Importance of etiology in canalicular obstruction surgery.

PURPOSE: The treatment options for canalicular obstruction remain controversial, and there are different approaches. In this study, we aimed to evaluate the success of balloon dilatation and silicon tube intubation according to the etiology in patients with canalicular obstruction. METHODS: The files of 91 patients with isolated monocanalicular obstruction were retrospectively reviewed. Patients were grouped according to surgical methods (Group A: both balloon dilatation and silicon tube intubation; Group B: Only balloon dilatation) and etiologies (topical anti-glaucomatous usage-related, inflammatory, chemotherapy-related, radiotherapy-related, trauma-related, idiopathic). Preoperative and postoperative Munk scores and lacrimal irrigation results were noted in all cases. RESULTS: Munk score was found to be statistically significantly lower in the 1st year in both groups. The patency rate with lacrimal syringing was found to be statistically significantly higher in group A. Success rates both in the munk score and lacrimal passage patency were found to be statistically significantly lower in inflammatory etiology than other etiologies. CONCLUSIONS: Both techniques can be used as first-line therapies for canalicular obstruction. It should be considered that recurrence may develop in stenosis of inflammatory origin and more invasive surgery may be required.

A novel monocanalicular silicone intubation technique for canalicular laceration repair.

OBJECTIVES: This study aimed to evaluate the clinical efficacy and reliability of a novel monocanalicular silicone intubation (nMCI) technique for canalicular laceration repair in a series of patients treated over a 3-year period. METHODS: The case records of 86 patients (86 eyes) who had undergone nMCI-based surgical repair of canalicular lacerations were retrospectively reviewed. The silicone tube removal was planned for 3 months postoperatively. A minimal follow-up of 6 months was adopted for the final analysis. The primary outcome measures included anatomical patency on irrigation and relief from epiphora, which were assessed subjectively and objectively through a fluorescein dye disappearance test. RESULTS: A total of 86 patients (72 males and 14 females; mean age = 34 years) were included. The upper canaliculus was damaged in 13 cases, while the lower canaliculus was damaged in 73 cases. Successful stenting was achieved in all cases. The postoperative eyelid position was satisfactory in the majority of the patients. The mean period of stenting was 3 months, while the mean postoperative follow-up period was 6 months. There were no cases of premature stent extrusion. The functional drainage following stent removal was normal in 95% of the patients, while the syringing revealed full patency with no narrowing or reflux. CONCLUSION: The present results suggest that the nMCI technique presents an effective and atraumatic surgical approach for adult patients with canalicular lacerations. The main advantages of the technique are the simple insertion and the easy removal of the tube, which results in high anatomical and functional success rates and offers an effective alternative in the treatment of monocanalicular lacerations.

Lacrimal stenting versus three-snip punctoplasty for treatment of punctal stenosis or occlusion: an open- label, randomized clinical trial.

Background: To compare the short-term anatomical and functional outcomes of, as well as patient satisfaction with, lacrimal stenting and three-snip punctoplasty for the treatment of punctal stenosis or occlusion. Methods: In this open-label, randomized clinical trial, we included 50 eyes of 30 patients diagnosed with punctal stenosis or occlusion. They were randomly allocated to two groups of 25 eyes each, using central telephone randomization. Group A underwent a lacrimal stenting procedure and was subdivided into two subgroups: Group A1 (13 eyes) received polyvinylpyrrolidone-coated perforated punctal plugs, and Group A2 (12 eyes) received closed intubation using a bicanalicular silicon tube. Group B included 25 eyes that underwent three- snip punctoplasty. All eyes were examined after 1 day, 1 week, 1 month, 3 months, and 6 months. Postoperative anatomical success assessing the punctum size, functional success using the fluorescein disappearance test (FDT), and patient satisfaction based on epiphora scoring were recorded. Results: Both study groups were comparable in terms of sex and age distribution. Compared to Group B, Group A had a significantly larger punctum size at one, three, and 6-month postoperatively (P = 0.009, 0.01, and 0.02, respectively). The difference in FDT results was significant between the two groups at all follow-up visits (P = 0.008, 0.0001, 0.003, and 0.002, at postoperative one week, one-months, three-month, and si-month, respectively). Likewise, patient satisfaction was significantly different between both groups at all follow-up visits (P = 0.007, 0.001, 0.005, and 0.002, at postoperative one week, one-months, three-month, and si-month, respectively). Conclusions: Lacrimal stenting is an effective method for the treatment of punctal stenosis or occlusion. Overall, the FDT results and patient satisfaction outcomes were significantly better.

Feasibility of Strip Meniscometry for Tear Volume Evaluation in Lacrimal Passage Obstruction.

Strip meniscometry tube (SMTube) is useful for assessing tear volume in dry eye disease. We performed an in vitro and a clinical study to examine whether the SMTube can also be used to evaluate tear quantity in lacrimal passage obstruction (LPO). In vitro experiments showed that the SMTube value and the amount of water absorption were significantly correlated (R2 = 0.816, p = 0.0008), but the measured value peaked when 4 µL was absorbed. In the clinical study, 12 eyes of 9 LPO patients and 17 eyes of 17 healthy control subjects were included. The patients' SMTube values were significantly higher than those of the control subjects (p < 0.05). The SMTube value significantly decreased after silicon tube intubation (p < 0.05). Tear meniscus height (TMH) and area (TMA), measured by anterior segment optical coherence tomography, exhibited a significant positive correlation with the SMTube value (TMH, p < 0.001, R2 = 0.396; TMA, p < 0.001, R2 = 0.366). Moreover, the SMTube value significantly correlated positively with the subjective symptom of epiphora (p = 0.012, R2 = 0.255). Thus, SMTube was useful for evaluating the tear volume and therapeutic effects in patients with LPO.

The clinical application of pigtail catheter thoracic closed drainage in the first diagnosed as spontaneous pneumothorax in adolescents / 中华胸心血管外科杂志

Objective To investigate the two kinds if thoracic cavity closed drainage contrast analysis and evaluate the pigtail catheter for treatment of spontaneous pneumothorax in adolescents.Methods This study included 53 adolescent patients with the first spontaneous pneumothorax in Huaihe Hospital of Henan University between January 2013 and December 2015.According to the different operation ways,they were divided into two groups:silicone tube and pigtail catheter group.The following post-operative data was evaluated:pain,subcutaneous emphysema,drainage time,hospital stay,new drain insertion,and wound healing at the site of insertion.Results There were 32 patients in the silicone tube group and 21 ones in the other group.The data revealed a significantly reduced the operation time and pain in the pigtail catheter group compared to the chest tube group(P ＜ 0.05).However,no statistical differences in success rate,postoperative hospital stay and complications incidence were found between the 2 groups.Conclusion Compared to common chest tube,the employment of pigtail catheter in the adolescent patients with pneumothorax significantly reduces the operation time and pain.Nevertheless,no statistically significant differences were discovered in success rate,postoperative hospital stay and the incidence of complications between the two corresponding groups.Thus pigtail catheter is competent in terms of closed thoracic drainage in adolescents who are the first diagnosed as spontaneous pneumothorax.

Comparison of two combined surgical methods in treatment of chronic dacryocystitis with upper lacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy of two combined surgical methods in treatment of chronic dacryocystitis with upper lacrimal duct obstruction. <p>METHODS: Totally 68 cases(68 eyes)of chronic dacryocystitis with upper lacrimal duct obstruction were enrolled. They were randomly divided into Group A and Group B through random number table method, each group of 34 cases, Group A was treated with nasal endoscopic dacryocystorhinostomy combined with silicone tube implantation. Group B was treated with traditional dacryocystorhinostomy combined with silicone tube implantation. All patients were followed up for 1a. <p>RESULTS: In Group A, the total success rate was 82%, that in Group B was 79%. There were no significant difference between two groups' total success rate(<i>P</i>>0.05). The incidence of postoperative facial swelling in Group A was 6%. The facial scar incidence rate was 0. Those of Group B were 47% and 100%. The incidence of complications in Group A was significantly lower than that in Group B with significantly difference(<i>P</i><0.05). Rate of patients' satisfaction was 82% in Group A, and 59% in Group B, which of Group A was significantly better than group B(<i>P</i><0.05). <p>CONCLUSION: Canalicular intubation combined dacryocystorhinostomy using endoscopy is an ideal method in treatment of chronic dacryocystitis with upper lacrimal duct obstruction. It is safe, effective with less injury and less complication.

Clinical research of canalicular intubation combined external dacryocystorhinostomy for chronic dacryocystitis and upper lacrimal duct stenosis / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To evaluate the clinical efficacy of canalicular intubation combined with external dacryocystorhinostomy ( ext-DCR ) for treatment of chronic dacryocystitis and upper lacrimal duct stenosis. METHODS:Thirty-three patients (33 eyes) with chronic dacryocystitis and upper lacrimal duct stenosis who underwent canalicular intubation combined ext-DCR were retrospective analyzed. The silicon tube was indwelt for 6mo. All cases were re-examined 1wk;1, 3, 6, 9mo post-operation, flow of tears, pus excretion and lacrimal duct clearance were observed. RESULTS: Clear lacrimal duct ratio was 100% in all cases during 1wk~6mo post-operation; Silicon tube was removed 6mo post-operation, 3mo after tube removal, rechecking reported 32 cases with clear lacrimal duct (97%) and 1 case with resistant duct (3%). Two cases ( 6%) with minor lacerations, no other complications were observed. CONCLUSlON: Canalicular intubation combined ext-DCR is an effective treatment for chronic dacryocystitis and upper lacrimal duct stenosis.