Virtual Reality and Mixed Reality-Assisted Endoscopic DCR in Extremely Complex Lacrimal Obstructions.

OBJECTIVE: To report the techniques and outcomes of virtual reality (VR) and mixed reality (MR)-assisted powered endoscopic dacryocystorhinostomy (DCR) in extremely complex lacrimal drainage obstructions. METHODS: A prospective, non-randomized clinical study was performed in complex syndromic congenital nasolacrimal duct obstruction (CNLDO) and post-traumatic secondary acquired lacrimal duct obstruction (SALDO) in the setting of Le Fort fractures. All patients underwent preoperative planning in VR and intraoperative planning with a step ahead with MR assistance during the surgery. Surgery was supported by mixed reality intraoperative guidance with the use of the prearranged 3D models and real-time-rendered digital models. Parameters assessed include demographics, clinical presentation, complexities of the nasolacrimal duct obstruction, preoperative and intraoperative utility of VR and MR models, surgical techniques, complications, and outcomes. RESULTS: The technique is described as a proof of concept in challenging situations with Apert syndrome and traumatic SALDOs with gross malposition of the sac, and gross nasal and lacrimal anatomical deformities. The VR models helped the surgeon to assess the details of the altered anatomy preoperatively to plan an appropriate approach. Intraoperatively, MR models were present in the surgeon's view without disturbing the endoscopic procedure. Intermittently, the surgeon could pull any of the models virtually present in the operating room, slice them, rotate them, and intricately study the alterations in a stepwise manner, as the surgery proceeds. CONCLUSION: Virtual reality and mixed reality-assisted powered endoscopic DCR can be an alternate approach reserved for extremely challenging cases of complex syndromic CNLDOs and post-traumatic SALDOs. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3508-3515, 2024.

Evidence of dengue virus in eviscerated specimens of panophthalmitis secondary to dengue fever: A possible cause-effect phenomenon.

PURPOSE: To report a retrospective series of three cases of infectious panophthalmitis post-dengue fever with ex vivo confirmation of dengue virusribonucleic acid (RNA) in the tissues of the eye. METHODS: Four eyes of three patients, who were diagnosed with panophthalmitis following dengue fever and who underwent evisceration, were included. All demographic and clinical data were recorded. The eviscerated samples were subjected to direct microscopy, culture for bacteria, fungi, and parasites, and molecular virology (dengue virus [DENV] NS1-specific reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay). RESULTS: The time from the development of dengue fever to the occurrence of ocular symptoms was 4.33 ± 1.15 (median 5) days. DENV NS1 RNA, suggestive of the presence of the dengue virus, was confirmed in all evisceration specimens (uveal tissue, cornea). All the patients recovered completely from dengue fever and on follow-up had healthy eviscerated sockets. CONCLUSION: Demonstration of the DENV RNA in the eviscerated specimens of panophthalmitis following dengue fever implicates the DENV in the pathophysiology of the ocular infection.

Complications and adverse effects of periocular aesthetic treatments.

The popularity and variety of temporary and permanent periocular aesthetic treatments has increased over the past decade. Patients frequently present to eye clinics with ocular complications and side effects following these treatments, their severity ranging from ocular irritation from dry eyes to visual loss from vascular occlusion. A careful, thorough history is essential, as many patients may not associate aesthetic procedures with ocular complications, and some may be embarrassed to disclose this information. All ophthalmologists should understand the potential ocular sequelae of these treatments and be able to initiate treatment in sight-threatening cases. We summarize the current literature on ophthalmic complications of the most common periocular aesthetic treatments.

Self-regurgitation on pressure over lacrimal sac in cases of primary-acquired nasolacrimal duct obstruction: Correlation with physician examination and patients' perceptions.

PURPOSE: To analyze the correlation between patient-reported regurgitation on pressure over lacrimal sac (ROPLAS) with the physician's examination in diagnosing primary-acquired nasolacrimal duct obstruction (PANDO). METHODS: A cross-sectional study was done over 5 months (March-July 2018). All cases diagnosed as PANDO were included in the study. The maneuver of pressing over the lacrimal sac area and noticing the egress of mucoid or clear fluid from the surrounding area by the patient was termed as self-ROPLAS. A specific patient history of performance of this maneuver was compared with a clinician-performed ROPLAS and subsequent objective lacrimal drainage evaluation. The various reasons for performing self-ROPLAS by the patients were documented. RESULTS: A total of 134 patients were included in the study, out of which 59 (44.02%) were males and 75 (55.9%) were females. History of self-ROPLAS was present in 64 (47.8%) of the patients, whereas the physician examination revealed ROPLAS to be positive in 92 (68.6%) of the patients. All patients (100%) with a positive history of self-ROPLAS had nasolacrimal duct obstruction on subsequent examination. The most common reason for performing self-ROPLAS was for emptying the discharge from the medial canthal region to reduce the painless swelling. CONCLUSION: Self-ROPLAS is highly suggestive of an obstructed nasolacrimal duct and can be used as a screening tool by the primary physician to triage the patients toward ophthalmic plastic clinics or consult.

Orbital involvement in lacrimal drainage disorders.

Lacrimal sac is situated anterior to the orbital septum, which acts as a barrier, thus limiting the posterior migration of the pathologies affecting the lacrimal drainage system. Certain pathologies can breach this barrier and secondarily involve the orbit causing significant clinical manifestations. This posterior migration of pathology also has a significant influence on the management and outcomes. The present paper will discuss the lacrimal pathologies which secondarily involve the orbit and its influence on the management and outcomes.

Endoscopic assessment of the dacryocystorhinostomy ostium after powered endoscopic surgery: behaviour beyond 4 weeks.

BACKGROUND: This study aims to assess the shrinkage of dacryocystorhinostomy (DCR) ostium beyond 4 weeks. DESIGN: Prospective series in a University setting. PARTICIPANTS: Sixty consecutive patients. METHODS: Prospectively collected data of 60 consecutive powered endoscopic DCRs performed in 57 patients over a period of 10 years from 2002 to 2011. All patients had regular follow-up of 2 years post-surgery. The ostium size at 4 weeks, 6 months, 1 year and 2 years were evaluated. Analysis of variance was used to compare the differences. MAIN OUTCOME MEASURE: Changes in ostium measurements. RESULTS: The ostium measured 11.25 mm (standard deviation [SD] = 1.7; 95% confidence intervals [CI] = 10.80-11.69) × 7.07 (SD = 1.4; 95% CI = 6.71-7.42) at 4 weeks. It measured 10.48 mm (SD = 1.6; 95% CI = 10.06-10.90) × 6.65 mm (SD = 1.2; 95% CI = 6.34-6.95) at 6 months, 10.22 mm (SD = 1.5; 95% CI = 9.81-10.61) × 6.52 mm (SD = 1.2; 95% CI = 6.20-6.80) at 1 year and 10.15 mm (SD = 1.5; 95% CI = 9.76-10.53) × 6.45 mm (SD = 1.2; 95% CI = 6.14-6.75). There was no statistically significant decrease in either the ostium size or the area up to 2 years following surgery. CONCLUSION: The ostium achieved using the powered endoscopic DCR technique remains stable in size from 4 weeks to 2 years post-surgery. This likely reflects the advantages of this technique which facilitates healing by primary intention.

Endoscopic dacryocystorhinostomy and obstructive sleep apnoea: the effects and outcomes of continuous positive airway pressure therapy.

BACKGROUND: This study aims to assess the effects and outcomes of continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) in patients who have undergone endoscopic dacryocystorhinostomy (DCR). DESIGN: Retrospective series in a university setting. PARTICIPANTS: A total of 205 consecutive patients were included in this study. METHODS: A 10-year retrospective review was performed of 205 consecutive patients who had undergone powered endoscopic DCR for nasolacrimal duct obstruction. Patient notes were reviewed for demographic, clinical and surgical information. In addition, all patients were contacted and asked to complete a standardized telephone survey relating to OSA, CPAP use and associated symptoms. MAIN OUTCOME MEASURE: Effects of CPAP following DCR. RESULTS: Ten of the 205 patients undergoing DCR were identified to use CPAP for obstructive sleep apnoea. Eight patients were initiated on a nasal device, while two used a full-face mask. The mean CPAP pressures were 8 cm H20 (range: 6-10 cm H20). Eighty percent (8/10) of patients complained of symptoms from the use of their CPAP following DCR. The most commonly described symptom was that of air regurgitation in 70% of patients followed by ophthalmic symptoms in 60% (6/10). 50% (5/10) of patients discontinued their CPAP as a consequence of their symptoms with 20% (2/10) discontinuing because of intolerable ophthalmic symptoms. CONCLUSION: Symptoms from CPAP use post-endoscopic DCR are a common occurrence and may contribute to poor compliance with CPAP therapy. Detailed preoperative counseling with regards to CPAP use and its effects should be mandatory in known or at risk OSA patients undergoing DCR.

Orbital retinoblastoma: Present status and future challenges - A review.

Orbital retinoblastoma is a catastrophic event traditionally carrying a dismal prognosis. Although its incidence is less in the developed countries it continues to be one of the major diagnosis at presentation in the developing world. Orbital retinoblastoma encompasses a wide range of distinct clinical entities with varying tumor load. There are no standard treatment protocols as of now but the current preferred management is multimodal with a combination of initial high-dose chemotherapy, surgery, external beam radiotherapy and prolonged chemotherapy for twelve cycles. In spite of progress on all fronts including surgical, medical, diagnostic, genetic and rehabilitative with improving survival rates, however, lack of access to medical facilities, lack of education about the need for early medical attention and cultural resistance to enucleation continue to contribute to an epidemic of extra ocular disease at diagnosis in the developing world. This review introduces the various terminologies used in the spectrum of orbital retinoblastoma, discusses in details the clinical aspects and management protocols, current status and the future directions.