Management of chronic dacryocystitis cases after failed external dacryocystorhinostomy using endoscopic technique with a novel lacrimal ostium stent.

AIM: To demonstrate the outcomes of endoscopic endonasal dacryocystorhinostomy (En-DCR) with an novel lacrimal ostium stent (LOS) which was performed in patients with recurrent epiphora after failed external dacryocystorhinostomy (Ex-DCR) and analyze the causes of failed Ex-DCR. METHODS: From September 2015 and December 2017, the clinic data of 29 cases suffered from recurrent epiphora after failed Ex-DCR was reviewed. The LOS were implanted into the ostium at the end of the revisional surgery. The causes of failed Ex-DCR were analyzed before revisional surgeries. Outcome of revisional surgeries with the new device were evaluated as well. RESULTS: The major causes of failure of the external approach were synechiae formation in the nasal ostium (29/29), followed by inadequate removal of the bony wall (21/29), nasal synechiae formation between lateral wall of nose and middle turbinate (11/29), and the bone opening was not in good location (7/29). The rate of success after revisional surgery was 82.76%. Re-obstruction of the ostiums were found in 5 failed cases. CONCLUSION: Endoscopic approach with a novel LOS may be an effective procedure to manage recurrent epiphora after previous failed Ex-DCR surgery. Synechiae formation in the nasal ostium and inadequate removal of the bony wall were the major causes of failure of Ex-DCR.

Endoscopic transnasal canaliculorhinostomy for refractory common canalicular obstruction with an unidentifiable lacrimal sac.

AIM: To describe the role of endoscopic transnasal canaliculorhinostomy (ETC) in refractory common canalicular obstruction (CCO) associated with an absent or unidentifiable lacrimal sac. METHODS: The records of patients with refractory CCO who underwent ETC at the Eye Hospital of Wenzhou Medical University from October 2007 to December 2016 were retrospectively reviewed. RESULTS: Fifty-six patients (56 eyes) with refractory CCO were recruited into the study. Eight patients were excluded due to the presence of a residual lacrimal sac or failure to complete the follow-up duration. The anatomic and functional success rates were both 85.4% (41/48) at a mean follow-up of 18.6mo. Five cases failed as a result of ostial synechia and two failed because of ostial obstruction by granulation. Postoperative complications included mild nasal bleeding in 5 cases, dried nasal feeling in 8 cases, and olfactory dysfunction in 4 cases. CONCLUSION: Although being surgically challenging, ETC has comparable findings to its external approach counterpart or conjunctivodacryocystorhinostomy (CDCR) with Jones tube. And it may prove to be a novel alternate surgical technique for patients with refractory CCO without identifiable lacrimal sac.

Rapid Integration of Tactile and Visual Information by a Newly Sighted Child.

How we learn to interact with and understand our environment for the first time is an age-old philosophical question. Scientists have long sought to understand what is the origin of egocentric spatial localization and the perceptual integration of touch and visual information. It is difficult to study the beginnings of intermodal visual-motor and visual-tactile linkages in early infancy since infants' muscular strength and control cannot accurately guide visual-motor behavior and they do not concentrate well [1-6]. Alternatively, one can examine young children who have a restored congenital sensory modality loss. They are the best infant substitute if they are old enough for good muscle control and young enough to be within the classic critical period for neuroplasticity [7, 8]. Recovery studies after removal of dense congenital cataracts are examples of this, but most are performed on older subjects [9-14]. We report here the results of video-recorded experiments on a congenitally blind child, beginning immediately after surgical restoration of vision. Her remarkably rapid development of accurate reaching and grasping showed that egocentric spatial localization requires neural circuitry needing less than a half hour of spatially informative experience to be calibrated. 32 hr after first sight, she visually recognized an object that she had simultaneously looked at and held, even though she could not use single senses alone (vision to vision; touch to touch) to perform this recognition until the following day. Then she also performed intersensory transfer of tactile object experience to visual object recognition, demonstrating that the two senses are prearranged to immediately become calibrated to one another.