Optimizing clinical outcomes for endoscopic lacrimal duct recanalization in patients with complete PANDO.

PURPOSE: The study aims to describe modifications and refinements in the technique and technology of Transcanalicular Endoscopic Lacrimal Duct Recanalization (TELDR) based on anatomical foundations to optimize its clinical outcomes in patients with complete Primary Acquired Nasolacrimal Duct Obstruction (PANDO). METHODS: The medical records of 115 patients who underwent TELDR procedures from January 2018 to July 2020 were reviewed retrospectively. Of the 115 patients, only those 35 patients with complete PANDO characterized by longstanding epiphora of 3-5 years duration, dense, diffuse fibrous tissue obstruction involving the sac, sac duct junction and the entire length of the nasolacrimal duct were included in the study. Parameters for success were analyzed based on patency on irrigation, functional endoscopic dye test, and improvement of epiphora. RESULTS: Forty-five cases from 35 patients with complete PANDO were included in the study. The mean length of time from the date of operation to silicone stent removal was 8.1 weeks, while the mean length of follow-up starting from the removal of silicone stent to last follow-up was 61.0 weeks. There were 95.6% anatomic patency on canalicular irrigation with saline and 95.6% functional patency based on functional endoscopic dye test. There was significant improvement of epiphora (p value of < 0.0001) post-operatively. CONCLUSION: The results of modified TELDR improved clinical outcomes and could be a definitive treatment in patients with complete PANDO with longstanding, dense, diffuse, fibrous tissue obstruction. Patients who experience reobstruction, may undergo a repeat of the recanalization approach.

Retention rates and benefits of Painless Punctal Plug F(TM) in dry eye patients.

In this article, the authors attempt to determine the retention rate and benefits of Painless Punctal Plug F(TM) placed in patients diagnosed with dry eye. This is a prospective, observational cohort study. Forty patients diagnosed with dry eye underwent Painless Punctal Plug F placement in the inferior puncta (80 puncta) in a private clinic from January 2010 to July 2012. Patients were then followed up monthly for seven months taking note of plug retention, spontaneous plug loss, and complications. Retention rates of patients with mean age of 58.6 years were 100% after one month, 98.75% after two months, 96.25% after three months, 95% after four months, 93.75% after five months, and 92.5% after seven months. In the 80 plugs, three plugs underwent spontaneous punctal plug loss and three plugs were removed due to local discomfort. In total, 74 out of 80 plugs remained intact after seven months of follow-up. Kaplan-Meier analysis showed that there was propensity for spontaneous punctal plug loss or plug removal in the Sjogren group as compared to the non-Sjogren group. No complications were noted such as epiphora, local inflammatory reaction, nor canalicular pyogenic granuloma except for local discomfort. This study showed that Painless Punctal Plug F has a high retention rate with the following benefits, it has one-size, fitted for small to medium puncta; extended round end which made prior dilation unnecessary and once inserted, the soft round bulb fits snugly inside the punctum preventing plug loss.

Surgical technique and preliminary results of transcanalicular endoscopic lacrimal duct recanalization and balloon dacryoplasty with silicone intubation in Filipino patients with complete nasolacrimal duct obstruction

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the surgical technique of transcanalicular endoscopic lacrimal duct recanalization (TELDR) with balloon dacryoplasty and silicone intubation in patients with complete nasolacrimal duct obstruction and assess their effectivity.</p> <p style="text-align: justify;"><strong>METHODS:</strong> Ten lacrimal systems from eight patients diagnosed with complete nasolacrimal duct obstruction (NLDO) underwent TELDR and balloon dacryoplasty with silicone intubation.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> All 10 lacrimal systems from eight patients who underwent TELDR and balloon dacryoplasty with silicone intubation had 100% anatomical and functional patency.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> TELDR and balloon dacryoplasty with silicone intubation represents an alternative, minimally invasive technique in the management of complete nasolacrimal duct obstruction.</p>

Use of an imaging device after nonablative radiofrequency (Pellevé): treatment of periorbital rhytids.

OBJECTIVE: To use the Canfield Reveal imager in objective photo documentation of the effect of nonablative radiofrequency (Pellevé) treatment on periorbital rhytids. METHODS: This is a prospective cohort study. Twelve patients underwent 1 to 2 sessions of nonablative radiofrequency (Pellevé) treatment over the periorbital region. INCLUSION CRITERIA: aged 30 to 60 years old, minimal tissue laxity, and shallow wrinkle development. Standardized reproducible photographs (left, frontal, right views) with use of the Canfield Reveal imager's superimposition feature were taken of each patient prior, immediately after application, and on 2nd, 4th, 6th, and 8th week follow up. Brow elevation was measured in the pre- and posttreatment photographs with the use of the Canfield Reveal imager and rendered the photographs in 3-dimensional images. RESULTS: Comparison of the pre- and posttreatment photographs taken via the Canfield Reveal imager showed reduction in the wrinkles, smoothening, and tightening of the eyelid and the periorbital tissue. Patients exhibited an average increase of 2.05 mm (p<0.001) of eyebrow lift and 0.98 mm (p<0.001) of superior eyelid crease elevation immediately after treatment. Eight weeks after, average brow elevation was measured at 3.52 mm (p<0.001) and crease elevation at 1.84 mm (p<0.001). The 3-dimensional imaging feature rendered in normal skin tone, and shades of gray showed softening of fine lines and crow's feet after treatment. Furthermore, it also rendered in color relief that highlighted the changes seen with depressions noted to decrease after treatment. CONCLUSION: The Canfield Reveal imager can be used in the objective photodocumentation of subtle and modest effects of nonablative radiofrequency (Pellevé) treatment to the periorbital region.

Nonablative 4-MHz dual radiofrequency wand rejuvenation treatment for periorbital rhytides and midface laxity.

PURPOSE: To evaluate the wrinkle-reducing effects of 4-MHz radiofrequency (RF) energy applied to human periorbital, frontal, and midface facial skin using clinical wrinkle grading, patient self-satisfaction survey, and limited histologic studies. METHODS: Thirty-two patients, ranging from 29 to 71 years of age with skin types varying from class I to class III using the Fitzpatrick Wrinkle Classification system, underwent 8 weekly treatment sessions of nonablative RF therapy on the periorbital, frontal, and midface regions and were subjected to follow up for 6 months after treatment. Pretreatment and post-treatment evaluations were compared. Two female subjects gave informed consent for RF treatment for the right upper eyelid and no treatment for left upper eyelid. Specimens from both upper eyelids then underwent histologic examination using light and transmission electron microscopy. RESULTS: Pre- and post-RF treatment evaluation by 3 independent observers using the Fitzpatrick wrinkle classification system showed progressive improvements in wrinkle score at 1-, 3-, and 6-month intervals (p < 0.01). Self-evaluation of 32 patients using a 9-point rating scale after application of RF treatment also showed improving satisfaction (p < 0.01). The most commonly noted adverse reaction was transient erythema (62.5%) lasting from a few hours to a day. Transmission electron microscopy (25,000×) showed scattered diffuse changes in collagen fibril architecture with a shift from smaller-diameter collagen fibers in the untreated samples to larger-diameter fibers in the treated samples and a loss of distinct fibril borders. CONCLUSIONS: Four-megahertz dual RF wand delivery rejuvenation treatment produces a reduction in periorbital and midface rhytides.

Efficacy of endoscopic lacrimal duct recanalization using microendoscope.

PURPOSE: To describe a new endoscopic procedure to restore the passage of tears in an obstructed lacrimal drainage system and to compare its efficacy with the standard external dacryocystorhinostomy (SE-DCR). METHODS: Patients with complete and partial primary acquired nasolacrimal duct obstruction (PANDO) were randomly allocated to 2 treatment groups using completely randomized design. The first group was treated using endoscopic lacrimal duct recanalization (ELDR), while the second group was treated using SE-DCR. Follow-up was conducted for at least 6 months and evaluated for anatomical and functional patency. Complications were also noted for both groups. RESULTS: A total of 86 patients underwent ELDR, 60 of whom had complete PANDO, while 26 patients had partial PANDO. Eighty patients underwent SE-DCR; 58 had complete PANDO, and 22 had partial PANDO. The combined success rate in terms of anatomical patency for ELDR was 93.02% (95% confidence interval [CI], 0.88-98) compared with 93.75% (95% CI, 0.87-90) for SE-DCR (p = 0.85). Meanwhile, the combined success rate (functional patency) for ELDR is 84.88% (95% CI, 0.77-93) versus 90.00% (95% CI, 0.83-97) for SE-DCR (p = 0.32). CONCLUSIONS: ELDR using microendoscope is as efficacious as SE-DCR, without its associated major complications.

Epinephrine in irrigating solutions and its effect on blood pressure and pulse rates

A study was done to determine if epinephrine 1:600,000 concentration mixed with BSS will have any effect on a patients cardiovascular status during and after cataract surgery. A retrospective study was done on 50 cataract patients from January to June 1999. 0.3ml of epinephrine added to 500cc of BSS were used as the irrigating solution for phacoemulsification. Phacoemulsification using the pre-slice technique under topical anesthesia was performed on all patients. Irrigation and aspiration was done and small amounts of solution to reform the chamber. Patients blood pressure and pulse rates were taken preoperatively, intra-operatively, post-operatively and 24 hrs. post-operatively. Results showed no statistically significant rise in systolic blood pressure and pulse rates. We conclude that epinephrine 1:600,000 mixture in BSS is a safe way of maintaining pupillary dilatation during phacoemulsification. (Author)