Pegylated Interferon Alpha 2a for the Treatment of Ocular Surface Squamous Neoplasia.

PURPOSE: The purpose of this study was to introduce the initial experience in the use of topical pegylated interferon alpha 2a (PegIFN-α-2a) for ocular surface squamous neoplasia (OSSN). METHODS: A retrospective medical record review of 8 eyes of 8 patients diagnosed with OSSN and treated with PegIFN-α-2a was performed. All cases were diagnosed of noninvasive OSSN both clinically and histologically. The pegIFN-α-2a was prescribed at a concentration of 20 µg/mL and applied 4 times a day for at least 3 months. RESULTS: In all 8 cases, topical PegIFN-α-2a was well-tolerated and did not lead to discomfort or any adverse side effects. It resulted in reduction in lesion size and extent in all cases and complete resolution of the lesions. CONCLUSIONS: Topical PegIFN-α-2a might be an effective and safe treatment option for noninvasive OSSN.

Visual Outcomes and Optical Quality of Accommodative, Multifocal, Extended Depth-of-Focus, and Monofocal Intraocular Lenses in Presbyopia-Correcting Cataract Surgery: A Systematic Review and Bayesian Network Meta-analysis.

Importance: A bayesian network meta-analysis (NMA) can help compare the various types of multifocal and monofocal intraocular lenses (IOLs) used in clinical practice. Objective: To compare outcomes of presbyopia-correcting IOLs frequently recommended in clinical practice through a bayesian NMA based on a systematic review. Data Sources: Medline (PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on May 15, 2021, from inception. Study Selection: Based on the research question, randomized clinical trials assessing multifocal IOLs in patients who underwent bilateral cataract extraction were searched. Nonrandomized studies, studies in patients with unilateral or contralateral cataract extractions, duplicated studies, conference abstracts, and nonpeer-reviewed articles were excluded. Data Extraction and Synthesis: Descriptive statistics and outcomes were extracted. The NMA was conducted to compare different types of IOLs. The mean differences for continuous variables, odds ratios for binary variables, 95% credible intervals (CrIs), and ranks of interventions were estimated. Main Outcomes and Measures: The outcomes examined included binocular visual acuities by distance and optical quality, including glare, halos, and spectacle independence. Results: This NMA included 27 studies comprising 2605 patients. For uncorrected near visual acuity, trifocal IOLs (mean difference, -0.32 [95% CrI, -0.46 to -0.19]) and old bifocal diffractive IOLs (mean difference, -0.33 [95% CrI, -0.50 to -0.14]) afforded better visual acuity than monofocal IOLs. Regarding uncorrected intermediate visual acuity, extended depth-of-focus IOLs provided better visual acuity than monofocal IOLs. However, there were no differences between extended depth-of-focus and trifocal diffractive IOLs in pairwise comparisons. For uncorrected distant visual acuity, all multifocal IOLs were comparable with monofocal IOLs. There were no statistical differences between multifocal and monofocal IOLs regarding contrast sensitivity, glare, or halos. Conclusions and Relevance: For patients considering a multifocal IOL due to presbyopia, bilateral implantation of a trifocal IOL might be an optimal option for patients without compromising distant visual acuity.

Salvage of impending rhinostomy failure after dacryocystorhinostomy with office-based microdebrider treatment.

PURPOSE: This article is to introduce office-based salvage revision of impending rhinostomy failure after endoscopic dacryocystorhinostomy (EN-DCR), using a microdebrider. METHODS: The authors conducted retrospective medical chart review of 27 eyes of 26 patients who underwent microdebrider treatment for impending rhinostomy failure in an office setting. After local anesthesia, obstructive soft tissue, interfering with ostium function (granuloma, cicatrization, synechia), was treated with a microdebrider (Osseoduo s120, Bien-Air Surgery, Le Noirmont, Switzerland) within 6 months after primary EN-DCR. Anatomical improvement and functional relief of epiphora were evaluated after revision. RESULTS: The causes of impending rhinostomy failure were granuloma formation (17/27 eyes, 63.0%), cicatrization (8/27 eyes, 29.6%), and synechial formation (2/27 eyes, 7.4%). The surgery did not exceed 5 min in all cases, and partial damage to pre-placed silicone tubes occurred in the first two cases (7.4%). Salvage revision resulted in anatomical success in all eyes, based on patent syringing and a positive functional endoscopic dye test. All cases showed improvement of epiphora after revision surgery. CONCLUSIONS: Office-based salvage revision using a microdebrider provided effective management of impending rhinostomy failure during early follow-up period after primary EN-DCR. It enabled prompt management of excessive wound healing interfering with ostium function, while performing the routine postoperative nasal debridement.

Surgical Correction of Lower Lid Epiblepharon With Skin-Only Resection Using a Novel Design.

ABSTRACT: This study is to report the surgical outcome of lower lid epiblepharon repair with skin-only resection using a newly designed incision line. A retrospective, noncomparative, interventional case series analysis of 134 eyes of 67 patients, who underwent surgical correction of lower lid epiblepharon with skin-only resection using the new incision design, was performed. After marking the 4 vertical lines at the medial canthus, punctum, midpoint, and lateral canthus, the upper and lower incision lines were drawn from the medial canthus through punctum to the lateral canthus with novel design. After incising the skin along the marked line, gentle dissection of the skin flap from the underlying orbicularis muscle was performed. Only skin flap was excised and closed. The patients were followed up for more than 6months. The mean age of patients was 7.9 ± 3.7 years (range 4-13 years) and the mean follow-up period was 18.0 ± 5.7 months (range 13-31 months). During the follow-up period, recurrence of the epiblepharon was not observed. There was no occurrence of complications such as lower lid ectropion or retraction. Skin-only resection using a newly designed incision line is a simple and effective method to fully correct the medial portion of the lower lid epiblepharon and prevent dog-ear formation or overcorrection at the lateral portion, and prominent lid crease.

Effects of Lipiflow Treatment Prior to Cataract Surgery: A Prospective, Randomized, Controlled Study.

To investigate the effects of preoperative Lipiflow (Johnson & Johnson, Jacksonville, FL, USA) treatment before cataract surgery on meibomian gland dysfunction (MGD) and dry eye induced by surgery. DESIGN: Prospective, randomized controlled study. METHODS: This study comprised 124 eyes of 124 patients with planned surgery for senile cataract. Participants were randomly allocated into control and Lipiflow groups based on administration of Lipiflow treatment 3 weeks before cataract surgery. For meibomian gland (MG) evaluation, MG atrophy, degree of gland expressibility, and quality of gland secretions were examined at the baseline visit and 1 and 3 months postoperatively. Ocular surface parameters of tear film break-up time, Oxford corneal staining score, and tear film lipid layer thickness were measured at each visit. Ocular Surface Disease Index and Dry Eye Questionnaire were also assessed. RESULTS: The control group exhibited a significant decrease in MG expressibility, worsened meibum quality, decreased lipid layer thickness, and worsened corneal staining after cataract surgery. Also, dry eye symptom showed significant worsening. Conversely, the Lipiflow group showed significantly improved MG patency and meibum quality, increased tear film break-up time, and reduced corneal staining, and presented improved subjective outcomes reported on both Ocular Surface Disease Index and Dry Eye Questionnaire. The improvement of each parameter in the Lipiflow group showed a linear correlation with baseline MGD grade. In addition, patients without baseline MGD showed less worsening or improvement of MGD and dry eye induced by surgery, with preoperative Lipiflow treatment. CONCLUSIONS: Preoperative Lipiflow treatment conducted before cataract surgery may be a safe and effective intervention for relieving MGD and dry eye induced by surgery. It might be recommended not only for the patients with preoperative MGD but also for those without baseline MGD, to prevent the development of MGD and dry eye induced by ocular surgeries.

Evaluation of tear osmolarity measured by I-Pen osmolarity system in patients with dry eye.

This retrospective comparative study was to evaluate tear osmolarity measured by I-Pen osmolarity system (I-MED Pharma Inc, Dollard-des-Ormeaux, Quebec, Canada) in healthy subjects without dry eye disease (DED) and patients with DED, and its association with other ocular surface parameters. This study comprised 65 eyes of 65 patients. The ocular surface parameters including tear osmolarity with I-Pen osmometer of the patients who visited the refractive surgery center of Samsung Medical Center between January 1, 2020 and May 31, 2020 were retrospectively collected. The subjects were divided as asymptomatic normal group and symptomatic dry eye group. The distribution of tear osmolarity and its association with other ocular surface parameters were evaluated. Total thirty-two patients (32 eyes) were included in the control group, and 33 patients (33 eyes) were included in the DED group. Tear osmolarity was significantly higher in the DED group. Tear osmolarity was negatively correlated with tear break-up time, and the Schirmer test, and was positively correlated with Ocular Surface Disease Index symptom score. The cut-off value of 318 mOsm/L showed a sensitivity of 90.9% and specificity of 90.6% for diagnosing DED. The I-Pen osmometer can be considered suitable for use in the clinical setting, with good performance in DED diagnosis.

Effects of the re-esterified triglyceride (rTG) form of omega-3 supplements on dry eye following cataract surgery.

BACKGROUND/AIMS: To evaluate the clinical outcomes of the systemic re-esterified triglyceride (rTG) form of omega-3 fatty acids in patients with dry eye symptoms after cataract surgery. METHODS: This prospective comparative cohort study comprised 66 patients complaining of new-onset non-specific typical dry eye 1 month after uncomplicated cataract surgery. Subjects were randomly allocated into control and omega-3 groups based on administration of the systemic rTG form of omega-3 fatty acids for 2 months, in addition to use of artificial teardrop. Ocular surface parameters (Schirmer's test, tear break-up time, corneal staining score and matrix metalloproteinase-9 (MMP-9)) and subjective questionnaire results (Ocular Surface Disease Index (OSDI)) and Dry Eye Questionnaire [DEQ]) for dry eye were evaluated before and after omega-3 supplementation. RESULTS: Two months after omega-3 supplementation, the Oxford score was lower in the omega-3 group than in the control group. There was an improvement of subjective symptom scores of OSDI and DEQ in the omega-3 group (both p<0.05). The ratio of increasing MMP-9 level in the omega-3 group was lower than that in the control group (p=0.027). CONCLUSION: The rTG form of omega-3 supplementation might be related to reduction of ocular surface inflammation rather than secretion of tears, and it might be effective for non-specific typical dry eye after uncomplicated cataract surgery. TRIAL REGISTRATION NUMBER: NCT04411615.

Factors affecting prediction error after cataract surgery with implantation of various multifocal IOLs in patients with previous refractive laser surgery.

BACKGROUND: This study aimed to compare the clinical outcomes of implantation of various multifocal intraocular lenses (mIOLs) and the prediction accuracy of two intraocular lens (IOL) power calculation formulas for eyes that underwent previous corneal refractive surgery. METHODS: Four types of mIOLs [TECNIS Symfony (Group I), AcrySof IQ PanOptix (Group II), LENTIS Mplus (Group III), and TECNIS ZLB00 (Group IV)] were used and the IOL power was calculated with the two no-history methods, Shammas-PL and Barrett True-K. Visual acuity and refractive outcomes including manifest refraction, prediction error (PE), absolute error (AE), and median absolute error (MedAE) were evaluated at three months after the cataract surgery. RESULTS: For all groups the Barrett True-K formula produced a narrower range of PEs and lower MedAE than Shammas-PL. Eyes of lower predictive accuracy (group B, AE >0.5D) showed weak uncorrected distance visual acuity resulting from myopic refractive error and target refraction when compared to that of higher predictive accuracy (group A, AE ≤0.5 D). CONCLUSIONS: Targeting emmetropia using the Barrett True-K, which considers both anterior and posterior corneal curvature is recommended in patients undergoing mIOL implantation with prior corneal refractive surgery. Additionally, history of prior large amount of laser ablation seems to be an important factor related to low predictive accuracy.

Clinical outcomes of management of posterior capsule rupture with air bubble techniques.

AIM: To introduce a new surgical technique, air-bubble technique for the management of posterior capsule rupture (PCR) and to evaluate the safety and efficacy of the technique. METHODS: A retrospective case series analysis of 24 eyes of 24 patients, in which the air bubble technique was used for the management of PCR, was performed. Once PCR occurred, a dispersive ophthalmic viscosurgical device (OVD) was injected into the tear. And small volumes (0.2-0.3 mL) of air bubbles were injected beneath the OVD. The air bubble served as a physical barrier and supported the posterior capsule. RESULTS: After surgery, none of the patients had serious complications during the follow-up period of 1y. Extension of the PCR size occurred in only 2 cases, and additional OVD injection was required only in 3 cases. Air bubbles imparted great stability to the nuclear pieces and the posterior capsule. CONCLUSION: The air-bubble technique may be considered a safe and effective procedure for managing a PCR. It may be of value to the inexperienced cataract surgeon.

Measurement of lamina and prelaminar thicknesses of both eyes in patients with unilateral branch retinal vein occlusion.

PURPOSE: Thinning of the lamina cribrosa thickness (LCT) and prelaminar tissue thickness (PT) has been observed in patients with glaucoma, and branch retinal vein occlusion (BRVO) is reportedly related to glaucoma. To test the hypothesis that thinning of the LCT and PT occurs in patients with BRVO, we investigated possible correlations of the LCT and PT in BRVO-affected eyes and fellow eyes and compared these values with age-, sex-, and underlying disease-matched eyes. METHOD: The study included 50 patients (50 eyes) with unilateral BRVO and 35 control subjects (35 eyes). The LCT and PT were measured using the enhanced depth imaging mode of spectral-domain optical coherence tomography. RESULTS: The mean LCT and PT in BRVO-affected eyes (208.26 ± 33.36 and 155.70 ± 76.89 µm, respectively) were significantly thinner than those in the normal control eyes (260.41 ± 43.25 and 201.74 ± 74.97 µm, respectively) (P = 0.000 and P = 0.008, respectively). The mean LCT and PT in the fellow eyes (204.97 ± 37.57 and 147.06 ± 71.33 µm, respectively) were also statistically thinner than those in the control group (P = 0.000 and P = 0.004, respectively). CONCLUSIONS: The LCT and PT in BRVO-affected eyes and fellow eyes were thinner than those in eyes of normal control subjects. Thinning of the LCT and PT may be associated with BRVO as well as glaucoma, suggesting that the two diseases have the similar structural abnormalities in the lamina cribrosa and prelaminar tissues.

Tick Infestation of the Eyelid and Removal With Forceps and Punch Biopsy.

Ocular tick infestation can occur in any age group or sex with exposure in an endemic setting. All parts of the ocular tissue have been reported to be susceptible to tick infestation. The authors present a rare patient with tick infestation of eyelid.An 88-year-old woman was referred for a yellowish lesion of the right upper eyelid. She had a history of sting 2 days before presentation, and developed eyelid swelling with mucopurulent discharge the next day. Slit lamp examination showed blepharitis and revealed that the lesion was the body of a hard tick, firmly attached to eyelid. First, blunt forceps were used for removal of the tick under a surgical microscope. However, attempted removal resulted in the disembodiement of the parasite and retention of the mouthparts in the skin. The retained tick parts were excised en bloc by skin punch biopsy. The tick was identified as Ixodes nipponensis. Subsequent treatment was given for blepharitis and skin lesion.This case introduces a rare patient with tick infestation of eyelid, and the proper management. Less than 20 documented patients with tick infestation of eyelid have been reported worldwide, and this is the first patient from South Korea in ophthalmological society.

Effect of transverse conjunctival advancement flap surgery for primary pterygium.

OBJECTIVE: To introduce a new surgical technique, transverse conjunctival advancement flap, and to evaluate the efficacy and safety of the technique in primary pterygium surgery. DESIGN: Retrospective, noncomparative, interventional case-series analysis. PARTICIPANTS: Sixty-three eyes of 63 patients. METHODS: The patients with primary pterygium were treated with transverse conjunctival advancement flap technique. After excision of the pterygium head and the perilimbal part of the pterygium body (within 2 mm from the limbus), the bare sclera was covered with the transverse conjunctival advancement flap using the conjunctiva of the remaining posterior part of the pterygium body. The patients were followed up for more than 6 months. RESULTS: The mean age of patients was 64.9 ± 8.7 years (range 43-85 years), and the mean follow-up period was 9.8 ± 3.9 months (range 6-18 months). In all cases, surgery did not exceed 20 minutes. During the follow-up period, recurrence of the pterygium occurred in 1 (1.5%) of the 63 cases, with recurrence only in the conjunctiva. There was no occurrence of serious complications. CONCLUSIONS: The transverse conjunctival advancement flap technique may be considered a safe and effective method, with a low rate of pterygium recurrence, after primary pterygium excision.

The Pre-Sac Reflux Test (PSRT): a new diagnostic test for presaccal stenosis/obstruction.

PURPOSE: To introduce a new procedure, the Pre-Sac Reflux Test (PSRT), to screen for epiphora caused by presaccal stenosis/obstruction, and to determine the reliability of this new test in the diagnosis of presaccal stenosis/obstruction. METHODS: A nonrandomized, prospective, comparative case series of 280 eyes of 140 patients with unilateral presaccal stenosis/obstruction was performed. The PSRT was performed by a masked examiner on both eyes of each patient. After fluorescein staining, the lower lid was everted and lower punctum was observed using a cobalt-blue filter under slit-lamp magnification. After blotting excess fluorescein on the punbtum, the area of lacrimal ampulla was massaged with mild pressure with an index finger. The reflux (billowing of the fluorescein-stained tear) from each lower punctum were compared, and the bilateral symmetry was measured. In the same way, reflux from each upper punctum were compared for bilateral symmetry. The PSRT was considered positive if reflux from punctum was absent, or reduced asymmetrically, compared with that from contralateral punctum. If the test of either upper or lower punctum showed positive, the eye was considered positive. The validity of PSRT was measured by sensitivity and specificity, as well as positive- and negative-predictive values. RESULTS: The PSRT used to diagnose presaccal stenosis/obstruction has a sensitivity of 92.9 % and a specificity of 97.1 %. It has a positive-predictive value of 97.0 % and a negative-predictive value of 93.2 %. CONCLUSIONS: The PSRT is a reliable screening test for diagnosis of presaccal stenosis/obstruction.

Effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness and retinal vessel diameter in branch retinal vein occlusion.

AIM: To investigate the effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness (SFChT) and retinal vessel diameter in patients with branch retinal vein occlusion. METHODS: An interventional, restrospective study of 41 eyes of 41 patients who had completed 12mo of follow-up, divided into group 1 (1.25 mg of bevacizumab, 21 eyes of 21 patients) and group 2 (2.5 mg of bevacizumab, 20 eyes of 21 patients). Complete ophthalmic examination, fluorescein angiography, enhanced depth imaging optical coherence tomography and measurement of retinal vessel diameter with IVAN software were performed at baseline and follow-up. RESULTS: The SFChT changed from 279.1 (165-431) µm at baseline to 277.0 (149-413) µm at 12mo in group 1 (P=0.086), and from 301.4 (212-483) µm to 300.3 (199-514) µm in group 2 (P=0.076). The central retinal arteriolar equivalent (CRAE) changed from 128.8±11.2 µm at baseline to 134.5±8.4 µm at 12mo in group 1, and from 134.6±9.0 µm to 131.4±12.7 µm in group 2 (P=0.767). The central retinal venular equivalent (CRVE) changed from 204.1±24.4 µm at baseline to 196.3±28.2 µm at 12mo in group 1, and from 205.8±16.3 µm to 194.8±18.2 µm in group 2 (P=0.019). The mean central macular thickness (P<0.05) and average best-corrected visual acuity (BCVA; P<0.05) improved in both groups. CONCLUSION: Changes in the SFChT are not statistically significant and not different according to the doses of bevacizumab. The CRAE did not show significant change, however, the CRVE showed significant decrease regardless of the dose.

Office-based endoscopic revision using a microdebrider for failed endoscopic dacryocystorhinostomy.

This article is to introduce office-based endoscopic revision surgery using a microdebrider for failed endoscopic dacryocystorhinostomy (EN-DCR). The authors conducted retrospective, non-comparative, interventional case series analysis of 27 eyes of 24 patients, treated by office-based revision EN-DCR using a microdebrider. After local anesthesia, anatomical failures (cicatrization, granuloma, synechia) after primary EN-DCR were treated with a microdebrider (Osseoduo 120, Bien-Air Surgery, Le Noirmont, Switzerland) in an office setting, and a bicanalicular silicone tube was placed. Anatomical improvement and functional relief of epiphora were evaluated at 6-months after revision. The causes of failed EN-DCR were rhinostomy site cicatrization (17/27, 63.0 %), granulomatous obstruction (7/27, 25.9 %) and synechial formation (3/27, 11.1 %). The anatomical success rate was 100 %, and 85.2 % cases achieved complete relief of epiphora. The surgery did not exceed 10 min in any case and no complications were observed. Office-based revision EN-DCR using a microdebrider provided prompt management of post-DCR epiphora. The portable nature and all-round ability of the microdebrider allowed office-based surgery, which offered advantage to work with the surgeon's own well-trained office staff. Office-based revision EN-DCR can be both time- and money-saving, and might be regarded the treatment of choice for failed EN-DCR.

Mucocele After Orbital Fracture Repair Masquerading as Optic Neuritis.

The authors report a patient of mucocele formation after orbital wall fracture repair masquerading as optic neuritis.A 38-year-old man with a history of medial orbital wall fracture repair with an alloplastic implant 10 years previously, presented with left visual disturbance and mild ocular pain with movement of the left eye of 3-day duration, and a relative afferent papillary defect in his left eye. He reported having cold symptoms 2 weeks before presentation. His symptoms were typical of retrobulbar optic neuritis. Under suspicion of optic neuritis, computed tomography and magnetic resonance imaging were performed and revealed a large cyst in the sphenoid sinus and ethmoid sinus, just behind the alloplastic implant, that was compressing the medial rectus muscle and optic nerve of the left eye. The patient underwent endoscopic marsupialization of the cyst. Subsequent histologic examinations revealed a cyst lined with ciliated pseudostratified columnar epithelium. The patient had an uncomplicated postoperative course and the visual disturbance resolved. For patients who present solely with optic neuropathy after orbital fracture repair, it is important to be vigilant of potentially rare cause, mucocele formation.

Removal of conjunctival cyst with high-frequency radio-wave electrosurgery.

OBJECTIVE: To introduce a new simple surgical approach for removal of conjunctival cysts with high-frequency radio-wave electrosurgery. DESIGN: Retrospective, noncomparative, interventional case series analysis. PARTICIPANTS: Twenty-one eyes of 21 patients. METHODS: Symptomatic conjunctival cysts, which did not show improvement despite conventional medical management or other surgical procedures were included. The conjunctival cysts were treated using a high-frequency radio-wave electrosurgical unit (Ellman Surgitron; Ellman International Inc, Oceanside, N.Y.). The conjunctiva surrounding the conjunctival cyst was grasped and lifted up using a smooth forcep and a fine-needle electrode (Ellman Insulated Needle Electrodes D6A; Ellman International Inc) was inserted into the cyst. A power setting of 0.5 to 1 was used for coagulation of cysts, without charring the tissue. RESULTS: After surgery, none of the patients had recurrence of conjunctival cysts during the follow-up period of 6 months, and symptoms also disappeared. The surgery did not exceed 5 minutes in all cases, and subconjunctival hemorrhage was observed in 1 case. Subconjunctival hemorrhage had completely resolved within 2 weeks and no other complications were observed. CONCLUSIONS: A surgical approach with high-frequency radio-wave electrosurgery successfully removed conjunctival cysts and produced improvement in symptoms. High-frequency radio-wave surgical techniques might be a favourable alternative to surgical treatment of conjunctival cysts.

Sequential probing and dilatation in canalicular stenosis.

PURPOSE: To assess the usefulness of sequential probing for diagnosing lacrimal canalicular stenosis, and the effectiveness of bicanalicular silicone intubation after sequential dilatation in treatment. METHODS: Canalicular stenosis was diagnosed by sequential probing in 22 patients (22 eyes) who were misdiagnosed as canalicular obstruction. The patients were treated by bicanalicular silicone intubation after sequential dilatation. Anatomical improvements and functional relief of epiphora were evaluated. In addition, complications were evaluated. RESULTS: The average age of the 22 patients was 57 years, and the average follow-up period was 13 months. The silicone tube was left in place for an average of 14 weeks. The anatomical success rate was 100 %. Fifty-four percent of patients achieved complete relief of epiphora, 32 % partial relief, and 14 % no relief. There were no complications. CONCLUSIONS: Sequential probing is an useful diagnostic method for canalicular stenosis. Bicanalicular silicone intubation after sequential dilatation is a simple and effective treatment, and could be performed as primary procedure for canalicular stenosis before invasive surgery.

Comparison of nonlaser endoscopic endonasal revision surgery and diode laser transcanalicular revision surgery for failed dacryocystorhinostomy.

BACKGROUND: Numerous surgical techniques for failed dacryocystorhinostomy (DCR) have been described. The aim of this study was to compare nonlaser endoscopic endonasal DCR revision surgery and diode laser transcanalicular DCR revision surgery. This study described the success rate, merits, and demerits of each surgery, and compared them. PATIENTS AND METHODS: As retrospective comparative study, 76 patients, who underwent revision DCR between January 2005 and September 2010, were included. The patients were divided into 2 groups. Group 1 consisted of 34 patients (average 59.2 yr), who were treated with nonlaser endoscopic endonasal revision DCR. Group 2 consisted of 42 patients (average 58.7 yr), who were treated with diode laser transcanalicular revision DCR. The visual analog scale (VAS) was used for clinical pain assessment. The mean follow-up period was 12.8 months for group 1 and 12.2 months for group 2. RESULTS: Success of revision DCR was defined as resolution of epiphora and patency of nasolacrimal drainage system, confirmed by irrigation and endoscopic examination. Moreover, 88.2% of patients (30 of 34 cases) were successful in group 1 and 90.5% (38 of 42 cases) in group 2. This difference was not statistically significant (P = 0.519). The operating time in group 2 (25.4 min) was significantly shorter than that of group 1 (43.8 min) (P < 0.001). The average VAS score of group 1 was 3.9 ± 1.4, compared with 1.9 ± 1.2 of group 2 (P < 0.001). CONCLUSIONS: There is no significant difference in success rates of the 2 groups. However, diode laser transcanalicular revision DCR is recommended, as operating time was shorter and showed lower VAS score.