External dacryocystorhinostomy: A critical overview of the current evidence.

PURPOSE: External dacryocystorhinostomy (ext-DCR) is still considered the gold standard in the treatment of distal lacrimal duct obstruction. Despite an overall high success rate, some patients do relapse after surgery and the ideal perioperative management has not been identified yet. The purpose of this study is to critically discuss the published evidence in the last five years on the medical and surgical management of external dacryocystorhinostomy. Furthermore, the drawbacks of the available literature and the perspectives in this field will be also highlighted. METHODS: Systematic review of the literature in the last 5 years by using PubMed and Google Scholar. RESULTS: A total of 64 articles were included. Many technical modifications and surgical refinements have been proposed but a formal comparison among the various techniques is hampered by methodological heterogeneity. The use of local anesthesia, and the perioperative adjunctive techniques to reduce the risk of restenosis are also gaining popularity but the level of evidence remains weak. CONCLUSION: Ext-DCR offers satisfactory clinical outcomes even though there are many gray areas that need to be addressed in future high-quality studies.

A Simple Way to Apply Moisture Chamber Eyeglasses During Oculoplastic Surgery.

Proper eyelid closure and a normal blink reflex are essential to maintain a stable tear film and a healthy corneal surface. We present a simple technique to apply moisture chamber eyeglasses after oculoplastic surgery. The Opti-Gard® protective eyewear is faster, easily applicable and well performing. It can be used with different face shape, and it does not require any additional trimming or modification. This technical note explains a very simple, economical and less time-consuming method to prevent a postoperative dry keratoconjunctivitis. It may be applied to all procedures within the field of ophthalmic surgery, including oculoplastic surgery.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Posterior lamellar reconstruction: a comprehensive review of the literature.

The aim of the review is to describe the different techniques and materials available to reconstruct the tarsoconjunctival layer of the eyelid; to analyze their indications, advantages, and disadvantages. We searched the Cochrane, PubMed, and Ovid MEDLINE databases for English articles published between January 1990 and January 2017 using variations of the following key words: "posterior lamella," "eyelid reconstruction," "tarsoconjunctival," "flap," and "graft." Two reviewers checked the abstracts of the articles found to eliminate redundant or not relevant articles. The references of the identified articles were screened manually to include relevant works not found through the initial search. The search identified 174 articles. Only a few articles with a therapeutic level of evidence were found. Techniques for the posterior lamellar reconstruction can be categorized as local, regional, and distant flaps; tarsoconjunctival, heterotopic, homologous, and heterologous grafts. Several techniques and variations on the techniques exist to reconstruct the posterior lamella, and, for similar indications, there's no evidence of the primacy of one over the other. Defect size and location as well as patient features must guide the oculoplastic surgeon's choice. The use of biomaterials can avoid possible complications of the donor site.

Bilateral simultaneous nonarteritic anterior ischemic optic neuropathy after ingestion of sildenafil for erectile dysfunction.

Purpose. To describe a patient who developed bilateral, simultaneous nonarteritic anterior ischemic optic neuropathy (NAION) after ingestion of Sildenafil citrate (Viagra) for erectile dysfunction. Methods. Observational case report. Results. A 60-year-old diabetic man noted sudden decrease of vision in both eyes 16 hours after his third consecutive 50 mg daily Sildenafil ingestion. A diagnosis of bilateral NAION was made and he was treated for three days with methylprednisolone 1 g/d intravenously, followed by oral prednisone 75 mg/d. Final visual acuity was 20/50 right eye (OD) and 20/20 left eye (OS). He had preexisting diabetes. Conclusion. This is the first reported case of simultaneous bilateral NAION occurred in a diabetic patient early after Sildenafil intake. Patients with predisposing conditions such as diabetes have to be warned against the use of PDE inhibitors.

Primary dermis-fat grafting in children.

PURPOSE: To report our experience with the use of primary dermis-fat grafts in the pediatric population. METHODS: The charts of 12 young patients under the age of 16 years who underwent dermis-fat graft implantation from 1992 to 2004 were reviewed and the functional and cosmetic outcome was assessed. RESULTS: Ten patients had enucleation combined with primary dermis-fat grafting. Age at the time of surgery ranged from 4.7 to 16 years. One patient was lost to follow-up after 1 year; the remaining 9 had follow-up between 3 to 10.2 years. In 8 of them, appropriate orbital soft tissue volume and good orbital symmetry, with a good prosthetic fit and good motility, were observed. In one patient there was hair growth on the graft, managed by laser coagulation. One child developed central graft ulcer that was repaired. Two children experienced abundant growth of their implants, managed by surgical debulking. Two patients had undergone dermis-fat grafting of congenital anophthalmic sockets, age 13.6 years and 10 months, respectively, at time of surgery. The 10-month-old showed adequate orbital soft tissue volume along with deep fornices (follow-up 6.5 years); the second was lost for follow-up. CONCLUSIONS: Some minor complications with the use of dermis-fat graft in children occur, but they are easily managed. The dermis-fat graft in young children's orbits appears to grow after implantation. Due to its high degree of safety concurrent with excellent functional and cosmetic results, the dermis-fat transplant appears particularly advantageous for young patients.