length of follow-up period, and surgical outcome. RESULTS: Mean patient age was 40.0 years (range, 17-71 y). The mean follow-up was 7.3 months. Fist to the orbital area (10 patients, 29.4%) was the most common cause. There were 24 lower canalicular lacerations (70.6%), 6 upper canalicular lacerations (17.6%), and 4 upper and lower canalicular lacerations (11.8%). Isolated medial wall fractures were most common (area A4: 20/34, 58.8%). Fractures involving both the floor and medial wall and maxillo-ethmoidal strut (areas A1, A2, A3, and A4) were the second most common (6/34, 17.6%), and floor and medial wall with intact strut (areas A1, A2, and A4) were injured in 6 patients (17.6%). Pure inferior wall fractures were least frequent (areas A1 and A2: 2/34, 5.9%). The severity of the fracture was severe in most patients except for 1 linear fracture with tissue entrapment and 1 moderate medial wall fracture (32/34, 94.1%). There was lid laceration in 20 patients (58.8%). Nasal bone fracture (5/34, 14.7%) was the most common facial bone fracture. Tubes were removed at a mean of 3.3 months (range, 3-4 mo). In total, 31 patients (91.2%) achieved complete success in canalicular laceration and blow-out fracture repair. No significant complications were encountered. CONCLUSION: Fractures involving the medial wall with a lower canalicular laceration were the most common among concomitant blow-out fractures and canalicular lacerations. The severity of the fracture was most often classified as severe. Computed tomographic scan of the orbit and facial bones for identification of any additional injuries such as orbital wall and facial bone fractures should be performed in patients with canalicular laceration. To avoid disruption of the medial canthal area, repair of the canalicular laceration with silicone tube intubation was performed before reconstruction of the blow-out fracture through transconjunctival and transcaruncular approaches. Finally, the tube was fixed after blow-out fracture surgery, and these surgical orders yielded good surgical outcomes without complications.

Clinical effectiveness of monocanalicular and bicanalicular silicone intubation for congenital nasolacrimal duct obstruction.

BACKGROUND: Numerous surgical techniques of silicone tube intubation in congenital nasolacrimal duct obstruction (CNLDO) have been described; these techniques can be divided into monocanalicular intubation (MCI) and bicanalicular intubation (BCI). The aim of this study was to compare the clinical effectiveness of MCI versus BCI of CNLDO. METHODS: In a prospective, nonrandomized, comparative case study, patients with CNLDO underwent probing under endoscopic control and either BCI or MCI under general anesthesia. Demographic data, including age and sex, duration of preoperative symptoms, method of previous treatment, operative time, timing of silicone tube removal, follow-up periods, complications, and outcomes, were analyzed. RESULTS: The study included 30 eyes from 22 patients for BCI and 30 eyes from 24 patients for MCI. The mean age in the BCI group was 23.3 months and in the MCI group was 23.1 months. Mean follow-up was 16.4 ± 5.9 weeks for BCI group and 11.6 ± 8.2 weeks for MCI group. Operation time was slightly longer in the BCI group. Tubes were most often removed in the operating room under general anesthesia for BCI (66.7%) and in an office setting under topical anesthesia for MCI (100%). Overall, BCI had a 93.3% success rate (28/30), and MCI had a 90.0% success rate (27/30). CONCLUSIONS: Although there was no significant difference between the success rates of the 2 groups, MCI allowed technical ease of insertion and tube removal. Moreover, the tubing does not threaten the unprobed part of the lacrimal drainage system. These advantages of MCI should be considered when selecting treatment methods for CNLDO.