Comparison of Two Conjunctival Incision Techniques in Strabismus Operations: Analysis of the Patient Population in 2008, 2010 - 2014. / Vergleich zweier Schnitttechniken zur Eröffnung der Bindehaut bei Augenmuskeloperationen: Analyse des Krankengutes der Jahre 2008, 2010 ­â€Š2014.

BACKGROUND: Until 2010, the Halle university hospital used the limbal approach in strabismus operations to open the conjunctiva, as first described by Harms in 1949. In 2010, this was changed the to a modified radial incision technique, as inspired by the fornix incision of Harms and the "minimally invasive strabismus surgery" (MISS) technique of D. S. Mojon. The indication is the reduction in complications and protection of the conjunctiva. METHODS: A retrospective analysis was performed of cases between 2008 and March 2014 was performed, including a total of 258 patients. 109 patients were treated with the limbal approach and 149 patients with the radial cut. The following aspects were included for comparison: the medium-term control of the squint angle after three months, intra- and postoperative number of complications, duration of the operations. A survey collected the reasons for not taking part in follow-up checks and the alignment of these patients. To compare binary variables, the chi-square-test was used and to compare average terms the unpaired t test, with a level of significance of 0.05%. RESULTS: The results of the postoperative square angles were comparable to both each other as to the literature. The number of complications was kept low in both techniques. The duration of the operations under the radial incision technique was clearly higher. However, throughout the observed years the duration of operations turned out to have decreased. The reasons for not taking part in controls were diverse and the alignment of these patients was high, regardless of the incision technique. CONCLUSIONS: The limbal approach was a well-proven method to open the conjunctiva. After changing to the radial incision technique, there was never a negative influence on the results of the surgeries or the rate of complications. The duration of the operations was extended. Superiority of the new technique was not shown. It could however be an alternative, as it spares the conjunctiva and permits glaucoma operations.

A Case Series of Dacryoendoscopy in Childhood: A Diagnostic and Therapeutic Alternative for Complex Congenital Nasolacrimal Duct Obstruction Even in the First Year of Life.

INTRODUCTION: Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in infancy. Spontaneous resolution occurs in the majority of the cases by 1 year of age. Nevertheless, obstruction has a negative impact on the outcome of conservative or surgical therapy, especially in cases of complex CNLDO. When the condition persists beyond several months, early intervention with dacryoendoscopy (DE) around the age of 1 year could yield good results. The objective of the study is to analyze the success rate and effectiveness of early DE for complex CNLDO in the first year of life. METHODS: A retrospective, non-comparative case series is presented. DE was performed under general anesthesia in patients between the age of 1 and 12 months with severe recurrent acute or chronic dacryocystitis. The medical histories, intraoperative and postoperative results after 3 months as well as via parents' interviews were analyzed to investigate the success rate. RESULTS: A total of 18 consecutive DE in 16 patients between the age of 1 and 12 months (mean 7.3 ± 3.4 months) were studied. Nine lacrimal ducts were diagnosed with persistent chronic dacryocystitis refractory to probing/syringing. The remaining 9 presented recurrent acute dacryocystitis. Diagnostic DE was performed in 18 cases. A therapeutic DE was conducted in 15 lacrimal ducts (83.3%) with simultaneous correction of the associated stenosiswith the tip of the endoscope. A visual controlled opening of the stenosis was impossible in 3 cases due to a too narrow presaccal anatomy (n = 1), an osseous duct stenosis (n = 1), and a bulging membrane of Hasner into the inferior nasal meatus (n = 1). Postoperative findings were classified into four categories: poor, fair, good and excellent. Good results were documented in 16.7% (n = 3) and excellent results in 77.7% (n = 14). The bony obstruction was treated with dacryocystorhinostomy. A minimum follow-up of 3 months was considered for final clinical analysis. Ten patients' parents (12 surgeries) were interviewed by telephone (mean follow-up 24.8 months). No recurrence of stenosis and no further postoperative complications were observed. CONCLUSION: DE is a diagnostic and therapeutic option for complex CNLDO in patients before the age of 1 year. The outcome of DE in the 3 months follow-up is highly indicative of positive final results in terms of patency of the lacrimal duct.

Bone marrow cells and CD117-positive haematopoietic stem cells promote corneal wound healing.

PURPOSE: The present study was conducted to evaluate the therapeutic effects of topically applied bone marrow (BM) cells and CD117-positive haematopoietic stem (CD117(+)) cells on alkali-induced corneal ulcers. METHODS: Bone marrow cells and CD117(+) cells were isolated from syngenic mice and labelled with an intracellular cell tracer. Defined corneal wounds were produced in 89 eyes of syngenic mice and allowed to partially heal in vivo for 6 hr. The alkali-burned eyes were enucleated 6 hr postinjury and randomly divided into three groups. Control group (33 eyes) was incubated with medium only. The treatment groups received either BM cells (30 eyes) or CD117(+) cells (26 eyes) suspended in medium. Re-epithelialization process of corneal defects was qualitatively and quantitatively assessed and statistically analysed. The corneas were examined by histological and immunohistochemical methods. RESULTS: We found that the re-epithelialization of corneal wounds in both treatment groups was significantly accelerated as compared to the control group. During the follow-up period (85 hr), the corneal transparency was comparable in all groups. Morphological investigations of corneas from control and treatment group showed no evident differences in the phenotype of the regenerated epithelium. Additionally, corneas in the treatment groups were devoid of donor-derived BM cells and CD117(+) cells, respectively. CONCLUSIONS: This study provides evidence that topical application of BM cells or CD117(+) cells can be used to reconstruct corneal surfaces. Because neither BM cells nor CD117(+) cells were integrated into the corneal epithelium, we suggest that soluble factors could be responsible for the positive effect of BM cells and CD117(+) cells on corneal wound healing.

Practical implications of the law on tissues for cornea banks in Germany.

ISSUE: On August 1, 2007, the Law on the Quality and Safety of Human Tissues and Cells came into force. IMPLICATIONS: As a consequence of the new legislation on human tissue, legislative changes were effected upon the Law Regulating Transplantations, Medicine Law and Transfusion Law and the regulation of pharmacies as well as the operating regulations for wholesale pharmaceutical holdings. RESULTS AND CONCLUSION: The substantial increase in regulation caused by the Tissue Act far exceeds the requirements of the EC directive on tissues. As such, it has resulted in a huge increase in material (financial, human) and bureaucracy, with no significant gains in safety or quality in an area that had functioned well under the previous legislation.