Surgical Outcomes of Endonasal Conjunctivodacryocystorhinostomy According to Jones Tube Location.

PURPOSE: The aim of this study was to compare surgical outcomes and complications of endonasal conjunctivodacryocystorhinostomy (CDCR) according to Jones tube location. METHODS: Patients who underwent endonasal CDCR owing to proximal obstruction of the lacrimal drainage system between 2009 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the location of the proximal end of the Jones tube. The canthal-based group included patients in which the proximal end of the Jones tube was located in the medial canthal angle, and the fornix-based group included patients in which the proximal end of the Jones tube was located in the inferomedial conjunctival fornix. Success rates were evaluated at 3 months and 6 months after surgery. Causes of failure, incidence of tube migration, and incidence of canthal deformity were also evaluated. RESULTS: The success rate at 3 months postoperative was 95% in the canthal-based group and 78.6% in the fornix-based group (P = 0.283). Success rates at 6 months postoperative were 85% in the canthal-based group and 71.4% in the fornix-based group, respectively (P = 0.410). The main cause of failure was granuloma in the canthal-based group (2/20) and medial migration in the fornix-based group (3/14). Medial canthal deformity occurred in 12 of 20 cases in the canthal-based group, but none occurred in the fornix-based group. CONCLUSION: The canthal-based group had a lower migration rate and slightly better surgical success rate than the fornix based group, but canthal deformity was more prevalent.

Hemorrhage and Infarction of the Conjunctiva and Orbit in Essential Thrombocythemia.

An 82-year-old woman who had a history of essential thrombocythemia presented with ocular pain, bleeding, and decreased visual acuity of the left eye. Orbital computed tomography revealed a relatively well-defined homogenous mass-like lesion in the left subconjunctival and intraconal space. Conjunctival biopsy showed acute inflammation with necrosis, vascular ectasia with thrombosis and hemorrhage. After the treatment with hydroxyurea and anagrelide, her symptom and lesion were markedly improved. Hematologic disorders like essential thrombocythemia should be considered in patients with severe spontaneous bleeding around the eye.

Measurement of Lacrimal Sac Fossa Using Orbital Computed Tomography.

PURPOSE: To evaluate the clinical usefulness of measuring the lacrimal sac fossa length using orbital computed tomography in normal Koreans. METHODS: The authors retrospectively evaluated 140 patients (70 males and 70 females) who underwent orbital computed tomography at Guro Hospital and who had no history of orbital disease or orbital trauma. Computed tomography scans of the right orbit, including the proportion of the lacrimal bone and maxillary bone that comprise the lacrimal sac fossa, were evaluated at 3 different axial planes (lower, middle, and upper levels). Additionally, the mid-point thickness and maximum thickness of the maxillary bone were measured. Finally, the authors also evaluated the relationship between nasal bone height and maxillary bone thickness in the lacrimal sac fossa. RESULTS: Maxillary bone thickness in the lacrimal sac fossa was thicker in males than in females at mid-point thickness and maximum thickness (P < 0.05). However, there was no significant difference in the size of the lacrimal sac fossa and the proportion of the maxillary bone between males and females.In comparisons between maxillary cross-sections, bone thickness was greater toward the upper level of the lacrimal sac fossa (P = 0.008), and the proportion of the maxillary bone was also greater (P = 0.006).Aging had a significant positive correlation with maxillary bone thickness at all 3 axial planes (P < 0.05), but there was no relationship between age and maxillary bone proportion. Nasal bone height and maxillary bone thickness were also not significantly related. CONCLUSION: In comprising the lacrimal sac fossa, the maxillary bone accounted for a bigger proportion than the lacrimal bone. Male maxillary bone thickness was greater than female thickness. The authors also observed that maxillary bone thickness increased toward the upper areas of the lacrimal sac fossa and with increasing subject age. Understanding the form and variation of a normal lacrimal sac fossa is helpful for preparing for a successful osteotomy with endoscopic dacryocystorhinostomy.

Risk factors for posterior synechiae of the iris after 23-gauge phacovitrectomy.

AIM: To identify risk factors for the development of posterior synechiae of the iris (PSI) after 23-gauge phacovitrectomy. METHODS: A retrospective chart review was performed in consecutive Asian patients treated with 23-gauge phacovitrectomy with a 3-piece intraocular lens (IOL) or a single-piece 4 haptics IOL. RESULTS: A total of 263 eyes from 242 patients were included in the study. Postoperative PSI was identified in 16 (6.1%) eyes. In multivariate analysis, C3F8 gas tamponade, oil tamponade, and long operation time were significantly associated with PSI formation. There was no difference in the incidence of PSI between the groups using two different types of IOL (P=0.779). CONLUSION: C3F8 gas or oil tamponade and long operation time increased the incidence of PSI after 23-gauge phacovitrectomy. The single-piece 4 haptics IOL, in lieu of a 3-piece IOL, may be inserted into the capsular bag with a comparable incidence of PSI.

Inferior oblique transposition onto the equator: the role of the equator in development of contralateral inferior oblique overaction.

PURPOSE: To investigate the role of the location of the equator and orientation of newly attached inferior oblique (IO) muscle in the development of contralateral inferior oblique overaction (IOOA). METHODS: Fourteen patients (14 eyes) with 5 to 12 prism diopters (PD) of hyperdeviation in primary position with unilateral, congenital, superior oblique palsy were included. Seven patients underwent modified IO transposition onto the equator (equator group) and seven patients underwent modified IO 14-mm recession (14-mm group). IOOA in the contralateral eye and the angle of strabismus were assessed at 3 months postoperatively. RESULTS: Mean angles of hyperdeviation in primary gaze and sursoadduction were 0.7 and 2.1 PD in the equator group and 0.6 and 2.4 PD in the 14-mm group, respectively. Six patients (86%) developed anti-elevation syndrome and four patients (57%) showed definite 2+ or higher IOOA in the contralateral eye in the equator group. Three patients (43%) in the 14-mm group also developed contralateral IOOA, although it was 1+ or less. The postoperative difference in contra-lateral IOOA between groups was statistically significant (P = .04). CONCLUSION: This finding suggests that vertical orientation of the IO muscle is another important contributor in the development of contralateral IOOA in addition to the location of the newly attached IO muscle.