Ophthalmologic Assesment of Patients with Syphilitic Optic Neuropathy.

PURPOSE: To assess the different clinical findings and symptoms of patients with optic neuritis (ON) and uveitis, who were diagnosed with syphilis. METHODS: The medical records of patients, who had ocular involvement of syphilis, were retrospectively reviewed. Thirteen patients with syphilitic optic neuropathy (SON) were enrolled and underwent complete ophthalmological examinations and auxiliary laboratory testing. RESULTS: Nine patients (69.2%) had comorbidities in addition to syphilis. One patient (with two eyes) presented with retrobulbar neuritis, and 12 patients (with 17 eyes) presented with anterior optic neuritis. Three patients (23.1%) had no uveitis, and 10 patients (76.9%) had uveitis in cases with SON. Four eyes (16.6%) had subretinal fluid, and three eyes (12.5%) had cystoid macular edema. CONCLUSIONS: Visual function can be preserved with early diagnosis and proper treatment. Accordingly, newly diagnosed patients with ON and uveitis should undergo syphilitic investigation in routine practice.

The prevalance of congenital optic disc anomalies in Turkey: a hospital-based study.

PURPOSE: The aim of this study was to investigate the prevalence of congenital optic disc anomalies in Turkey. METHODS: The 11,123 eyes of 5570 patients were screened for optic disc anomalies. All patients were underwent a complete ophthalmic examination including best corrected visual acuity, refraction, spherical equivalent, slit lamp biomicroscopy, intraocular pressure measurements, dilated stereoscopic fundus examination. Data analyses were performed by using SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL, United States). RESULTS: 11,123 eyes of 5570 participants were screened. Of the 5570 participants who underwent optic disc examination, 246 eyes of 174 patients (3.12%, 95% CIs 2.66-3.58%) had optic disc anormalies. 92 (52.9%) were female, 82 (47.1%) were male and the mean of age was 44.25 ± 15.67 years. 72 (41.4%) patients were bilateral, 102 (58.6%) patients were unilateral involvement. The tilted disc was the most common anomaly and was found at least one eye in 46 patients (75 eyes) and 0.83% of all screened patients. Peripapillary myelinated nerve fibers was the second common anomaly and was found at least one eye in 31 subjects (35 eyes) and 0.56% of all screened subjects. Peripapillary atrophy was the third common anomaly, and was found in at least one eye in 24 patients (37 eyes) and 0.43% of all screened subjects. CONCLUSION: To our knowledge, this is the first study that the prevalences of all congenital optic disc anomalies from Turkey. The prevalence of congenital optic disc anomalies is higher than in other countries.

Assessment of inner retina layers thickness values in eyes with pituitary tumours before visual field defects occur.

BACKGROUND: The purpose of this study was to evaluate macula, retinal nerve layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL) and macular nerve fibre layer (mNFL) thickness in patients with pituitary tumours who has normal visual field (VF). METHODS: Thirty-five eyes of 35 patients with pituitary tumours with normal VF and 41 eyes of 41-healthy subjects were underwent a complete ophthalmic examination. The spectral domain- optical coherence tomography (OCT) was used to measure macular and optic disc parameters. Layer-by-layer segmentation was done automatically by using the new software. Data analyses were performed by using SPSS for Windows, version 22.0. RESULTS: Average of total macula thickness inner temporal (p: 0.006), outer temporal (p < 0.001), inner nasal (p: 0.03), outer nasal (<0.001) were significantly lower in pituitary tumour group than normal group. Average of RNFL (p:0.009), temporal (p: 0.001), superiotemporal (p:0.004) and inferiotemporal (p: 0.01) were significantly lower in pituitary tumour group than normal group. Average of central GCL (p: 0.01) and central NFL (p: 0.03) were significantly lower in pituitary tumour group than normal group. There was no statistically significant difference between the two groups in IPL averages. CONCLUSIONS: Pituitary tumour patients with normal VF had reduced nasal and temporal section of the total macula, temporal RNFL, central mGCL and mNFL thicknesses, reflecting the corresponding to the anatomical substrate of the underlying pathology of chiasmal compression. This indicates that the presence of retinal thinning may be a sign of early detection of anterior visual pathway injury before VF loss becomes apparent.

Anterior segment parameters in Behçet's patients with ocular involvement.

PURPOSE: To evaluate anterior segment findings in Behçet's disease patients within the ocular involvement inactive period. METHODS: One hundred twenty patients with Behçet uveitis in the inactive period (Behçet's disease group) and 121-age and sex matched healthy subjects (control group) were examined. Anterior segment parameters were assessed by Scheimpflug camera. RESULTS: In Behçet's disease group, the mean age was 39.89 ± 10.16 years, and 55.8% of patients were male; in the control group, the mean age was 38.69 ± 14.08 years, and 56.2% of control subjects were male. Pachymetric measurements of corneal apex (523.84 ± 30.36 µ vs 540.73 ± 27.85 µ, p < 0.001) thinnest point (518.70 ± 30.75 µ vs 537 ± 28.66 µ, p < 0.001), mean corneal volume (57.90 ± 3.39 mm3 vs 59.57 ± 3.37 mm3, p < 0.001) were significantly lower and anterior elevation [5.0 (1.0-34.0) vs 2.0 (1.0-7.0) diopter(D), p < 0.001], posterior elevation [11.0 (1.0-66.0) vs 4.0 (0-22.0) D, p < 0.001)] and corneal astigmatism [1.1 (0-7.1) vs 0.7 (0.1-5.7) D, p = 0.005] were significantly higher in the Behçet's disease group than in control group. No significant difference was found in other anterior segment parameters between the Behçet's disease group and control group. Concurrent keratoconus was detected in two cases (1.7%). A statistically significant correlation was found between the corneal measurements and frequency of uveitis attacks. CONCLUSION: The chronic inflammatory process associated with various proinflammatory cytokines, which play a role in the pathogenesis of keratoconus, may also contribute to a decrease in corneal thickness and corneal volume in Behçet's patients with ocular involvement.

Clinical Features and Prognosis of Uveitis in a Turkish Patient Population with Ankylosing Spondylitis: Incidence and Management of Ocular Complications.

Purpose: To investigate clinical features, visual prognosis, and ocular complications in patients with ankylosing spondylitis (AS)-associated anterior uveitis (AU). Methods: Data of 211 eyes of 145 patients with AU associated with AS were reviewed retrospectively. Results: Mean follow-up time was 6.31 ± 6.33 years. Men were younger than women at AS diagnosis (p = 0.035). The mean number of uveitis flares was highest during the first quarter of the year and lowest during the third quarter (p = 0.017). Immunosuppressive agent use was higher in women than men (p = 0.052). Ocular complications developed in 120 eyes (56.9%), and the complication rate was 0.146/eye year. Males developed cystoid macular edema more frequently than females (p = 0.05). Glaucoma was observed more often in early-onset disease (age at AS onset <45 years) than late-onset disease (p = 0.028). Conclusions: Visual prognosis of AU in patients with AS was good, although more than half of the eyes developed ocular complications (56.9%).

Long-term results of cataract surgery in patients with anterior uveitis.

PURPOSE: This study was aimed to assess the long-term results of phacoemulsification and posterior chamber intraocular lens implantation in patients with anterior uveitis. METHODS: Patients with complicated cataract secondary to anterior uveitis who underwent phacoemulsification and posterior chamber intraocular lens implantation were included in this study. Long-term results and all complications were evaluated throughout the postoperative 4 years. RESULTS: A total of 55 eyes of 48 patients were identified in this study. Cases with anterior uveitis were categorised into four aetiologic groups. Of the 55 eyes, 22 (19 patients) had idiopathic anterior uveitis, 10 (9 patients) had viral anterior uveitis, 10 (9 patients) had Fuchs' anterior uveitis and 13 (11 patients) had anterior uveitis associated with collagen vascular diseases. Preoperative macular oedema was more frequent (63.6%) in the idiopathic group than in the other groups (p < 0.001). The success rates of the best corrected visual acuity of 20/40 or better ranged from 80.0 to 100.0% in the groups. While postoperative increased intraocular pressure rate was statistically significantly higher in the Fuchs' group (p = 0.047), there was no statistically significant difference in other complication rates between the groups. CONCLUSIONS: The long-term outcomes of phacoemulsification with intraocular lens implantation in patients with uveitic cataract were satisfactory with excellent visual acuity and relatively low complication rates.

Outcomes of Ahmed glaucoma valve implantation for steroid-induced elevated intraocular pressure in patients with retinitis pigmentosa.

PURPOSE: To evaluate the outcomes of Ahmed glaucoma valve (AGV) in the management of elevated intraocular pressure (IOP) secondary to steroid use for macular edema in patients with retinitis pigmentosa (RP). METHODS: A total of nine eyes of five patients were evaluated retrospectively. Complete success was defined as IOP ≤ 21 mmHg without glaucoma medications, while qualified success was defined as IOP ≤ 21 mmHg with glaucoma medications. RESULTS: Mean age at surgery was 25.0 ± 8.3 years, and mean follow-up time was 38.4 ± 13.2 months. Mean IOP was 41.0 ± 8.3 mmHg preoperatively, 9.4 ± 3.5 mmHg at first week (p = 0.008), 13.1 ± 3.6 mmHg at first month (p = 0.008), 14.8 ± 4.1 mmHg at 6th month (p = 0.008), 11.7 ± 2.6 mmHg at 12th month (p = 0.008), 12.4 ± 2.9 mmHg at 24th month (p = 0.008), 12.6 ± 3.6 mmHg at 36th month (p = 0.043) and 12.8 ± 4.2 mmHg at 48th month (p = 0.068) postoperatively. The mean number of topical anti-glaucomatous medications decreased from 2.8 ± 0.4 preoperatively to 0.4 ± 0.9 postoperatively (p = 0.007). Complete success was obtained in 7 (77%) eyes, and qualified success in 2 (23%) eyes. No failure was detected. CONCLUSIONS: AGV implantation can be considered as an alternative and safe option in the management of resistant, elevated IOP secondary to steroid treatment for macular edema in patients with RP.

Retinal toxicity related to hydroxychloroquine in patients with systemic lupus erythematosus and rheumatoid arthritis.

PURPOSE: To compare the retinal toxicity due to hydroxychloroquine (HCQ) use in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) using multifocal electroretinography (mfERG), fundus autofluorescence (FAF) and optical coherence tomography (OCT). METHODS: Patients who were using HCQ due to SLE and RA, and healthy subjects evaluated in this study. Central foveal thickness (CFT), inner-outer segment (IS-OS) junction irregularity, retinal nerve fiber layer thickness, mfERG and FAF measurements were performed to evaluate retinal toxicity. RESULTS: Study included 35 eyes of 35 SLE patients, 40 eyes of 40 RA patients and 20 eyes of 20 healthy subjects. In SLE group, retinal abnormality was found in three eyes with mfERG, in one eye with FAF and in four eyes with OCT. In RA group, retinal abnormality was found in 10 eyes with mfERG, in five eyes with FAF and in nine eyes with OCT. A statistically significant difference was found with respect to mfERG between "eyes with abnormal responses and without abnormal responses" and "eyes with abnormal responses and controls" (p < 0.05). A statistically significant difference was found with respect to CFT between "eyes with IS-OS junction irregularities and without IS-OS junction irregularities" and "eyes with/without IS-OS junction irregularities and controls" (p < 0.05). CONCLUSIONS: The use of HCQ seems to cause retinal toxicity more often in RA patients compared to SLE patients. For the early detection of retinal changes, OCT and mfERG can be used as screening tools due to their higher sensitivity rates compared to other tests.

Short- to long-term results of Ahmed glaucoma valve in the management of elevated intraocular pressure in patients with pediatric uveitis.

OBJECTIVE: The aim of this study was to evaluate the long-term outcome of Ahmed glaucoma valve (AGV) implant for elevated intraocular pressure (IOP) in pediatric patients with uveitis. DESIGN: This was a retrospective chart review. PARTICIPANTS: The study included 16 eyes (11 children) with uveitis. METHODS: Success was defined as having IOP between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucoma medications and without the need for further glaucoma or tube extraction surgery. RESULTS: Mean age of patients at the time of AGV implantation was 14.19 ± 3.25 years. AGV implantation was the first glaucoma surgical procedure in 12 eyes (75%). Average postoperative follow-up period was 64.46 ± 33.56 months. Mean preoperative IOP was 33.50 ± 7.30 mm Hg versus 12.69 ± 3.20 mm Hg at the last follow-up visit (p < 0.001). Three eyes (18.7%) were determined as cases of "failure" because of tube removal in 2 eyes and a second AGV implantation in 1 eye. The cumulative probability of complete success was 68.8% at 6 months, 56.3% at 12 months, 49.2% at 36 months, 42.2% at 48 months, and 35.2% at 84 months, and the cumulative probability of eyes without complication was 75.0% at 6 months, 66.7% at 24 months, 58.3% at 36 months, 48.6% at 48 months and 24.3% at 108 months based on Kaplan-Meier survival analysis. CONCLUSIONS: Although AGV implant is an effective choice in the management of elevated IOP in pediatric uveitis, antiglaucoma medications are frequently needed for control of IOP. Tube exposure is an important complication in the long term. Differential diagnosis between relapse of uveitis and endophthalmitis is important in patients who received AGV implantation.

Pattern Visual Evoked Potential Changes in Diabetic Patients without Retinopathy.

Purpose. To assess the different check sizes of pattern visual evoked potential (PVEP) in diabetic patients without retinopathy according to HbA1c levels and diabetes duration. Methods. Fifty-eight eligible patients with type 2 diabetes mellitus and 26 age- and sex-matched healthy controls were included in the study. Only the right eye of each patient was analyzed. All of the patients underwent a comprehensive ophthalmic examination, and the PVEPs were recorded. Results. There was a statistically significant difference in P100 latency in 1-degree check size and in N135 latency in 2-degree check size between controls and patient groups which have different HbA1c levels. There were statistically significant, positive, and weak correlations with diabetes duration and P100 latency in 7-minute and 15-minute check sizes and N135 latency in 15-minute check size. Conclusions. It was showed that there were prolongations in P100 latency only in 1-degree check size and in N135 only in 2-degree check size in diabetic patients without retinopathy. There was statistically significant correlation between diabetes duration and P100 and N135 latencies in different check sizes.

Short-term to Long-term Results of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

PURPOSE: To evaluate short-term to long-term outcomes of Ahmed glaucoma valve (AGV) implantation in the management of uveitic glaucoma (UG) secondary to Behçet disease (BD). PATIENTS AND METHODS: A retrospective chart review of 47 eyes of 35 patients with UG secondary to BD who underwent AGV implantation was conducted. Success was defined as having an intraocular pressure (IOP) between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucomatous medications and without need for further glaucoma surgery. RESULTS: Mean postoperative follow-up was 57.72±26.13 months. Mean preoperative IOP was 35.40±8.33 mm Hg versus 12.28±2.90 mm Hg at the last follow-up visit (P<0.001). Mean number of preoperative topical antiglaucomatous medications was 2.96±0.29 versus 0.68±1.12 at the last follow-up visit (P<0.001). In all eyes, IOP could be maintained between 6 and 21 mm Hg with or without antiglaucomatous medications during follow-up. The cumulative probability of complete success was 46.8% at 6 months, 40.4% at 12 months, and 35.9% at 36 months, and the cumulative probability of eyes without complication was 53.2% at 6 months, 46.5% at 12 months, and 39.6% at 24 months postoperatively based on Kaplan-Meier survival analysis. No persistent or irreparable complications were observed. CONCLUSIONS: This study includes one of the largest series of AGV implantation in the management of UG with the longest follow-up reported. AGV implantation can be considered as a primary surgical option in the management of UG secondary to BD with 100% total success rate (with or without medications).

Genetic Polymorphism of Manganese Superoxide Dismutase in Behçet's Disease.

OBJECTIVES: This study aims to investigate the genetic association between single nucleotide mutation in mitochondrial manganese superoxide dismutase and a Behçet's disease (BD) population by using molecular techniques. PATIENTS AND METHODS: Ninety-three BD patients (45 males, 48 females; mean age 33.15±8.99 years; range 17 to 65 years) and 125 controls (58 males, 67 females; mean age 28.33±7.31 years; range 18 to 62 years) were genotyped by polymerase chain reaction-restriction fragment length polymorphism method. The genotypic distributions in BD patients and controls were consistent with the Hardy-Weinberg equilibrium. RESULTS: Significant differences were observed between BD patients and controls in terms of genotypic distribution. Frequencies of alanine (Ala)/Ala, Ala/valine (Val), and Val/Val were 14.0% (n=13), 45.2% (n=42), and 40.9% (n=38) in BD patients and 21.6% (n=27), 53.6% (n=67), and 24.8% (n=31) in controls, respectively (p=0.033). CONCLUSION: The Val/Val genotype of the manganese superoxide dismutase gene is associated with the physiopathology of BD in a group of Turkish patients.

Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

PURPOSE: To evaluate outcomes of patients with uveitic glaucoma secondary to Behçet disease (BD) who underwent Ahmed glaucoma valve (AGV) implantation. PATIENTS AND METHODS: A retrospective chart review of 14 eyes of 10 patients with uveitic glaucoma associated with BD who underwent AGV implantation at a tertiary referral center. Treatment success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg with or without antiglaucoma medication, without further additional glaucoma surgery or loss of light perception. The main outcome measures were IOP, best-corrected visual acuity measured with Snellen charts, and number of glaucoma medications. RESULTS: Mean duration of postoperative follow-up was 18.2±6.6 months (range, 6 to 31 mo). Of the 14 eyes, 10 (71.4%) were pseudophakic and 5 (35.7%) had primary AGV implantation without a history of previous glaucoma surgery. At the most recent follow-up visit, 13 of the 14 eyes had an IOP between 6 and 21 mm Hg. Mean IOP was significantly reduced during follow-up, as compared with preoperative values (P≤0.005). The cumulative probability of surgical success rate was 90.9% at 18 months based on Kaplan-Meier survival analysis. The mean number of antiglaucoma medications required to achieve the desired IOP decreased from 3.4±0.5 preoperatively to 1.0±1.1 postoperatively (P≤0.05). Visual acuity loss of >2 lines occurred in 4 eyes (28.5%) due to optic atrophy associated with retinal vasculitis. Temporary hypotony developed during follow-up in 4 eyes (28.5%) at first postoperative week. CONCLUSIONS: For the management of uveitic glaucoma associated with BD, AGV implantation is a successful method for glaucoma control but requires additional surgical interventions for high early hypotony rates.

Pattern of ocular findings in patients with biopsy-proven sarcoidosis in Turkey.

PURPOSE: To evaluate demographic, clinical, and ocular features of patients with sarcoidosis. METHODS: The study involved 47 biopsy-proven sarcoidosis patients. Patients were divided into 2 groups; group 1 had uveitis and group 2 had no uveitis. Demographic and clinical features of groups were compared. Ocular manifestations in group 1 were also evaluated. RESULTS: Twenty-six patients (53.3%) had uveitis. The incidence of uveitis was more frequent between ages 21 and 40. The most frequent type of uveitis was intermediate uveitis (46.1%), followed by panuveitis (38.4%) and anterior uveitis (15.3%). The incidence of advanced pulmonary disease was significantly higher in patients with uveitis. CONCLUSIONS: Intermediate uveitis was the most frequent type of uveitis noted in our series of patients with sarcoidosis.

Phacoemulsification with intraocular lens implantation in patients with anterior uveitis.

PURPOSE: To assess the results of phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in patients with cataract secondary to anterior uveitis. SETTING: Department of Ophthalmology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey. DESIGN: Case series. METHOD: Consecutive patients with anterior uveitis and cataract were prospectively studied for outcomes after phacoemulsification and PC IOL implantation. RESULTS: Fifty-five eyes (48 patients; mean age 44.9 years ± 15.6 [SD]) were included. Patients were followed for 6 months. The etiology of uveitis was presumed idiopathic anterior uveitis (n = 22), herpes simplex virus-associated anterior uveitis (n = 10), Fuchs heterochromic iridocyclitis (n = 10), and anterior uveitis associated with collagen vascular disease (n = 13). Preoperative complications secondary to uveitis included posterior synechiae (12 eyes), glaucoma (26 eyes), and sequelae of cystoid macular edema (CME) (21 eyes). At the final visit, the corrected distance visual acuity (CDVA) was 20/40 or better in 52 eyes (94.5%) and 20/20 in 33 eyes (60.0%). The CDVA was worse than 20/40 in 3 eyes because of preoperative anterior and posterior segment abnormalities. Postoperative complications were CME, recurrent uveitis, and posterior capsule opacity in 7 eyes (12.7%) each; fibrinous anterior chamber reaction in 6 eyes (10.9%); raised intraocular pressure in 4 eyes; peripheral anterior synechiae in 1 eye (1.8%); and hypotony in 1 eye (1.8%). CONCLUSION: Patients with a history of anterior uveitis and cataract having phacoemulsification with PC IOL implantation had excellent visual results with a relatively low complication rate. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Systemic and pulmonary screening of patients with Behçet's disease during periodic follow-up.

Behçet's disease (BD) is a multisystemic disease that may involve all systems, the most common symptoms being oral and genital ulcerations and ocular involvement. Pulmonary involvement is not usually investigated in BD unless there is a specific complaint. In this study, pulmonary parameters and findings were investigated in BD patients at periodic follow-ups. A total of 112 subjects with a definitive diagnosis of BD from the Ocular Diseases Polyclinic, Behçet Disease Center, Ankara Training and Research Hospital and who had been referred to the Thoracic Diseases Polyclinic between January-October 2010 were evaluated. In the patients, the absence of active smoking, pregnancy, lactation and systemic steroid use were especially considered. A total of 112 patients between 14 and 61 years-old (53 male, 59 female) were enrolled in the study. The duration of follow-up varied between 1 and 22 years. The most commonly encountered symptom was hemoptysis observed in 18 subjects. 43 patients had mild obstruction, 9 patients had moderate obstruction, 4 patients had advanced obstruction and 4 patients showed restrictive alterations. Thoracic CT was normal for 83 subjects. Pulmonary involvement was observed as a pulmonary artery aneurysm in 4 patients and was treated. In BD, although anyone of PFT and CT values is normal, others may show pathological values. We believe that it would be useful in the follow-up to keep a regular record of the patient data and to perform PFT and, if possible, CT periodically.

Demographic, clinical, and ocular features in patients with late-onset Behçet disease.

PURPOSE: To evaluate demographic, clinical, and ocular features of patients with late-onset Behçet disease (BD). METHODS: The study included 26 patients with late-onset BD. Onset of their first symptoms was before age 40. They fulfilled the diagnostic criteria after age 40. Patients were divided into 2 groups: group 1 had uveitis and group 2 had no uveitis. Clinical and demographic features of the groups were compared. Ocular manifestations in group 1 were also evaluated. RESULTS: Fourteen patients (53.8%) had uveitis and 12 patients (46.2%) had no ocular involvement. The incidence of genital ulcer was higher in group 1. Twelve patients (18 eyes) had anterior uveitis and 2 patients (4 eyes) had panuveitis. The incidence of anterior uveitis was higher in females. The incidence of panuveitis was higher in males. CONCLUSIONS: As compared to potentially devastating posterior uveitis, anterior uveitis is more often encountered in patients with late-onset BD. Hence, with respect to ocular involvement, the prognosis is better.

Actinomyces canaliculitis and its surgical treatment.

The objective of this article is to describe four rare cases of Actinomyces israelii canaliculitis and their surgical treatment in a case series consisting of four cases of Actinomyces israelii canaliculitis. Patient charts were reviewed retrospectively. All four patients presented with epiphora, recurrent conjunctivitis, swelling around the superior canaliculus, and mucopurulent punctal discharge persisting despite medical treatments. Two patients with large canalicular dilation were treated with canaliculoplasty and the other two patients with minimal canalicular dilation were treated with one-snip punctoplasty. The specimens that were evacuated were sent for microbiological and histopathological examinations. The results showed that Actinomyces israelii was isolated in all patients. After medical and surgical treatment, the patients experienced resolution of signs and symptoms. The disease did not recur during the 2-4-year follow-up period. In conclusion Canaliculoplasty with canalicular intubation and one-snip punctoplasty may be safe and efficacious techniques in largely dilated canaliculum and mildly dilated canaliculum, respectively, with no demonstrable risk of post-treatment epiphora in patients with Actinomyces canaliculitis.