Clinical effects of three types of silicone intubations in repairing lacerations of canaliculus.

OBJECTIVE: To evaluate the clinical effects of one-passage, double-passage and circular canalicular intubations in repairing lacerations of canaliculus. METHODS: A total of 109 eyes in 109 cases of canalicular laceration were repaired with three types of silicone intubations, among which 23 with one-passage canalicular intubation, 51 with double-passage canalicular intubation, and 35 with circular canalicular intubation. The average follow-up period was 12-15 months. RESULTS: The wound/junction of the lacrimal canaliculi was ruptured in 5 cases (9.80%) of the double-passage group, 3 cases (8.57%) of the circular group, and 8 cases (34.78%) of the one-passage group. The rupture incidence of the one-passage group was significantly higher than that of the other two groups (X(2) equal to 9.416, P less than 0.01). During the intubation, canaliculitis was observed in 12 cases (23.53%) of the double-passage group, while only 3 cases (8.57%) in the circular group and 8 cases (34.78%) in the one-passage group. The circular group had significantly lower incidence of canaliculitis than the other two groups (X(2) equal to 6.095, P less than 0.05). After extubation 6 months after laceration repair, the lacrimal passage remained patent with canalicular irrigation in 46 cases (90.20%) in the double-passage group, 30 cases (85.71%) in the circular group and 15 cases (65.22%) in the one-passage group. Six months after surgery, the canalicular patency in the one-passage group was significantly lower than that of the other two groups (X(2) equal to 7.390, P less than 0.05). CONCLUSIONS: Circular canalicular intubation is more stable and has less surgical complications than the double-passage and one-passage canalicular intubations. It is also more effective clinically 12-15 months after laceration surgery.

Clinical analysis of hydroxyapatite orbital implantation after ocular trauma in 211 cases.

OBJECTIVE: To evaluate the therapeutic effects and complications of hydroxyapatite (HA) orbital implantation on patients after trauma-related surgeries. METHODS: Retrospective analysis was made from 211 cases (211 eyes) who underwent HA orbital implant placement after trauma-related enucleation or evisceration, including 68 cases of evisceration and primary HA implant placement, 77 cases of enucleation and HA implant placement wrapped with multi-windowed sclera, 66 cases of enucleation and HA implant placement free of wrapping. All the cases were followed up for 1-5 years to observe the therapeutic effects and major complications. RESULTS: Five of 211 cases had wound dehiscence. Ten cases had HA implants exposure, including 1 case suffering severe orbital infection and requiring HA implant removal. The implants exposure incidences by the three surgical methods were from 1.30% to 10.06% and averaged 4.74%. Significant difference was found in late exposure incidence and total incidence from the three methods (chi(2)=13.372, P < 0.01 and chi(2)=7.540, P < 0.05). Two cases had shrinkage of the lower fornix. Enophthalmos occurred in 1 case treated by method 1 and was corrected by implanting porous polyethylene (Medpor) plate into the bottom of orbit. In 210 cases, the artificial eye moved well and the cosmetic results were satisfactory. CONCLUSIONS: Different surgical methods have their own merit and disadvantage. Enucleation and placement of HA implant wrapped with multi-windowed sclera has corroborated fewer complications than others.

Visual outcome following intraocular foreign bodies: a retrospective review of 5-year clinical experience.

PURPOSE: To determine the main prognostic factors related to final visual acuity (VA) after intraocular ocular foreign body (IOFB) extraction. METHODS: We performed a retrospective chart review of 80 patients (84 eyes) who underwent surgical removal of IOFBs and repair of associated ocular trauma. Data on age, gender, presenting clinical features, characteristics of IOFB, complications, interval between time of injury and IOFB removal, and final VA were recorded and analyzed. RESULTS: Male adults were the major population affected by IOFBs. Improved vision outcome was obtained after the removal of IOFBs and surgical repair of the eyes (p=0.011). Factors showing statistical association with final VA included initial VA (p=0.000), size of IOFB (p=0.010), IOFB location inside the eye (p=0.000), and preoperative retinal detachment (p=0.011). Factors showing no statistical association with final VA included nature of IOFB (p=0.445), entrance wound location, other IOFB-related complications (such as cataract, vitreous hemorrhage, secondary glaucoma, hyphema, endophthalmitis, siderosis, and atrophia bulbi), and interval between injury and IOFB removal. CONCLUSIONS: Prognostic factors for poor final VA related to IOFBs included poor initial VA, large IOFB size, posterior segment location, and preoperative retinal detachment.