Comparison of the surgical outcomes of endoscopic dacryocystorhinostomy in chronic dacryocystitis with or without previous bicanalicular silicone tube intubation.

AIMS: To compare the outcomes of endoscopic dacryocystorhinostomy (En-DCR) in chronic dacryocystitis (CD) with or without previous bicanalicular silicone tube intubation (BSTI), and investigate whether previous BSTI influenced postoperative outcomes. METHODS: We conducted a retrospective review of medical records of CD patients (group A) who had previously undergone BSTI for nasolacrimal duct stenosis and an age- and sex-matched control group of CD patients (group B) without previous intubation receiving En-DCR from November 2017 to January 2022. Sixty-one patients (61 eyes) were included in group A and age- and sex-matched 122 patients (122 eyes) in group B. Dacryocystic parameters were measured by computed tomography-dacryocystography and surgical findings were recorded during surgeries. The surgical success rates of the two groups were compared at 12 months post-operation. RESULTS: The mean horizontal, sagittal, and vertical lengths were 6.06 ± 1.24, 6.03 ± 1.44, and 8.05 ± 2.00 mm, respectively, in group A and 6.33 ± 1.25, 6.26 ± 1.19, and 10.40 ± 2.45 mm, respectively, in group B. There were no differences in the horizontal or sagittal parameters between the two groups. The vertical parameter in group A was significantly lower than that in group B. Scar formation in the sac was observed in 54 patients in group A but was absent in group B. At 12 months postoperatively, the anatomical and functional success rates were 88.52 % and 85.25 %, respectively, in group A and 92.62 % and 89.34 %, respectively, in group B, with no difference between the two groups. CONCLUSION: Previous BSTI reduced dacryocyst vertical parameter and caused dacryocyst scar formation but did not affect postoperative En-DCR efficacy.

Use of Silicone Tubes as Antiadhesion Devices in a Modified Two-Stage Flexor Tendon Reconstruction in Zone II: A Retrospective Study.

PURPOSE: This study aimed to assess the outcome of a modified two-stage flexor tendon reconstruction using silicone tubes as antiadhesion devices while performing simultaneous tendon grafting. METHODS: From April 2008 to October 2019, 16 patients (21 fingers) with zone II flexor tendon injuries, who sustained failed tendon repair or neglected tendon laceration, were treated by a modified two-stage flexor tendon reconstruction. The first stage of treatment comprised flexor tendon reconstruction with interposition of silicone tubes to minimize fibrosis and adhesion around the tendon graft; the second stage of treatment comprised silicone tube removal under local anesthesia. RESULTS: The patient median age was 38 (range, 22-65) years. After a median follow-up period of 14 (range, 12-84) months, the median total active motion (TAM) of fingers was 220° (range, 150-250°). Excellent and good TAM ratings were identified in 71.4%, 76.2%, and 76.2% according to the Strickland, modified Strickland, and American Society for Surgery of the Hand (ASSH) evaluation systems, respectively. At follow-up, complications included superficial infections in two fingers of one patient whose silicone tube was removed 4 weeks postoperatively. The most common complication was a flexion deformity of the proximal interphalangeal joint (four fingers) and/or distal interphalangeal joint (nine fingers). The rate of failed reconstruction was higher in patients with preoperative stiffness and infection. CONCLUSIONS: Silicone tubes are suitable antiadhesion devices, and the modified two-stage flexor tendon reconstruction technique is an alternative procedure with a shorter rehabilitation period for complicated flexor tendon injury, compared with current popular reconstructions. Preoperative stiffness and postoperative infection may compromise the final clinical outcome. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Trephination and silicone tube intubation in the treatment of canalicular obstruction.

PURPOSE: To evaluate the efficacy of trephination and monocanalicular/bicanalicular silicone tube use depending on the number of affected canaliculi in patients with canalicular obstruction. METHODS: This retrospective study included 46 eyes of 36 patients who underwent trephination and silicone tube intubation performed by a single experienced oculoplastic surgeon due to canalicular obstruction between 2005 and 2020. Monocanalicular silicone tube was applied to patients with one canalicular obstruction, and bicanalicular silicone tube was applied to those with the upper and lower canalicular involvement of the same eye. Canalicular obstructions were divided into groups according to their localization as proximal, middle, and distal. The silicone tubes were kept in place for at least 5 months after the operation, and the follow-up duration of the patients was at least 12 months. RESULTS: Twenty (55.6%) patients were female and 16 (44.4%) were male. The mean age was 15.82 ± 7.02 years in the treatment success group and 28.87 ± 12.74 years in the treatment failure group (p = 0.001). While 67.6% of the eyes in the treatment success group had monocanalicular obstruction (monocanalicular silicone tube applied), 66.7% of those in the treatment failure group had bicanalicular obstruction (bicanalicular silicone tube applied) (p = 0.049). The most common distal obstruction was seen in the treatment success group, and the least distal obstruction and the most proximal obstruction were observed in the treatment failure group (p < 0.001). The mean duration silicone tube stay was 9.37 ± 1.96 months in the treatment success group and 7.25 ± 1.42 months in the treatment failure group (p = 0.003). CONCLUSION: We consider that trephination with the use of a monocanalicular or bicanalicular silicone tube depending on the number of affected canaliculi can be the first choice of treatment in canalicular obstruction due to its high success rate, especially in distal obstruction.

Factors affecting the need for silicon tube implantation in cases of congenital dacriostenosis: time of delivery, type of delivery and age of operation.

PURPOSE: To evaluate the delivery time, type of delivery, age at the time of operation, and surgical methods applied in cases of congenital nasolacrimal duct obstruction (CNLDO). METHODS: This study retrospectively included a total of 207 eyes of 160 cases who underwent surgery for CNLDO between February 2012 and April 2021. According to their age at the time of operation, the cases were divided into 0-12, 12-24, 24-36, 36-48 and > 48 months groups. The cases were evaluated as term/preterm according to the delivery time and cesarean section/vaginal delivery according to the type of delivery. The surgical methods applied were examined as probing alone and probing plus silicone tube implantation. RESULTS: Of the cases, 146 (91.2%) were born at term and 14 (8.7%) were born preterm, and there was no statistically significant difference in the silicone tube implantation rates according to the time of delivery. The rate of silicone tube implantation was statistically significantly higher in the vaginal delivery group than in the cesarean section group (p = 0.001; p < 0.01). The rate of silicone tube implantation was higher in those who were older than the age of the operation. CONCLUSIONS: Although the rate of those who were born by cesarean section was higher in probing cases, those who required silicone intubation were more common in those who were born vaginally. This suggests that dacryostenosis in the vaginally born cases resulted from a persistent structural and anatomical obstruction despite the presence of a high intrauterine pressure increase and enzymatic lysis.

Can preoperative lacrimal endoscopic evaluation change the paradigm of conventional lacrimal surgery?

PURPOSE: To evaluate the effectiveness of preoperative lacrimal endoscopic evaluation (LEE) of lacrimal duct system (LDS). DESIGN: Retrospective comparative case series METHODS: From March 2016 to February 2020, the charts of patients chosen to undergo endoscopic dacryocystorhinostomy (EDCR) or silicone tube intubation (STI) were reviewed retrospectively. Group 1 included patients that underwent EDCR, and group 2 included patients that underwent STI. Preoperative LEE was performed for all patients. In group 1, we compared the functional success rate for patients who had been converted to STI with the patients who had undergone EDCR. In group 2, we compared the functional success rate of STI with those who had had STI without LEE. RESULTS: In group 1, 19 (54.3%) eyes were converted to STI following LEE, and the functional success rate was 84.2%, which is not significantly different from that of the EDCR group following LEE (p = 0.608). The functional success rate of EDCR without LEE was not different from that of STI following LEE (p = 1.000). In group 2, five eyes (26.3%) were converted to EDCR following LEE. The group undergoing STI following LEE showed a significantly higher functional success rate (95.7%) than the group without LEE (66.6%, p = 0.023). CONCLUSION: Preoperative LEE enables direct visualization of the LDS and helps to obtain more accurate diagnosis. This allows for the best surgical option based on LEE findings, which can contribute to better results. Therefore, LEE would be expected to change the paradigm of the classical management of LDS.

Longitudinal randomized study to evaluate the long-term outcome of endoscopic primary dacryocystorhinostomy with or without silicone tube.

OBJECTIVE: Dacryocystorhinostomy (DCR) is indicated for the treatment of nasolacrimal obstruction with some authors suggesting the use of a silicone tube (stent) to maintain rhinostomy patency a long time. This study aims at comparing the results of endoscopic-DCR (En-DCR) with and without silicone stenting. METHODS: A randomized prospective study was conducted from January 2013 to January 2018, following patients for up to 72 months. Sixty outbound patients suffering from chronic epiphora for primary acquired nasolacrimal duct obstruction were simply randomized and assigned to En-DCR with "silicone stent tube" (SST) or "no silicone stent tube" (NSST) group. Data about the results of the two procedures were collected using Munk' and Ali' assessments. The results were statistically compared to evaluate the differences. RESULTS: 30 patients were in the SST group and 30 in NSST. In the SST group, the tube remained in place for 3-6 months (4.1 ± 1.2 months). The follow-up period was 12-72 months (48.3 ± 6.2 months). Success rates (Junk and Javed Ali assessments) were, respectively, 97% in SST and 90% NSST group, with no statistical difference (Student's test). On a long-term follow-up, SST patients had an increased risk of re-stenosis by 14 months. CONCLUSIONS: Our results showed there were not benefit in using tube, in the opposite it increased risk of re-stenosis. Despite preliminary results, our data confirmed comparing the two methods that silicone tube should not be used.

Derivation of the toxicological threshold of silicon element in the extractables and leachables from the pharmaceutical packaging and process components.

Silicon is one of the most monitored elements in extractables and leachables studies of pharmaceutical packaging systems and related components. There is a need to review and evaluate toxicological thresholds of silicon because of its direct contact with drug products (DP) especially a liquid form of DP with the widely used pharmaceutical packaging systems made of silicon materials like glass and silicone. It is required by regulatory authorities to test silicon content in DP; however, there are no official guidelines on the toxicology of silicon that are currently available, yet the knowledge of toxicological thresholds of silicon is critical to justify the analytical limit of quantification (LOQ). Therefore, we reviewed the toxicity of silicon to derive a toxicological threshold by literature review of toxicity studies of both inorganic and organic silicon compounds. Oral toxicity is low for inorganic silicon like silicon dioxide or organic silicon polymers such as silicone tube/silicone oil (polydimethylsiloxane, or namely, PDMS as the major ingredient). In comparison, inhalational toxicity of silicon dioxide leads to pulmonary silicosis or even lung cancer. When orally administered, the toxicity of silicon dioxide, glass, polymers, or PDMS oligomers varies depending on their morphology, molecular weight (MW), and degrees of polymerization. PDMS with high MW has minimal toxic symptoms with non-detectable degradation/elimination by both intraperitoneal and subcutaneous administration routes, while exposure to either PDMS or small molecule dimethyl silicone compounds by the intravenous administration route may lead to death. We here determined a general parenteral permitted daily exposure (PDE) of 93 µg/day for inorganic silicon element and 100 µg/day for organic silicon element by reviewing toxicological data of both forms of silicon. In conclusion, this work provides evidence for pharmaceutical companies and regulatory agencies on the PDEs of silicon elements in pharmaceutical packaging and process components through a variety of administration routes.

Nanocoating and biological evaluation of clindamycin- and rifampicin-loaded nanospheres impregnated silicone tube for antibacterial application.

Two types of nanospheres, namely clindamycin-loaded nanospheres (CN) and rifampicin-loaded nanospheres (RN) were successfully prepared using emulsion solvent evaporation technique. Poly(ε-caprolactone-random-d,l-lactide)-block-poly(ethylene glycol)-block-poly(ε-caprolactone-random-d,l-lactide) (PLEC) was used for preparing nanospheres. CN and RN were coated on an antibiotic-impregnated silicone tube surface by spray coating technique. The formulations of antibiotic-loaded nanospheres (CN and RN) and the amount of spray coating cycles were optimized. Drug-loading content (DLC), encapsulation efficiency, zeta potential, and size of nanospheres were characterized. The optimal ratios of PLEC to clindamycin; and PLEC to rifampicin were both at 2:1. Drug-loading contents of CN and RN were 2.62 ± 0.04% and 7.02 ± 0.02%, respectively. The optimum coating of 90 cycles was provided DLCs of 0.0637 ± 0.033 wt.% and 0.0613 ± 0.018 wt.% for rifampicin and clindamycin, respectively. The coating of silicone tube was able to prolong the release of both antibiotics for at least 30 days. Antibacterial activity test was performed using MRSA (ATCC 43300) and S. Epidermidis (ATCC 12228). Moreover, the cytotoxicity of antibiotic-loaded nanospheres coated on silicone tubes was evaluated. The coated silicone tube showed antibacterial activity for at least 28 days and was biocompatible with L929 cells.

Transcanalicular endoscopic dacryoplasty in patients with primary acquired nasolacrimal duct obstruction.

BACKGROUND: To investigate the lacrimal drainage system (LDS) from the punctum to the inferior meatus and the clinical outcomes of transcanalicular endoscopic dacryoplasty and silicone intubation through dacryoendoscopy in patients with primary acquired nasolacrimal duct obstruction (PANDO). METHODS: We conducted a retrospective chart review of 203 cases from 156 patients who underwent dacryoendoscopy (FT-203F; Fibertech Co., Tokyo, Japan) and sheath-guided silicone intubation for PANDO from December 2014 to March 2018. Clinical characteristics, tear meniscus height, irrigation test, dacryocystographic findings, and dacryoendoscopic findings related to clinical factors and surgical outcomes were evaluated. RESULTS: The study population consisted of 44 males and 119 females (mean age, 60.4 ± 13.6 years). The mean epiphora duration was 3.8 ± 4.8 years. Dacryoendoscopic findings revealed that the following factors were associated with LDS obstruction (% cases): mucus, 39.9%; fibrotic membrane, 19.2%; stones, 9.4%; granulation, 8.9%; and stenosis, 2.7%. The locations of obstruction were as follows (% cases): nasolacrimal duct, 35.7%; canaliculus, 33.0%; sac, 27.6%; and inferior meatus, 3.5%. The types of LDS obstruction were classified into two groups: secretory group (n = 118) that included mucus, stones, and granulation, and structural group (n = 85) associated with the membrane and stenosis; the pattern of them was divided into focal (n = 134) and diffuse (n = 76). The overall success rate was 86.2%. The success rate of the structural group (95.3%) was significantly higher than that of the secretory group (79.7%) (p = 0.001). All membranous obstruction cases at the inferior meatus were treated successfully, regardless of the irrigation test results. The success rate of the focal group (93.1%) was significantly higher than that of the diffuse group (74.0%) (p = 0.003). CONCLUSIONS: Dacryoendoscopic findings were informative regarding the clinical factors leading to LDS in PANDO patients. Mucus and stones in the lacrimal sac were common findings of functional lacrimal duct obstruction. Membranous obstruction and stenosis could be managed by recanalization under direct visualization. Transcanalicular endoscopic dacryoplasty and silicone intubation is considered to be a safe and effective procedure, sparing the patient from bony destruction in selected cases of PANDO.

[Determination of o-toluidine in workplace air by solvent desorption-gas chromatography].

OBJECTIVE: To establish solvent desorption gas chromatograph method for o-toluidine determination in workplace air. METHODS: The o-toluidine vapour in workplace air was collected with silicone tube, and desorbed with absolute ethanol. Then the desorption solution was separated with polyethylene glycol HP-INNOWax capillary column(30 m×0. 32 mm, 0. 50 µm)and measured with flame ionization detector. RESULTS: Detection limit of the method was 0. 18 µg/mL, quantification limit of the method was 0. 60 µg/mL, quantitative determination range of method was 0. 60-245. 37 µg/mL, and the minimum quantitative determination concentration was 0. 20 mg/m~3(based on 3. 0 L sample). The method had a good reproducibility, the relative standard deviation was 1. 0%-3. 5%, the average of desorption efficiency was 98. 7%, and the average of sampling efficiency was 93. 7%. The penetrating capacity of 200 mg alkaline silicone was over than 2. 1 mg, and the samples at room temperature could be preserved for 15 days at least. Methanol, toluene, chlorobenzene, acetoacetic ester, aniline, N-methylaniline, N, N-dimethylaniline, o-nitroaniline, p-toluidine or m-toluidine coexisted in the air did not interfere during the determination of o-toluidine. CONCLUSION: The method with low determination concentration, high accuracy and precision, is feasible for determination of o-toluidine vapour in workplace air.

[Determination of diethylenetriamine in workplace air by solvent desorption-gas chromatography].

OBJECTIVE: To establish solvent desorption gas chromatograph method for diethylenetriamine determination in workplace air. METHODS: Diethylenetriamine in workplace air was collected with alkaline silicone tube, and desorbed with 0. 2 mol/L methanol solution of hydrochloric acid. After centrifugation, the supernatant neutralized with 0. 3 mol/L methanol solution of potassium hydroxide, was separated with 5%-phenyl-methyl polysiloxane(HP-5)(25 m×0. 32 mm×0. 52 mm)and measured with flame ionization detector. RESULTS: Detection limit of the method was 0. 49 µg/mL, quantification limit of the method was 1. 64 µg/mL, quantitative determination range of method was 1. 64-233. 80 µg/mL, and the minimum quantitative determination concentration was 0. 22 mg/m~3(based on 7. 5 L sample). The method had a good reproducibility, the relative standard deviation was 1. 4%-3. 3%, the average of desorption efficiency was 90. 8%, and the average of sampling efficiency was 93. 2%. The penetrating capacity of 200 mg alkaline silicone was over than 7. 1 mg, and the samples at room temperature could be preserved for 15 days at least. Ethylenediamine, triethylenetetramine or tetraethylenepentamine coexisted in the air did not interfere during the determination of diethylenetriamine. CONCLUSION: The method with low determination concentration, high accuracy and precision, is feasible for determination of diethylenetriamine in workplace air.

[Development of ethylene glycol Samples in silicone tubes and their application in inter-laboratory comparison].

Objective: To development of ethylene glycol samples in silicone tubes, and the samples were applied to inter-laboratory comparison, through it to evaluate the detection capacity of occupational health testing laboratories. Methods: Three content levels of ethylene glycol samples in silicone tubes were prepared, and the homogeneity and stability of samples were investigated, the results were statistically analyzed. A robust statistical four-point distance method was used to calculate the results submitted by each participant laboratory and the test capability of the laboratory was assessed by the z-score method. Results: The statistic of the homogeneity of ethylene glycol samples in silicone tubes were less than the critical value (P>0.05) , and the samples were stable at room temperature for one month. The satisfactory rate of comparison between 204 laboratories was 88.24%. Conclusion: The homogeneity and stability of the ethylene glycol samples in the silicone tubes can meet the requirements of proficiency testing and can be used for laboratory comparison. Most of the laboratories that participated in the comparison had the ability to detect ethylene glycol.

Species-specific characteristics of the biofilm generated in silicone tube: an in vitro study.

BACKGROUND: To investigate characteristics of biofilm which is usually found in silicone tube for nasolacrimal duct surgery and can be the root of chronic bacterial infections eventually resulted in surgical failure. METHODS: To form a biofilm, sterile silicone tube was placed in culture media of Staphylococcus aureus, Corynebacterium matruchotii, Pseudomonas aeruginosa, or Streptococcus pneumonia. Biofilms formed on these silicone tubes were fixed with 95% ethanol and stained with 0.1% crystal violet. After staining, the optical densities of biofilms were measured using spectrophotometer on a weekly basis for 12 weeks. RESULTS: Staphylococcus aureus group and Pseudomonas aeruginosa group formed significantly more amounts of biofilms compared to the control group. The maximum optical densities of the two groups were found on week 3-4 followed by a tendency of decrease afterwards. However, the amounts of biofilms formed in other groups of silicone tubes were not statistically significant from that of the control group. CONCLUSIONS: Bacterial species that could form biofilm on silicone tube included Staphylococcus aureus (week 3) and Pseudomonas aeruginosa (Week 4). It is important to first consider that the cause of infection around 1 month after silicone tube intubation can be Staphylococcus aureus and Pseudomonas aeruginosa.

[Temporary replacement of the common biliary duct by a silicone tube as an urgent repair of iatrogenic injury. Experimental study in pigs]. / Reemplazo temporal del colédoco por tubo de silicona como reparación urgente de la lesión de vía biliar. Estudio experimental en cerdos.

Surgery of the biliary tract is complex, and its volume has increased with iatrogenic injuries and living donor transplantation. The aim of this study was to analyze if the common duct can be temporarily replaced. We used nine 18-20 kg pigs. They were operated on, and their bile duct was replaced by a 100% silicone tube. All pigs underwent laboratory tests, magnetic resonance imaging, intraoperative ultrasound, cholangiography and biliar manometry with pathological biopsy examination within 60 days from the initial surgery. All pigs survived the first surgery over 60 days without laboratory evidence of evident cholestasis. Nine pigs were re-operated on at 60 days showing dilated common bile duct and hepatic ducts doubling its original size without dilating the intrahepatic bile ducts. There were no clinical, relevant laboratory or biopsy signs showing cholestasis. This experience represents the initial intention to find an optimal situation and prosthesis for replacement of the thin biliary tract, in surgical emergencies or palliative situations. The silicon tube, is a positive answer that remains permeable. A non-fibrotic reaction was found that allows a posterior definitive procedure, maintaining a good nutritional status.

An effective approach for the treatment of severe punctal stenosis: Bicanalicular silicone tube intubation with pigtail probe.

PURPOSE: To evaluate the results of using a pigtail probe to open the inferior punctum followed by bicanalicular silicone tube intubation in patients with severe acquired punctal stenosis. METHODS: Forty-one eyes of 25 patients with severe inferior punctal stenosis admitted to our tertiary care center were included in the study. The degree of epiphora was determined using the Munk score and the fluorescein disappearance test. The inferior punctum was located and opened by entering the superior punctum with a pigtail probe. Then, bicanalicular silicone tube intubation was performed. The silicone tube was removed after six months. A Munk score of 0 or 1 and a fluorescein disappearance test score of 1 and 2 were considered a complete success. RESULTS: Ten (40%) patients were male, and 15 (60%) were female. The mean age was 60.4±15.5years. One year after the surgery, epiphora was absent in 18 eyes (43.9%) (Munk score grade 0) and rarely seen in 9 eyes (22%) (Munk score grade 1). At the one-year follow-up, the fluorescein disappearance test score was stage 1 (<3min) in 21 eyes (51.2%) and stage 2 (3-5min) in 13 eyes (31.7%). There was a statistically significant difference between the preoperative and one-year postoperative test results (P<0.001). CONCLUSION: In cases with severe punctal stenosis, a pigtail probe is an effective method for locating and opening the punctum, and punctal opening and prevention of restenosis were achieved by a bicanalicular stent.

Bicanalicular-nasal silicone stent for deep canalicular laceration management.

We evaluated the efficacy and clinical outcomes of bicanalicular-nasal silicone stents for deep canalicular lacerations and their anatomical restoration advantages. This retrospective case series study included patients with deep canalicular lacerations who underwent bicanalicular-nasal silicone stent intubation between January 2010 and June 2021 at a Chinese tertiary hospital and two primary hospitals. Intra- and post-operative complications were recorded. Anatomical, functional, and cosmetic outcomes were evaluated as anatomical restoration assessments at the last follow-up. We defined anatomical success as a free passage with no reflux during irrigation. Functional success was evaluated using the Munk epiphora scale and fluorescein dye disappearance test. Cosmetic outcomes were evaluated by examining the eyelid, lacrimal punctum, and medial canthus for any structural abnormalities and recorded objectively using a grading scale. We evaluated 92 eyes of 92 patients (63 men and 29 women); the mean distance from the lateral lacerated end to the punctum was 7.74 mm (range 7-10 mm). Bicanalicular-nasal silicone stents were successfully used in all 92 eyes with no severe intra- or post-operative complications noted. The stent placement duration ranged from 12 to 16 weeks (mean, 13.18 weeks). The follow-up period after stent removal ranged from 3 to 12 months (mean, 6.04 months). The anatomical and functional restoration success rates were 96.74% (89/92) and 100% (92/92), respectively. Satisfactory eyelid position realignment was achieved in all patients. Bicanalicular-nasal silicone stent placement sufficiently relieved orbicularis muscle tension during deep canalicular laceration repair, providing good functional results and excellent cosmetic realignment and anatomical restoration of the eyelid.

Effect of intubation in patients with functional epiphora after endoscopic dacryocystorhinostomy.

AIM: To investigate the effect of bicanalicular silicone tube intubation (BSTI) in the treatment of functional epiphora after endoscopic dacryocystorhinostomy (En-DCR). METHODS: Clinical data of 84 patients (95 eyes) with functional epiphora after En-DCR were retrospectively analyzed. Functional epiphora was confirmed as persistent or recurrent epiphora by fluorescein dye disappearance test (FDDT), lacrimal irrigation test, as well as endoscopic examination. Secondary BSTIs were recommended for patients with functional epiphora. These tubes were removed 1mo after surgery. Functional success and associated complications were assessed after 2y of follow-up. RESULTS: Seven patients (9 eyes) refused intervention, 5 patients (6 eyes) did not complete postoperative follow-up, and 1 patient (1 eye) developed tube prolapse within 1mo after surgery. Seventy-one patients (79 eyes) were included at last. Functional success ratios at six months, one year, as well as two years post-operation were 94.9% (75/79), 92.4% (73/79), and 91.1% (72/79), respectively. Three eyes presented with punctal slitting (2 eyes without epiphora), 1 eye with proximal canaliculus slitting, 1 eye with canaliculus stenosis and 4 eyes with still present functional epiphora without detectable abnormal at the last follow-up. CONCLUSION: Secondary intubation is an effective procedure with low recurrence probability for functional epiphora after En-DCR. Punctal and canaliculus injury are the main tube-associated complications after secondary intubation.

Endoscopic dacryocystorhinostomy with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent incarceration.

AIM: To investigate the feasibility of endoscopic dacryocystorhinostomy (En-DCR) with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent (NDS) incarceration. METHODS: En-DCRs were performed on 44 chronic dacryocystitis patients (46 eyes) secondary to NDS incarceration from April 2016 to October 2022. The granuloma and scar tissues were separated, and the removal of NDS incarceration was achieved during the surgery; the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal, a bicanalicular silicone tube was implanted, and lacrimal size and condition were assessed. The tube was removed 3mo after surgery. During the final follow-up of 12mo when the surgery was completed, the complications and the rates of surgical success were assessed. RESULTS: This study covered 40 patients (42 eyes). Intraoperatively, it was found that the lacrimal sac became small, and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes. At 12mo after surgery completed, the rates of the functional and anatomical success reached 80.95% (34/42) and 83.33% (35/42), respectively. Under the effect of intranasal ostial closure, seven eyes failed to achieve anatomical success. No serious complications (e.g., visual impairment, sinusitis, and orbital fat prolapse) was observed. CONCLUSION: With the success rate over 80% and no serious complications, En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.

Host-Reaction Following Silicone Tube Implantation For Lower Limb Lymphoedema Mimicking Implant Infection.

INTRODUCTION: Silicone tube implantation in lymphoedema reduces symptoms by improving fluid drainage. Although there are descriptions of implant host reaction that can be misdiagnosed as graft infections these are scarce. REPORT: A 34 year old female with lymphoedema of the lower limb, underwent silicone tube implantation. Ten months after surgery, the patient presented with fever and dermatolymphangioadenitis of the limb. Ultrasound suggested an abscess surrounding the tubes. Clinical improvement was achieved after a 6-day cycle of meropenem. She was discharged under oral cefuroxime and clindamycin for one week. After 1 month, CT-angiography was performed showing only residual inflammation surrounding the tubes, the patient was asymptomatic and limb diameter was normal. CONCLUSION: Sudden onset and improvement of the patient's condition after a short cycle of antibiotics without the need of tube removal supports a host-like reaction rather than an actual infection. Doctors should be aware of such complications avoiding unnecessary procedures.

Comparison of Outcomes of Silicone Tube Intubation with or without Dacryoendoscopy for the Treatment of Congenital Nasolacrimal Duct Obstruction.

In this retrospective study, we compared and analyzed two groups of patients who underwent silicone tube intubation (STI) to treat congenital nasolacrimal duct obstruction (CNDO). We employed dacryoendoscopy to visualize the lacrimal pathways of one group. In total, 85 eyes of 69 patients were included (52 of 41 patients in the non-dacryoendoscopy and 33 eyes of 28 patients in the dacryoendoscopy group). Clinical characteristics, dacryoendoscopic findings, and surgical outcomes were evaluated. The overall STI success rate was 91.8%, and the success rate was significantly higher in the dacryoendoscopy versus non-dacryoendoscopy group (97.0% and 88.5%, respectively). For patients < 36 months of age, the success rate was 100% (23 eyes). All patients with Hasner valve membranous obstructions were younger than 36 months and had structural obstructions of the lacrimal drainage system (LDS) (p = 0.04). However, in patients lacking Hasner valve obstructions, LDS secretory (50.0%) and structural (50%) obstructions occurred at similar rates, which did not vary by age. Dacryoendoscopy-assisted STI enhanced the therapeutic efficacy of CNDO and identified diverse CNDO etiologies beyond Hasner valve obstructions. These findings emphasize the potential advantages of dacryoendoscopy in surgical treatment for CNDO patients.