Canalicular laceration repair using a novel bicanalicular silicone stent versus traditional bicanalicular stent with nasal fixation.

PURPOSE: To compare the clinical effects of two types of lacrimal stents in the repair of canalicular lacerations. METHODS: A retrospective analysis was conducted on patients with canalicular lacerations between January 2017 and December 2022. The canalicular reconstruction was performed using either the Runshi-RS bicanalicular silicone stent or the traditional bicanalicular silicone stent with nasal fixation, under a surgical microscope. The stent was placed for 3 months, and patients were followed up for more than 3 months after extubation. The anatomical and functional success rates were compared between the two groups. Anatomical success was assessed through diagnostic probing and irrigation of lacrimal passage, while functional success was determined by the patient's subjective symptoms of epiphora. RESULTS: The study included 315 patients (315 eyes) undergoing canalicular laceration repair. The Runshi-RS stent was utilized in 147 patients (46.7%), while the traditional stent with nasal fixation was employed in 168 patients (53.3%). The anatomical success rates (99.3% vs 98.8%, P = 0.642) and functional success rates (87.2% vs 88.1%, P = 0.926) were similar between the RS group and the traditional stent group. Postoperative complications were fewer (4.1% vs 10.1%, P = 0.04) and the operation time was shorter (67.1 ± 35.3 min vs 86.1 ± 43.4 min, P < 0.001) in the RS group. CONCLUSION: The Runshi-RS tube demonstrates favorable surgical outcomes for the repair of canalicular lacerations. Compared to the traditional stent with nasal fixation, the RS stent allows for shorter operation times and fewer postoperative complications in the repair of canalicular lacerations.

Morphological characterization of nevi on the caruncle conjunctiva under in vivo confocal microscopy.

Objective: This study aimed to investigate the microscopic structure and characteristics of nevi on the conjunctiva of the lacrimal caruncle by in vivo confocal microscopy. Methods: In total, four patients with nevi growing on the lacrimal caruncle conjunctiva were recruited. The morphological characteristics of the nevi were evaluated by in vivo confocal microscopy before excision surgery; the results were compared with histopathological analyses of the surgical specimens. Results: The nevi of the four patients were all located at the conjunctiva of the lacrimal caruncle, with a slightly nodular surface, mixed black and brown color, and clear boundary. The nevi were round and highly protruded on the surface of the lacrimal caruncle, with an average diameter of 4.5 ± 1.29 mm. Under in vivo confocal microscopy, the pigmented nevus cells on the conjunctiva of the lacrimal caruncle were observed to be clustered in nests with irregular boundaries. The cells were round or irregular, with clear cell boundaries, hyper-reflective at the periphery, with low reflectivity in the center. Vascular crawling was observed in some regions. Histopathological analysis showed that nevus cells were roughly equal in size and distributed in a nodular pattern. Melanin granules were observed in the cytoplasm. No atypia or mitotic figures of the cells were found. Conclusion: This study revealed that the microstructure of nevi growing on the conjunctiva of the lacrimal caruncle can be identified by in vivo confocal microscopy.

Pretarsal orbicularis oculi muscle tightening with skin flap excision in the treatment of lower eyelid involutional entropion.

BACKGROUND: To evaluate a modified technique for involutional entropion correction in a retrospective cohort study. METHODS: The patients with involutional entropion eyelid were corrected by tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid. The patients received correction surgery from April 2013 to March 2019 were followed up for more than 6 months postoperatively. The outcome measures included the complications and the recurrence rates. RESULTS: Total 152 patients (169 eyes) were included. The mean follow-up period was 29.6 months (range: 6-36 months). Postoperative ectropion (over-correction) was observed in 1 patient with 1 eyelid (0.59%); yet, no further surgery was needed for this patient. Recurrence of entropion was found in 1 patient (0.59%). The patient with recurrent entropion received repeated surgery with the same method and achieved a good eyelid position. CONCLUSIONS: This study demonstrated that tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid could be an effective surgical method to correct lower eyelid involutional entropion. This method is technically easy with a low recurrence rate and not associated with significant complications in Asians.

Longitudinal Evaluation of Wound Healing after Penetrating Corneal Injury: Anterior Segment Optical Coherence Tomography Study.

PURPOSE: Ocular imaging can enhance our understanding of wound healing. We report anterior segment optical coherence tomography (ASOCT) findings in penetrating corneal injury. METHODS: Serial ASOCT was performed after repair of penetrating corneal injury. Internal aberrations of wound edges were labeled as "steps" or "gaps" on ASOCT images. The wound type was characterized as: type 1: continuous inner wound edge or step height ≤ 80 µm; type 2: step height > 80 µm; type 3: gap between wound edges; and type 4: intraocular tissue adherent to wound. Surgical outcomes of different wound types were compared. RESULTS: 50 consecutive patients were included (6 females, 44 males; mean age 33 ± 12 years). The average size of wound was 4.2 ± 2.6 mm (type 1, 8 eyes; type 2, 27 eyes; type 3, 12 eyes; type 4, 3 eyes). At the end of 3 months, 70% (n = 35) of the wounds were type 1. At the end of 6 months, all type 1 wounds had healed completely, whereas about half of type 2 (48.1%) and type 3 (50%) wounds had recovered to type 1 configuration. The wound type at baseline affected the height of step (p = 0.047) and corneal thickness at 6 months (p = 0.035). CONCLUSIONS: ASOCT is a useful tool for monitoring wound healing in cases with penetrating corneal injury. Majority of the wound edges appose between 3 and 6 months after trauma. In our study, baseline wound configuration affected the healing pattern.

Change of Optical Intensity during Healing Process of Corneal Wound on Anterior Segment Optical Coherence Tomography.

The purpose of this study is to investigate the process of corneal wound healing after penetrating injury with the change in optical intensity on anterior segment optical coherence tomography (AS-OCT) and to investigate factors associated with severity of corneal scar. Forty-seven eyes from 47 patients with repaired corneal laceration were included. AS-OCT was performed on 1day, 1week, 1, 3 and 6 months after primary repair. Internal aberrations of wound edges were observed on AS-OCT images. Parameters including height of steps, width of gaps, maximal corneal thickness, area and optical intensity of corneal wound/scar were measured. The relationship between the parameters at day 1 and the optical intensity at 6 months were analyzed. The results showed that optical intensity of corneal wound/scar increased from 124.1 ± 18.8 on day 1 postoperatively to 129.3 ± 18.7, 134.2 ± 23.4, 139.7 ± 26.5, 148.2 ± 26.4 at 1 week, 1 month, 3 months and 6 months postoperatively. Height of steps at 1 day after surgery was the only factor identified as correlated with optical intensity of corneal scar at 6 months (beta = 0.34, p = 0.024). The increase of optical intensity represents the process of fibrosis of corneal wound healing. Higher step after suturing is associated with more severity of corneal scar at last.

Mantle cell lymphoma in a lacrimal gland in a female and a review of the literature.

PURPOSE: To report a rare case of Mantle cell lymphoma in lacrimal gland and review of the literature CASE REPORT: We report a case of a 59-year-old female who presented with an upper eyelid mass in the right eye for 3 months, without pain and irrigation. A computerized tomography (CT) scan showed a mass in the bilateral lacrimal gland region, more significant in right eye. The patient underwent a lacrimal gland mass excision surgery and diagnosis of mantle cell lymphoma by histopathology. Immunochemistry for CD20, CD79a, CD5, and CyclinD1 was positive. She was recommended to the Shantou cancer hospital for chemotherapy. CONCLUSION: Mantle cell lymphoma is a rare type of malignant lymphoma, over expressing CD5 and cyclin D1 antigens, which distinguishes it from other B cell lymphomas.

Comparison of pterygium recurrence rates after limbal conjunctival autograft transplantation and other techniques: meta-analysis.

PURPOSE: Meta-analysis to compare pterygium surgery outcomes using limbal conjunctival autograft (LCAG) and other techniques. METHODS: A comprehensive literature search was conducted through June 2011 using PubMed, Embase, and the Cochrane Registry to identify all randomized control trials reported so far, comparing the recurrence rates of pterygium after LCAG and other surgical techniques. The odds ratios (ORs) and 95% confidence intervals (CIs) of rates of pterygium recurrence were pooled using the Mantel-Haenszel method. RESULTS: Overall, 13 randomized control trials were included in the analysis (Jadad score, 1-3). The pooled OR from individual studies showed that the recurrence rates after pterygium excision with LCAG were lower as compared with pterygium excision with bare sclera technique (95% CI, 0.04-0.17; pooled OR=0.08, P<0.01), bulbar conjunctival autograft (95% CI, 0.04-0.23; pooled OR=0.10, P<0.01), or intraoperative mitomycin C (95% CI, 0.09-0.52; pooled OR=0.22, P<0.01). There was no statistically significant difference in the recurrence rates after LCAG and amniotic membrane graft (95% CI, 0.26-1.70; pooled OR=0.66, P=0.39). CONCLUSIONS: According to the current evidence from literature, recurrence rates after pterygium excision with LCAG are lower when compared with the use of bare sclera, bulbar conjunctival autograft, or intraoperative mitomycin C. Although recurrence rates of LCAG were similar to the amniotic membrane graft, further large-scale randomized controlled trials would be required to confirm these results.

Histological and ultrastructural study on the medial canthal ligament of blepharophimosis, ptosis and epicanthus inversus syndrome.

BACKGROUND: Blepharophimosis ptosis epicanthus inversus syndrome (BPES) is a rare congenital ophthalmic disorder, characterized by congenital eyelid malformation including bilateral ptosis, shortening of the horizontal eyelid fissure, epicanthus inversus, and increased distance between the inner canthi. In this research, we studied the histological structure and ultrastructure of medial canthal ligament of patients with BPES. METHODS: Thirty patients with BPES who received plastic surgery at the Zhongshan Ophthalmic Center from March 2006 to January 2008 were studied. There were 17 males and 13 females with an average age of (8.73 +/- 3.37) years (3 - 31 years). The medial canthal ligaments of patients were collected during the plastic surgery to analyze the histological structure by hematoxylin and eosin (HE), Congo red, van Gieson's (VG), Masson trichrome and aldehyde-fuchsin staining. The ultrastructures of the medial canthal ligaments were also analyzed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Fifteen samples of medial canthal ligament from healthy persons with an average age of (9.02 +/- 3.12) years (6 - 30 years) were collected as a control group. RESULTS: Morphological and histological study showed that the medial canthal ligaments of BPES patients were composed of collagen fibers, a few elastic fibers and striated muscles. The collagen fibers assemblies were disorganized and the fibrous connective tissues were undergoing hyaline degeneration. The karyopycnosis of fibroblasts was located among the collagen fibrils and the numbers of fibroblasts were decreased. Ultrastructural study with SEM showed that the collagen fibers were larger than normal, irregular and loose. Parts of the collagen fibers were broken and had a coarse surface. Ultrastructural study with TEM showed that the fibroblasts had less cytoplasm, fewer organelles and the nucleus displayed pyknosis. CONCLUSIONS: The medial canthal ligament in BPES patients is composed chiefly of collagen fibers. The collagen fibers of medial canthal ligaments in BPES patients are disorganized and hyaline degeneration is present. The study revealed that the medial canthal ligament of BPES patients might have congenital dysplasia.

A modified evisceration technique with scleral quadrisection and porous polyethylene implantation.

PURPOSE: To propose and evaluate a modified evisceration technique that aiming to minimize the extrusion or exposure and improve motility of the implant. DESIGN: Interventional prospective study. METHODS: There were 154 patients referred to our clinic from March 1, 2003 to March 1, 2007. All the patients underwent the primary evisceration and implantation of a porous polyethylene implant using the modified technique, which included quadrisecting the sclera, suturing the implant with each rectus muscle through the scleral petal, and then covering the implant with 2 layers of the sclera. Main outcome measures were complications such as conjunctival dehiscence, implant extrusion, implant exposure, significant enophthalmos, superior sulcus deformity or orbital cellulitis, and cosmetic outcome. RESULTS: All patients received porous polyethylene implants with 18 mm or larger sphere. In a mean 3.5 years follow-up period (range, 1 to 5 years), there was no case of conjunctival dehiscence, implant extrusion, implant exposure, significant enophthalmos, superior sulcus deformity, or orbital cellulitis. The cosmetic appearance and implant mobility were satisfactory. CONCLUSIONS: This technique appears to be an excellent modification for anophthalmic socket reconstruction.