Application Possibilities of a New Preloaded Nasolacrimal Duct Intubation System. / Anwendungsmöglichkeiten eines neuartigen vorgeladenen Intubationssystems für Tränenwege.

INTRODUCTION: The LacriJet (FCI S. A. S. - France Chirurgie Instrumentation, Paris, France) represents a novel, simplified and preloaded system for monocanalicular or monocanaliculonasal nasolacrimal duct intubation. It is a further development of the Masterka and shall reduce the intubation time during the surgical procedure. The aim of the present study was to present first experiences with this system for different indications. MATERIAL AND METHODS: All patients who underwent nasolacrimal duct intubation with the LacriJet at the University of Muenster Medical Center in the period from March to November 2019 were included. The postoperative outcome was evaluated 3 to 6 months later. RESULTS: In total, 12 nasolacrimal duct intubations with the LacriJet were performed at our center in the above-mentioned period. The main indication for intubation was congenital nasolacrimal duct obstruction (CNLDO). In addition, intubation was performed in cases with eye lid tumors involving the nasolacrimal duct, in a case of canalicular laceration and in a case of canaliculitis. In 3 cases, there was an early dislocation or a complete loss of intubation. Of these, 2 were cases with CNLDO and the third dislocation was due to manipulation by the patient. All in all, the functional results were satisfying. SUMMARY: The use of the LacriJet is highly suitable for the treatment of CNLDO, stenting in canalicular laceration or lid tumours involving the lacrimal drainage system. However, the known disadvantages of monocanalicular intubation (dislocation, early loss of intubation) also occur with this type of system and a system briefing seems useful. The LacriJet therefore represents a modern and simple method for nasolacrimal duct intubation and can be used for various indications.

[Importance of Cryotherapy for Eyelid Papillomas]. / Kryotherapie in der Behandlung ausgedehnter Lidpapillome.

PURPOSE: Cryotherapy as a destructive procedure is an important alternative to the surgical excision of eyelid tumors. METHODS: We report our own experiences in the cryotherapy of large upper eyelid papillomas using spray- and contact-freezing. RESULTS/CONCLUSIONS: Cryotherapy gave excellent results in the treatment of unusually large papillomas. The preservation of collagen structures during cryotherapy provides a good aesthetic and functional outcome.

[Treatment Options for Adenoid Cystic Lacrimal Gland Carcinoma - A Case Series and Literature Review]. / Therapieoptionen bei adenoidzystischem Tränendrüsenkarzinom ­ Fallserie und aktueller Literaturüberblick.

Adenoid cystic carcinoma of the lacrimal gland (ACC) is a rare malignant orbital tumour with a poor overall prognosis. Current therapeutic approaches like radical and local surgery, adjuvant radiation and neoadjuvant intra-arterial chemotherapy are controversial. We present three cases of patients with ACC with different therapy concepts and discuss these with current recommendations from the literature.

Leukemic hypopyon in acute myeloid leukemia.

PURPOSE: Leukemic hypopyon uveitis in acute myeloid leukemia (AML) is a very rare condition. We report this case of an unusual finding in a 2½-year-old boy in second remission after chemotherapy for relapsed AML. METHODS: A young patient with an AML FAB M5 in second remission developed pain, photophobia, and conjunctival injections in the right eye. Recent bone marrow aspiration showed no blast increase and recent peripheral blood sampling presented no evidence of relapse. RESULTS: The patient showed a viscous hypopyon and a myotic pupil in the right eye that was refractory to corticosteroids. Anterior chamber aspiration revealed atypical blasts similar to the leukemic cells that were found in the bone marrow aspirate at the time of systemic relapse. CONCLUSIONS: Timely anterior chamber aspiration and subsequent cytology is useful in differentiating leukemic hypopyon from true intraocular inflammation in AML patients. This is the first report about a leukemic hypopyon uveitis in AML without systemic findings of malignant cells in a child.

Preseptal transconjunctival approach for orbital floor fracture repair: ophthalmologic results in 209 patients.

CONCLUSIONS: The transconjunctival approach to orbital floor fractures permits excellent exposure of the inferior orbit and provides a good surgical outcome, especially with regard to ocular motility. OBJECTIVE: Surgical access to orbital floor fractures can be accomplished via the transconjunctival approach. The majority of studies on this subject deal with surgical aspects and complications. The purpose of this study was to report the ophthalmologic outcome after transconjunctival orbital floor fracture repositioning in a significant number of patients. MATERIAL AND METHODS: In a retrospective study, the data of 209 patients with orbital floor fractures treated via the transconjunctival approach with (n=181) and without (n=28) lateral canthotomy were analyzed. RESULTS: The commonest cause of injury was forms of violence (32%). An isolated fracture of the orbital floor had occurred in 62 cases, while concomitant facial fractures were present in the remaining 147. A total of 24 patients (11%) had an exophthalmos and 13 (9%) an enophthalmos. Most patients (69%) complained of infraorbital dysesthesia. When elevating the eyeball, the majority of patients showed a marked or severe disturbance of ocular motility (53% in abduction; 51% in adduction) and diplopia (37% in abduction; 36% in adduction). Thirteen patients required repeat surgery. After a follow-up period of 2 years, infraorbital dysesthesia was observed in only three patients, one of whom presented with a considerable persistent enophthalmos of 4 mm, and only four patients had persistent reduced motility and diplopia.

Examination of preschool children for ametropia: first experiences using a new hand-held autorefractor.

INTRODUCTION: Over the last decades, various methods have been investigated for preschool screening for amblyogenic ametropia. The SureSight is a new hand-held wavefront-analyzing autorefractor designed for screening. METHODS: A total of 338 children (3 1/2 - 4 1/2 years-old) were examined in their kindergartens without cycloplegia using the new instrument. Of these, 56 had a cycloplegic retinoscopy as a reference measurement. Hyperopia > or =3 dpt, myopia > or =1 dpt, astigmatism > or =1 dpt and anisometropia > or =1 dpt were considered amblyogenic ametropia. RESULTS: Testability was 99.4%. Accuracy was high for cylinder power and axis but poor for the spherical equivalent. Sensitivity was 41% for the detection of amblyogenic hyperopia, 95% for astigmatism and 75% for anisometropia, with specificity values of 92, 79 and 73%. CONCLUSION: The high testability and accuracy for cylinder power and axis are the strong points. The poor accuracy for the spherical equivalent is probably caused by the lack of cycloplegia. At present, non-cycloplegic autorefractor screening cannot be recommended due to the low specificity. Our findings support the advice that objective refraction in childhood must be performed with cycloplegia.

[Development of ocular motility following modified 3-wall decompression of the orbita in endocrine orbitopathy for functional and rehabilitative indication]. / Motilitätsentwicklung nach modifizierter 3-Wand-Dekompression der Orbita bei endokriner Orbitopathie aus funktioneller und rehabilitativer Indikation.

INTRODUCTION: Permanent visual damage due to an increase in volume of the orbital contents may be the result of the failure of conservative therapeutic concepts in the treatment of endocrine orbitopathy. Considerable progress has been achieved in developing successful orbital decompression techniques with regard to functional and cosmetic outcome. Decompression techniques with resection of the bony orbital walls are adequate tools in restoring visual acuity and reducing exophthalmus. A considerable degree of deterioration of motility disorders has been described in the literature depending on the techniques being used. PURPOSE: The purpose of this study was to investigate whether a modified technique of 3-wall orbital decompression with preservation of a medial part of the periorbital tissue to support the medial rectus muscle, is able to reduce the postoperative risk of diplopia. MATERIAL AND METHODS: A modified technique of orbital 3-wall decompression with resection of the medial orbital wall, the medial orbital floor and the floor of the frontal sinus has been used in patients with compressive optic neuropathy (n = 20) and for cosmetic reasons (n = 7) in cases of uni- or bilateral proptosis. Analysis of the results was performed concerning visual outcome, exophthalmus reduction and development of horizontal and vertical motility changes. RESULTS: In all cases of optic neuropathy improvement of visual function at an average of 4.63 +/- 4.5 lines could be achieved. Exophthalmus reduction was 3.2 +/- 2.4 mm in the functional group and 3.9 +/- 1.7 mm in the rehabilitative group. In this group motility of the medial rectus muscle remained unaffected except in one eye. In the functional group motility deterioration was observed in 62 %. CONCLUSION: The modified 3-wall decompression technique with preservation of a medial periorbital tissue strip is an adequate alternative technique in the therapy of optic neuropathy and exophthalmus reduction in endocrine orbitopathy with a low risk of postoperative motility disorders.