Classification of Lacrimal Punctal Stenosis and Its Related Histopathological Feature in Patients with Epiphora.

PURPOSE: To evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features. METHODS: Patients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated. RESULTS: Punctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type. CONCLUSIONS: Acquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.

Efficacy of temperature-sensitive Guardix-SG for adhesiolysis in experimentally induced eyelid adhesion in rabbits.

PURPOSE: To determine the efficacy of a temperature-sensitive poloxamer/alginate mixture (Guardix-SG) for reducing adhesions after blepharoplasty in rabbit models. METHODS: Thirty-six intact eyes of 18 rabbits were randomly designated to 2 groups, and primary blepharoplasty was performed on both the upper eyelids of the 18 rabbits. Sterile cotton soaked in 1 N NaOH was used to produce chemical tissue damage to experimentally induce eyelid adhesion, which was followed by adhesiolysis in 2 weeks. During adhesiolysis, Guardix-SG was applied to the OD of rabbits in the experimental group, while adhesiolysis alone was performed on the OS of rabbits in the control group. Both sides were compared by gross examination 1 day, 1 week, and 4 weeks after surgery, and the degrees of inflammation and fibrosis were examined with hematoxylin-eosin (H&E) and Masson's trichrome (MT) stains. The expression of α-smooth muscle actin (α-SMA) antibody was also immunohistochemically examined. RESULTS: The gross examinations performed after adhesiolysis yielded results that were not significantly different between the experimental and the control groups, and no prevalent complications, such as eyelid traction or distorted eyelids, were observed. One day (p = 0.028), 1 week (p = 0.028), and 4 weeks (p = 0.028) after surgery, the experimental group had a lower infiltration rate of inflammatory cells than the control group, as shown by H&E staining. The MT staining and α-SMA staining also showed that the collagen deposition and fibrosis (1 week, p = 0.059; 4 weeks, p = 0.034) and the degree of myofibroblast differentiation were significantly lower in the experimental group than in the controls (1 week, p = 0.027; 4 weeks, p = 0.024). CONCLUSIONS: The temperature-sensitive poloxamer/alginate mixture (Guardix-SG) decreased inflammation and fibrosis after blepharoplasty and histopathologically prevented the readhesion of secondary blepharoplasty in rabbit models. Therefore, additional clinical studies are needed for other ophthalmic surgeries that could benefit from preventing postoperative adhesions.

Efficacy of Seprafilm(®) graft with adhesiolysis in experimentally induced lid adhesion in rabbits.

AIM: To evaluate the efficacy of Seprafilm(®) transplantation following adhesiolysis for preventing postoperative readhesion and improving surgical outcomes. METHODS: Primary blepharoplasty was carried out on both eyelids of 18 albino rabbits. After 2 weeks, a new skin incision was made, and adhesiolysis was performed on both eyelids. The rabbits were categorized into two groups, one with adhesiolysis alone in the left eyelid (control group), and the other with adhesiolysis with a Seprafilm(®) graft in the right eyelid (Seprafilm(®) group). The degrees of inflammation and fibrosis were examined with hematoxylin-eosin (HE) and Masson's trichrome stains. Expression of α-smooth muscle actin (α-SMA) was also immunohistochemically examined. RESULTS: Eyelid examination immediately after the operation revealed mild swelling and hemorrhage in both groups, but these symptoms resolved after 1 week-2 weeks, and eyelid shape had recovered completely in both groups. Microscopic assessments demonstrated that the Seprafilm(®) group showed less inflammation and fibrosis than the control group. The Seprafilm(®) group also exhibited fewer α-SMA-positive cells than the control group. CONCLUSION: Based on these findings, we conclude that Seprafilm(®) graft with adhesiolysis is an effective method for preventing postoperative readhesions after eyelid surgery.