Synthesis, delineation and technological advancements of algae biochar for sustainable remediation of the emerging pollutants from wastewater-a review.

The use of algae for value-added product and biorefining applications is enchanting attention among researchers in recent years due to its remarkable photosynthetic ability, adaptability, and capacity to accumulate lipids and carbohydrates. Algae biomass, based on its low manufacturing costs, is relatively renewable, sustainable, environmentally friendly and economical in comparison with other species. High production rate of algae provides a unique opportunity for its conversion to biochar with excellent physicochemical properties, viz. high surface area and pore volume, high adsorption capacity, abundant functional groups over surface, etc. Despite several potential algal-biochar, a detailed study on its application for removal of emerging contaminants from wastewater is limited. Therefore, this technical review is being carried out to evaluate the specific elimination of inorganic and organic pollutants from wastewater, with a view to assessing adsorption performances of biochar obtained from various algae species. Species-specific adsorption of emerging pollutants from wastewater have been discussed in the present review. The promising methods like pyrolysis, gasification, dry and wet torrefaction for the production of algae biochar are highlighted. The strategies include chemical and structural modifications of algae biochar for the removal of toxic contaminants have also been considered in the current work. The overall aim of this review is to confer about the synthesis, technological advancements, delineation and application of algae biochar for the treatment of wastewater.

Function of the mdxR gene encoding a novel regulator for carbohydrate metabolism and sporulation in Bacillus subtilis 168.

The mdxR gene located upstream of mdxD, encoding a maltogenic amylase, has been annotated as a member of LacI-type transcriptional regulator in Bacillus subtilis 168 but its function has not been investigated yet. In this study, expression pattern of the mdxR promoter (PmdxR) and effects of mdxR were investigated to elucidate the function of mdxR. Expression of PmdxR was monitored by the ß-galactosidase activity expressed from the PmdxR-lacZ fusion integrated at the amyE locus on the chromosome. The promoter was induced by starch, ß-cyclomaltodextrin, or maltose at early exponential phase and kept expressed until late stationary phase. However, it was repressed by glucose, sucrose, or glycerol, suggesting that it was under catabolite repression. Furthermore, interactions of MdxR and Spo0A to the DNA fragment carrying PmdxR or PmdxD were detected by mobility-shift assay, implying that MdxR was a novel transcription regulator for both genes, which were regulated also by Spo0A. The mdxR mutant impaired the expressions of mdxD and malL (encoding an α-glucosidase); degraded accumulated glycogen slower than the wild type and the mdxD mutant. Both of the mdxR and the mdxD mutants formed more endospores (50.95% and 47.10%) than the wild type (23.90%). Enhanced sporulation by these mutations could be of industrial interest where sporulation or endospores of B. subtilis matters. These results indicate that MdxR functions as a transcriptional regulator for mdxR, mdxD, and other genes in the gene cluster that is related to the maltose/maltodextrin metabolism. MdxR and MdxD are also involved in glycogen metabolism and sporulation, tentatively by modulating the net energy balance in the cell.

Identification of a novel cyclomaltodextrinase annotated as a neopullulanase in the genome of Bacillus cereus.

Bacillus cereus is a rod-shaped, gram-positive, motile, and ß-hemolytic soil bacterium. B. cereus is an opportunistic pathogen, often responsible for human foodborne illness that is caused by ingestion of starchy foods with symptoms of diarrhea and vomiting. Among the numerous amylolytic enzymes in the genome of the pathogen, the one annotated as a putative neopullulanase (NPase) was cloned and its biochemical properties were characterized in this study. The corresponding gene encoded an enzyme of 586 amino acids with a predicted molecular mass of 68.25 kDa. The putative NPase shared 43.7-59.2% of identity with NPases, cyclomaltodextrinases (CDases), and maltogenic amylases from various bacteria, but shared very low similarity with other amylolytic enzymes of B. cereus. The optimal pH and temperature of the enzyme was 6.5 and 37 â„ƒ, respectively. The enzyme activity was decreased by the cations tested in this study and completely inhibited by Co2+ and Cu2+. The purified enzyme showed substrate preference in the order of α-CD > ß-CD > starch > maltodextrin > γ-CD and hydrolyzed them mainly to maltose. However, it did not hydrolyze maltose, pullulan, and glycogen. The enzyme was designated herein as a CDase of B. cereus (BcCDase). Furthermore, the enzyme could transfer the sugars released from CDs and maltotriose to acceptor molecules. BcCDase was likely to be involved in the maltodextrin metabolism in B. cereus.

Functional characterization of maltodextrin glucosidase for maltodextrin and glycogen metabolism in Vibrio vulnificus MO6-24/O.

Glycogen is important for transmission of V. vulnificus undergoing disparate environments of nutrient-rich host and nutrient-limited marine environment. The malZ gene of V. vulnificus encoding a maltodextrin glucosidase was cloned and over-expressed in E. coli to investigate its roles in glycogen/maltodextrin metabolism in the pathogen. The malZ gene encoded a protein with a predicted molecular mass of 70 kDa. The optimal pH and temperature of MalZ was 7.0 and 37 °C, respectively. MalZ hydrolyzed maltodextrin to glucose and maltose most efficiently, while hydrolyzed other substrates such as starch, maltose, ß-cyclomaltodextrin, and glycogen less efficiently. The activity was enhanced greatly by Mn2+. It also exhibited transglycosylation activity toward excessive maltotriose. The malZ knock-out mutant accumulated 2.3-5.6-fold less glycogen than the wild type when excessive maltodextrin or glucose was added to LB medium, while it accumulated more glycogen than the wild type (3.5-fold) in the presence of excessive maltose. Growth and glycogen accumulation of the mutant were retarded most significantly in the M63 minimal medium supplemented with 0.5% maltodextrin. Side chain length distributions of glycogen molecules were varied by the malZ mutation and types of the excessive carbon source. Based on the results, MalZ of V. vulnificus was likely to be involved in maltose/maltodextrin metabolism, thereby balancing synthesis of glycogen and energy generation in the cell. The bacterium seemed to have multiple and unique pathways for glycogen metabolism according to carbon sources.

Comparison of visual outcomes after two types of mix-and-match implanted trifocal extended-depth-of-focus and trifocal intraocular lenses.

PURPOSE: To compare visual outcomes between two types of mix-and-match implanted trifocal extended-depth-of-focus (EDoF) and trifocal intraocular lenses (IOLs). METHODS: A total of 212 eyes of 106 subjects with mix-and-match implanted FineVision Triumf and FineVision HP IOLs (Triumf-HP group) and 212 eyes of 106 subjects with mix-and-match implanted Zeiss AT LARA and AT LISA IOLs (AT LARA-LISA group) were enrolled in this retrospective case-control study. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and binocular distance-corrected defocus curves were measured between 6 and 10 weeks after cataract surgery. RESULTS: There was no significant difference in UDVA among the four IOLs. UNVA was the best in eyes with the FineVision HP IOL (0.04 ± 0.06 logMAR), followed by eyes with the AT LISA IOL (0.07 ± 0.07 logMAR), the FineVision Triumf IOL (0.09 ± 0.09 logMAR), and the AT LARA IOL (0.11 ± 0.08 logMAR), respectively. The AT LARA-LISA group had better visual acuity than the Triumf-HP group between - 1.00 D and - 1.50 D of defocus, and the Triumf-HP group had better visual acuity than the AT LARA-LISA group between - 3.00 D and - 4.00 D of defocus. CONCLUSION: Mix-and-match implantation of trifocal EDoF and trifocal IOLs provided good visual outcomes in far, intermediate, and near distances. The mix-and-match implantation of Triumf-HP IOLs led to better visual outcomes in near vision, while that of the AT LARA-LISA IOLs led to better visual outcomes in intermediate vision.

An evidence of microalgal peptides to target spike protein of COVID-19: In silico approach.

The outbreak of the novel coronavirus (COVID-19) has affected millions of lives and it is one of the deadliest viruses ever known and the effort to find a cure for COVID-19 has been very high. The purpose of the study was to investigate the anti-COVID effect from the peptides derived from microalgae. The peptides from microalgae exhibit antimicrobial, anti-allergic, anti-hypersensitive, anti-tumor and immune-modulatory properties. In the In silico study, 13 cyanobacterial specific peptides were retrieved based on the extensive literature survey and their structures were predicted using Discovery Studios Visualizer. The spike protein of the novel COVID19 was retrieved from PDB (6LU7) and further molecular docking was done with the peptides through CDOCKER. The five peptides were bound clearly to the spike protein (SP) and their inhibitory effect towards the SP was promising among 13 peptides were investigated. Interestingly, LDAVNR derived from S.maxima have excellent binding and interaction energy showed -113.456 kcal/mol and -71.0736 kcal/mol respectively to target SP of COVID. The further investigation required for the in vitro confirmation of anti-COVID from indigenous microalgal species for the possible remedy in the pandemic.

Factors for good near and distance visual outcomes of multifocal intraocular lens with inferior segmental near add.

PURPOSE: This study was conducted to investigate factors related to postoperative good near and distance visual outcomes in the Lentis Mplus LS-313 MF20 (Oculentis Gmbh, Berlin, Germany) intraocular lens (IOL)-implanted eye. METHODS: A retrospective cross-sectional study analyzed a total of 198 eyes of 198 patients. Patients with 20/20-or-more uncorrected distance visual acuity (UDVA, 5 m) and J2-or-more uncorrected near visual acuity (UNVA, 40 cm) were distributed into the good visual outcome (GVO) group (n = 96), and the remaining patients were distributed into the moderate visual outcome (MVO) group (n = 102). Differences between the two groups were compared for patient age, preoperative measurements (kappa distance, kappa angle, and pupil size), and postoperative measurements (residual sphere, cylinder, and spherical equivalent) to explore factors related to good visual outcomes after IOL implantation. RESULTS: The average age of the GVO group (56.2 years) was significantly lower than that of the MVO group (58.6 years), and the average kappa distance of the former was significantly smaller than that of the latter. However, there were no significant differences between the two groups in kappa angle and pupil size. Notably, multivariate binary regression analysis revealed that multiple factors including age, residual cylinder, and spherical equivalent were associated with good visual outcomes. Based on the receiver operating characteristic curve, cutoff values regarded as good visual outcome following cataract surgery were calculated to be - 0.38 CD in residual cylinder and - 0.32 D in residual spherical equivalent. CONCLUSIONS: Patients with implanted Lentis Mplus LS-313 MF20 IOL who are young, had small kappa distance, and had low levels of postoperative residual cylinder and spherical equivalent tended to exhibit good vision at both near and distance. These results imply that surgeons should minimize postoperative residual cylinder and spherical equivalent to provide good visual outcomes to patients with implanted Lentis Mplus LS-313 MF20 IOL.

An evidence of C16 fatty acid methyl esters extracted from microalga for effective antimicrobial and antioxidant property.

Fatty acid methyl esters (FAME) derived from lipids of microalgae is known to have wide bio-functional materials including antimicrobials. FAME is an ideal super-curator and superior anti-pathogenic. The present study evaluated the efficiency of FAME extracted from microalgae Scenedesmus intermedius as an antimicrobial agent against Gram positive (Staphylococcus aureus, Streptococcus mutans, and Bacillus cereus) Gram negative (Escherichia coli and Pseudomonas aeruginosa) bacteria and Fungi (Aspergillus parasiticus and Candida albicans). The minimal inhibitory concentration (MIC) for the gram negative bacteria was determined as 12-24 µg mL-1, whereas MIC for gram positive bacteria was 24-48 µg mL-1. MIC for the fungi was as high as 60-192 µg mL-1. The FAME profiles determined by gas chromatography showed 18 methyl esters. Among them, pharmacologically active FAME such as palmitic acid methyl ester (C16:0) was detected at high percentage (23.08%), which accounted for the bioactivity. FAME obtained in this study exhibited a strong antimicrobial activity at the lowest MIC than those of recent reports. This result clearly indicated that FAME of S. intermedius has a strong antimicrobial and antioxidant property and that could be used as an effective resource against microbial diseases.

Antioxidant potentials of nanoceria synthesized by solution plasma process and its biocompatibility study.

Nanoceria were synthesized by discharging plasma at 800 V with a frequency of 30 kHz for 0-25 min using a pulsed unipolar power supply into solutions containing 1 or 2 mM of Ce(NO3)2. UV-Vis spectroscopy showed a characteristic absorbance maxima at 304-320 nm for the nanoceria with increase in the intensity of the peaks as the concentration of Ce(NO3)2 increased. The peaks exhibited transition red shift due to nanoceria formation. High resolution transmission electron microscopy revealed that spherical nanoparticles with an average size of 7.0 ±â€¯0.2 nm were formed by discharging plasma for 15 min. The nanoceria showed excellent pH dependent antioxidant properties in hydroxyl and superoxide anion radical scavenging assays. Effect of the nanoceria on cell viability in vitro and inhibition of reactive oxygen species (ROS) by the nanoceria were examined using HeLa cell lines. As the results, no toxic effect was found up to 1600 µg mL-1 of nanoceria and they had an effective antioxidant property. Therefore, the nanoceria synthesized by one-step solution plasma process without employing hazardous chemicals have potential for utilization as antioxidant biomaterials and sustained release in the stream to scavenge ROS in the modern medicine.

The facile synthesis of chitosan-based silver nano-biocomposites via a solution plasma process and their potential antimicrobial efficacy.

Silver nanoparticles (AgNPs) were synthesized in a chitosan matrix with varying AgNO3 (1, 3, 5 mM) and chitosan (1, 3%) concentrations via the one-step solution plasma process (SPP). Plasma was discharged for 3 min in the AgNO3 and chitosan solutions using unipolar power at 800 V with a frequency of 30 kHz. Fibrous 3D scaffolds were prepared by lyophilizing the nano-biocomposite solutions, and they were stabilized via cross-linking with UV irradiation. UV-Vis spectroscopy showed strong peaks with maximal absorbance at 415-440 nm, indicating the formation of AgNPs in the chitosan with an increase in peak height as the concentration of the precursor, AgNO3, increased. The chemical association between AgNPs and chitosan was confirmed using Fourier transform infrared spectroscopy (FTIR). The scaffolds had a micro-porous structure with pore diameters in the range of 5.8-157.0 µm, and a transmission electron microscopy (TEM) analysis revealed that spherical shaped AgNPs with diameters in the range of 2.5-27.6 nm were well-dispersed in the biocomposites. The nano-biocomposites had a broad spectrum of antimicrobial activity against various pathogens with minimal inhibition concentrations of 0.68-2.71 and 2.71-10.80 µg mL(-1) for bacteria and fungi, respectively. These are the lowest concentrations achieved by nano-biocomposites reported thus far. The SPP was shown to be a facile, effective, and eco-friendly method of synthesizing nano-biocomposites for biomedical applications.

Gingival crevicular blood as a source to screen for diabetes control in a dental office setting.

UNLABELLED: screen for diabetes control, this study compared glycosylated hemoglobin (HbAlc) levels found in GCB and serum. Methods: Patients diagnosed (n= 29), with diabetes received a venipuncture on the finger and serum blood (METHODS) obtained was tested for HbAlc status chair-side. GCB (test) was collected at site(s) with evidence of bleeding after probing and the HbAlc value was determined in the same manner as with the serum blood. Results: There was a significant correlation between serum blood and GCB using the HbAlc test. The Pearson RESULTS: tion was 0.98 (P< 0.0001). The Altman-Bland bias was -0.21 (P= 0.0095), indicating that on average, the GCB method slightly underestimated the venipuncture serum (control) method for determining HbA1c values. The Altman-Bland 95% agreement interval ranged from -1.02 to 0.6. Furthermore, the HbAlc values were independent of the gingival sites used for collection with intra-patient GCB values exhibiting a correlation value between sites of 0.91 (P< 0.0001).

The synthesis of Pt/Ag bimetallic nanoparticles using a successive solution plasma process.

A successive solution plasma process was developed for the synthesis of Pt/Ag bimetallic nanoparticles. Ag nanoparticles were made first by applying a high voltage of bipolar pulsed DC to anode and cathode electrodes composed of Ag rods. The solution containing Ag nanoparticles was discharged successively using Pt electrodes. The joule heating and electrolysis between electrodes generated vapors, and solution plasma was sustained due to progressive ionization and excitation in the vapor phase. The maximum current and voltage breakdown was observed at approximately 8.9 A and 900 V with an interval of 25 µs, which indicated that an intense solution plasma was sustained continuously. The Pt-on-Ag heterogeneous nanostructures formed, and finally, the Ag nanoparticles were completely covered by Pt nanoparticles after a discharge duration of 1,200 s.

An Evidence of Carbonic Anhydrase Activity in Native Microalgae for CO2 Capture Application.

A promising alternative for effective carbon capture has been found in microalgae because of their high photosynthetic capacity and quick growth. The carbon concentration mechanism of many microalgae is heavily reliant on the enzyme carbonic anhydrase (CA), which catalyze the production of bicarbonate from carbon dioxide. In this study, microalgal samples were collected, characterized, and cultured under controlled conditions for their optimal growth of cultures I-IX. The CA activity was investigated using a standard method; the Wilbur-Anderson assay was used to calculate CA activity in microalgal cultures. The comparative study was then used to measure the activity rate of the collected microalgae. Among the tested, culture I, VI, and IX showed a high enzyme activity rate of 4.15, 4.0, and 4.2 µg·mL-1, respectively. To determine the rate of carbon dioxide hydration, the method involved tracking the pH change in a reaction mixture. In addition, genetic analysis facilitates the identification of key genes involved in CA activity and other metabolic processes, which enhance the knowledge of microalgal physiology, and enables genetic engineering efforts in the future studies. Overall, this investigation emphasizes the significance of studying unknown microalgal culture and their potential CA activity for industrial and bio-energy applications.

Synthesis of Ag-Doped Tetrahedral Amorphous Carbon Coatings and Their Antibiofilm Efficacy for Medical Implant Application.

Tetrahedral amorphous carbon (taC) is a hydrogen-free carbon with extensive properties such as hardness, optical transparency, and chemical inertness. taC coatings have attracted much attention in recent times, as have coatings doped with a noble metal. A known antimicrobial metal agent, silver (Ag), has been used as a dopant in taC, with different Ag concentrations on the Ti64 coupons using a hybrid filtered cathodic vacuum arc (FCVA) and magnetron sputtering system. The physiochemical properties of the coated surface were investigated using spectroscopic and electron microscopy techniques. A doping effect of Ag-taC on biofilm formation was investigated and found to have a significant effect on the bacterial-biofilm-forming bacteria Staphylococcus aureus and Pseudomonas aeruginosa depending on the concentration of Ag. Further, the effect of coated and uncoated Ag-taC films on a pathogenic bacterium was examined using SEM. The result revealed that the Ag-taC coatings inhibited the biofilm formation of S. aureus. Therefore, this study demonstrated the possible use of Ag-taC coatings against biofilm-related complications on medical devices and infections from pathogenic bacteria.

Visual Outcomes According to Age After Bilateral Implantation of Trifocal Intraocular Lenses.

PURPOSE: To investigate the effect of age on visual outcomes after the bilateral implantation of trifocal intraocular lenses (IOLs). METHODS: A total of 290 patients (580 eyes) who underwent bilateral implantation of a trifocal IOL were enrolled in this retrospective case-control study. Patients were divided into five age groups: 45 to 49, 50 to 54, 55 to 59, 60 to 64, and 65 years and older. Postoperative monocular uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively), uncorrected near visual acuity (UNVA), binocular distance-corrected defocus curve, spectacle dependence for near and distance vision, and patient satisfaction scores were compared among the five groups. RESULTS: The 45 to 49 years group had significantly better mean UDVA (0.02 ± 0.05 logMAR) and UNVA (0.02 ± 0.04 logMAR) than the 65 years and older group (0.06 ± 0.09 and 0.09 ± 0.09 logMAR; P = .029 and P < .001; respectively). However, no significant differences were observed in the mean CDVA among the groups. Binocular visual performance of the 45 to 49 years group was better than that of the 65 years and older age group at defocuses of +1.00, +0.50, -1.00, and -3.00 D. No significant differences were observed in spectacle dependence for near and distance vision or in patient satisfaction scores among the five groups. CONCLUSIONS: Bilateral implantation of trifocal IOLs can provide excellent near and distance vision in both young and older patients. However, UDVA and UNVA revealed considerably worse results in the older group, although no significant difference was observed in CDVA and postoperative refractive errors by age. [J Refract Surg. 2024;40(4):e270-e277.].

Synthesis of biocomposites from microalgal peptide incorporated polycaprolactone/ κ- carrageenan nanofibers and their antibacterial and wound healing property.

Antimicrobial peptides (AMPs) are promising novel agents for targeting a wide range of pathogens. In this study, microalgal peptides derived from native microalgae were incorporated into polycaprolactone (PCL) with ƙ-Carrageenan (ƙ-C) forming nanofibers using the electrospinning method. The peptides incorporated in the nanofibers were characterized by fourier infrared spectroscopy, thermogravimetric analysis, scanning electron microscopy (SEM), and contact angle measurement. The results showed that peptides with molecular weights < 10 kDa, when loaded into nanofibers, exhibited lower wettability. The SEM analysis revealed a thin, smooth, interconnected bead-like structures. The antimicrobial activity of the electrospun nanofibers was evaluated through disc diffusion, and minimum inhibitory activity against Escherichia coli (MTTC 443), and Staphylococcus aureus (MTTC 96), resulting in zones of inhibition of 24 ± 0.5 mm and 14 ± 0.5 mm, respectively. The in vitro biocompatibility of the synthesized nanofibers was confirmed using in HEK 293 cell lines with an increased cell viability. Interestingly, the fibers also exhibited a significant wound-healing properties when used in vitro scratch assays. In conclusion, algal peptides incorporated with PCL/ ƙ-C were found to exhibit antimicrobial and biocompatible biomaterials for wound healing applications.

Incorporation of Ag metallic nanoparticles in 3D gelatin matrix via the green strategy solution plasma.

The environmental concern pays much attention to the recent cause of the global warming effect. The reduction of the chemical uses is one of many ways to avoid this crucial problem. Herein, the green process for silver nanometallic particle formation and incorporation in gelatin are proposed. By using a novel discharge process in solution named solution plasma, the silver nanometallic particle formation and its incorporation in gelatin could be accomplished in one-batch reactor during discharge by using silver nitrate (AgNO3) solution as the precursor and controlling systematical parameters. The three-dimensional scaffolds of gelatin/silver biocomposite were fabricated using lyophilizer and the water-soluble property of gelatin was improved by irradiation of ultraviolet ray. The well dispersed silver nanoparticles with the mean particle size 10-20 nm in the good texture of gelatin matrix were obtained. The density of micropore in gelatin/silver scaffold was proportional to the gelatin concentration. In addition, thermal stability of prepared samples had no change comparing with pure gelatin, indicating that the incorporation of silver nanoparticles in gelatin matrix did not affect to the nature of gelatin.

Functional and histologic changes in the lacrimal gland after botulinum toxin injection.

PURPOSE: The purpose of this study was to evaluate changes in tear volume, epidermal growth factor (EGF), and histology of the rabbit lacrimal gland after intraglandular application of botulinum toxin. METHODS: Ten New Zealand rabbits were separated into 3 groups. Eight rabbits received botulinum toxin injection (2.5 U per 0.1 mL) into the right lacrimal gland and saline injection (0.1 mL) into the left lacrimal gland as a sham control. Two rabbits were untreated to serve as normal controls. Tear volume was measured using cotton thread every 2 weeks, and 4 rabbits were killed after 2 and 4 weeks. The lacrimal glands were surgically excised and sectioned or lysed for gene expression analysis. Epidermal growth factor expression and concentration were evaluated by real-time polymerase chain reaction and enzyme-linked immunosorbent assay; morphometric and histologic analyses were performed. RESULTS: The rabbits that were killed 2 weeks after the injection showed decreased tear volume and increased EGF expression and concentration, but differences were not statistically significant. The rabbits that were killed 4 weeks after the injection exhibited similar results. When all 8 rabbits were considered, we detected a significant decrease in tear volume and increased EGF expression and concentration (P = 0.012, P = 0.011, and P = 0.012, respectively). The EGF level was not significantly correlated with the tear volume. There were no prominent histologic changes between the glands, and the lumen versus fibrosis ratio in the interlobular ducts showed no statistically significant difference. CONCLUSIONS: The use of botulinum toxin in patients with epiphora is effective, safe, and repeatable because it reduces tear volume and increases the EGF level to prevent corneal damage while causing no histologic changes.

The effectiveness of a simultaneous medial spindle procedure for involutional punctal ectropion with lid laxity in patients who require endonasal dacryocystorhinostomy instead of external dacryocystorhinostomy to prevent pump failure.

PURPOSE: The aim of this study was to determine the effectiveness of a concurrent medial spindle procedure (MS) to address involutional punctal ectropion and the proportion of combined surgery in patients who need endonasal dacryocystorhinostomy (DCR) instead of external dacryocystorhinostomy to prevent pump failure. METHODS: We conducted a retrospective, interventional study on endonasal DCR and MS procedures performed between March 2004 and January 2009 by a single surgeon (S.H.B.). Patient age, sex, the results of a medial distraction test, the surgical procedure, follow-up duration, and cause of failed surgery were recorded. The indication for the medial spindle procedure was punctal eversion on slit lamp biomicroscopic examination with classifications of grades 2 and 3 on the medial distraction test. RESULTS: Endonasal DCRs were performed on 169 eyes in 121 patients, and DCR and MS (D + M) were performed on 23 eyes in 17 patients. The proportion of combined surgery to total DCR was 13.6%. Our primary success rate was 86.9% in the combined surgery group and 87.2% in the DCR group (P = 0.39). CONCLUSIONS: The MS for correction of punctal ectropion concurrently performed with endonasal DCR will be an effective tool to manage epiphora caused by complex situations, such as nasolacrimal duct obstruction and involutional punctal ectropion. We recommend careful examination of the punctum, which is invisible in normal conditions, under slit lamp biomicroscopy before endonasal DCR.

The effectiveness of simultaneous lateral tarsal strip with endonasal dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction and lower lid laxity.

PURPOSE: The aim of this study was to evaluate the effectiveness of simultaneous lateral tarsal strip procedure (LTS) and endonasal dacryocystorhinostomy (DCR) for the treatment of nasolacrimal duct obstruction and lower lid laxity. METHODS: We conducted a retrospective, interventional study of concurrent DCR with LTS for patients with nasolacrimal duct obstruction and lower lid laxity performed between March 2009 and July 2011 by a single surgeon (S.H.B.). Patient age, sex, the results of dacryoscintigraphy, time of tube removal, follow-up duration, and cause of failed surgery were recorded. Lower eyelid laxity was evaluated by a medial distraction test. RESULTS: A total of 29 eyes in 17 patients were included in the study. The mean age was 61.1 ± 11.8 years (range 41 to 81 years). The mean degree of lower lid laxity was 2.4 ± 0.5. Dacryoscintigraphy showed presac delay in 22 eyes (75.9%). The tube was removed after 11.3 ± 1.9 weeks. The primary anatomical success rate was 89.5% (27 eyes) and the functional success rate was 86.2% (25 eyes). Membranous obstructions were the cause of failed surgery in 2 patients, but both patients remained symptom free after revision surgery with a diode laser. CONCLUSIONS: Concurrently performed DCR with LTS can be an effective tool for the treatment of nasolacrimal duct obstruction and lower lid laxity. It is recommended for examining lid laxity carefully using lid distraction test in patients with epiphora.