A novel surgical technique for punctal stenosis: placement of three interrupted sutures after rectangular three-snip punctoplasty.

BACKGROUND: We developed a novel surgical technique to treat punctal stenosis involving the placement of three interrupted sutures after rectangular three-snip punctoplasty (TSP). METHODS: Retrospective chart review of forty-eight eyes of 44 patients who underwent rectangular TSP with three interrupted sutures was performed. We investigated whether anatomical recurrences (re-stenosis) occurred during the follow-up period. The subjective symptoms of patients were surveyed. RESULTS: The mean patient age was 64.1 years, and the mean follow-up time was 17.4 months. The placement of three interrupted sutures after rectangular TSP afforded satisfactory outcomes. Regarding subjective symptoms, 91.7% of the eyes (44/48) were reported as improved. Among 4 eyes determined as symptomatic failure, anatomical recurrence (re-stenosis of the punctum) was observed in only one eye. The other three (6.25%, 3/48 eyes) showed functional nasolacrimal obstruction, namely epiphora with patent tear duct. CONCLUSIONS: Placement of three interrupted sutures after rectangular TSP to treat punctal stenosis showed promising results. Notably anatomical success rate was about 98%. Further comparisons between the novel surgical technique and conventional techniques are required.

Loss of reflex tearing after maxillary orthognathic surgery: a report of two cases.

BACKGROUND: Few reports have described the ophthalmic complications that occur after maxillary orthognathic surgery. Since cases of decreased reflex tearing after maxillary orthognathic surgery are extremely rare, we describe 2 cases of loss of reflex tearing after maxillary orthognathic surgery. CASE PRESENTATION: Two Asian women, an 18-year-old and a 32-year-old, suffered from unilateral dryness and irritation caused by maxillary orthognathic surgery. In both patients, Schirmer test (II) showed reduced reflex tearing in 1 eye. Computed tomography showed that the pterygoid plate had been fractured in both patients. CONCLUSIONS: The pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa may be injured during Le Fort osteotomy.

Nasolacrimal duct obstruction after maxillary orthognathic surgery.

PURPOSE: To report cases of nasolacrimal duct obstruction (NLDO) after maxillary orthognathic surgery. MATERIALS AND METHODS: The authors reviewed the clinical manifestations, dacryocystographic images, and orbital computed tomographic scans of 10 patients who were diagnosed with NLDO after undergoing maxillary orthognathic surgery. RESULTS: Six of the 10 patients (60%) complained of epiphora immediately after the surgery. Bilateral (n = 2, 20%) or unilateral (n = 8, 80%) NLDO occurred in all patients involved in the study. Twelve eyes of 10 patients were examined, and dacryocystography showed that the obstruction was present in the distal ostium in 7 eyes (58.3%), the junction between the sac and duct in 3 eyes (25%), and the common canaliculus in 2 eyes (16.7%). Computed tomographic scans of all subjects showed that mucosal swelling and congestion around the distal NLD opening narrowed the space between the lateral nasal wall and the inferior turbinate of the affected side. Dacryocystorhinostomy was performed in 9 eyes (8 patients), with a success rate of 100%. CONCLUSIONS: The distal to proximal portion of the NLD can become obstructed after maxillary orthognathic surgery. This obstruction seems to be caused by secondary inflammatory changes associated with an indirect injury of the NLD. Therefore, clinicians should be aware of the possibility of NLDO after orthognathic surgery, which can be treated successfully with dacryocystorhinostomy.

Change in quality of life of patients undergoing silicone stent intubation for nasolacrimal duct stenosis combined with dry eye syndrome.

AIMS: To investigate the effect of silicone stent intubation (SI) on the quality of life of patients diagnosed with nasolacrimal duct stenosis and dry eye syndrome. METHODS: This study is a prospective, interventional case series. Consecutive 30 patients diagnosed with nasolacrimal duct stenosis and reflex tearing due to dry eye syndrome were included. Eligible subjects underwent SI and were asked to complete the Glasgow Benefit Inventory (GBI) questionnaire. Surgical outcomes and GBI scores were investigated 6 months postoperatively. RESULTS: The surgical success rate determined by the patients' subjective symptoms was 76.7% (23/30). Mean total GBI score was +17.19 (95% CI 8.34 to 26.03). The general subscale score was +20.36 (95% CI 10.19 to 30.54), the social support scale score was +21.54 (95% CI 11.37 to 31.71) and the physical health score was -0.56 (95% CI -8.92 to 7.80). CONCLUSIONS: SI could be an effective treatment option for reflex tearing in patients diagnosed with dry eye syndrome and nasolacrimal duct stenosis.

Combined orbital floor wedge implant and fornix reconstruction for postenucleation sunken socket syndrome.

BACKGROUND: The purpose of this study was to evaluate the efficacy of simultaneous correction of a postenucleation sunken socket syndrome and deficient inferior fornix with a porous polyethylene wedge and oral mucosa graft. METHODS: In this study, the authors retrospectively reviewed 24 patients who underwent simultaneous correction of postenucleation sunken socket syndrome by wedge implants and deficient inferior fornix by oral mucosa graft from January of 2009 until December of 2011. Upper and lower fornix depths were measured and exophthalmometry was performed before and 6 months after surgery. A paired t-test analysis was used to compare preoperative and postoperative results of fornix depth and exophthalmos. RESULTS: Of the 24 patients, 15 were women and nine were men. The mean age of the patients was 44.1 years and the mean follow-up period was 11.2 months. Enophthalmos significantly decreased in all cases, with a mean change of 3.3 ± 1.26 mm (p < 0.001). Inferior fornix depth increased significantly, with a mean difference of 5.0 ± 0.86 mm (p < 0.001). There were no significant complications after surgery. CONCLUSION: A simultaneous correction of postenucleation sunken socket syndrome and deficient inferior fornix using porous polyethylene wedge implants and oral mucosa graft can be effective for cosmetic improvements in anophthalmic patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Neoadjuvant intra-arterial chemotherapy in patients with primary lacrimal adenoid cystic carcinoma.

BACKGROUND: We describe four cases of primary lacrimal adenoid cystic carcinoma (ACC) treated with neoadjuvant intra-arterial chemotherapy (NAIC). METHODS: The outcomes and complications of NAIC were reviewed. Several treatment-related local and/or systemic complications were noted. RESULTS: One patient experienced ipsilateral eyelid and eyeball necrosis and permanent facial palsy; the second patient developed ipsilateral facial swelling and jaw claudication; and the third patient had febrile neutropenia, cellulitis, and phlebitis. These three patients underwent total exenteration. The fourth patient experienced neutropenia and thrombocytopenia and underwent tumour removal without exenteration. All patients were followed for more than 4 years and were alive at the last follow-up. CONCLUSION: Neoadjuvant intra-arterial chemotherapy may be an alternative treatment that will improve the survival rate of ACC. However, careful and close observation is needed to minimise the risk of side effects. Further investigations are needed to justify the use of chemotherapy-related treatments and the associated costs.

Effects of nasopore packing on dacryocystorhinostomy.

PURPOSE: To investigate the effects of placement of the absorbable packing material Nasopore at the anastomosis site of newly formed mucosal flaps on postoperative re-bleeding, discomfort, and on the success rate of dacryocystorhinostomy (DCR). METHODS: A review of the medical records of patients with primary acquired nasolacrimal duct obstruction that underwent external or endonasal DCR by a single surgeon was performed. The degree of re-bleeding, discomfort, and postoperative results, including anatomical success, functional success and postoperative nasal findings such as granulation, synechiae, and membrane formation were compared in patients whose anastomosis site was packed with either Nasopore or Merocel, a non-absorbable packing material. RESULTS: A total of 77 patients (101 eyes) were included. Of the 101 eyes, 30 were packed with Nasopore, while 71 were packed with Merocel. The Nasopore group showed significantly better results than the Merocel group in the degree of re-bleeding and the level of patient discomfort (p = 0.000, 0.039, respectively; Pearson's chi-square test), whereas there were no statistically significant differences between the two groups in postoperative anatomical and functional success (p > 0.05). CONCLUSIONS: Nasopore significantly reduced postoperative nasal re-bleeding and patient discomfort during the early post-surgical period, but failed to show an effect on the postoperative anatomical and functional success of DCR.

Effect of yellow-tinted intraocular lenses on short-wavelength automated perimetry.

PURPOSE: To investigate the effect of yellow-tinted intraocular lenses (IOLs) on short-wavelength automated perimetry (SWAP). DESIGN: Cross-sectional observation study. METHODS: Twenty-two patients who had implantation of yellow-tinted IOLs (AcrySof SN60AT or SN60WF; Alcon Laboratories) in 1 eye and nontinted IOLs (AcrySof SA60AT) in the other eye were included in the study. Standard automated perimetry (SAP) and SWAP were performed. The results for the mean deviation (MD), pattern standard deviation (PSD), and glaucoma hemifield test results were compared intra-individually. RESULTS: There was no statistically significant difference between the IOLs on the SAP (MD, PSD; P = .851, P = .388, respectively). However, a significant difference was observed between the IOLs on the SWAP (MD, PSD; P = .033, P = .033, respectively). The glaucoma hemifield test did not show significant differences in the SAP (P = .083). However, the SWAP showed significant differences (P = .003). CONCLUSIONS: The yellow-tinted IOLs may affect the results of the SWAP; therefore, caution is needed in interpreting the results of the SWAP in eyes with implanted yellow-tinted IOLs.