Retrospective Analysis of Bicanalicular Lacrimal Silicone Tube Intubation in Patients with Congenital Nasolacrimal Duct Obstruction: A Long-term Follow-up Study.

Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in the first year of life. In addition to conservative therapy, there are several invasive methods available. The aim of this retrospective study was to conduct a long-term follow-up of bicanalicular lacrimal duct intubation as the primary intervention in a large cohort of patients with CNLDO. The electronic medical records of 487 patients with CNLDO who underwent bicanalicular tube intubation were reviewed. To determine the long-term outcomes, a telephone interview was conducted. A total of 328 eyes of 235 patients were included in the study. The median average follow-up period was 6.67 (5.58 - 8.67) years. At the time of the survey, 218 patients (92.8%) were symptom free. Mean patient satisfaction with surgical outcome was 10/10. To our knowledge, this study provides the longest follow-up of the largest patient cohort in the literature consisting of patients who underwent probing with bicanalicular lacrimal silicone tube intubation as a primary intervention for CNLDO. This study showed a high long-term postoperative success rate, with high postoperative satisfaction, few complications, and a low need for reintervention.

Comparison of the iStent Inject® versus the iStent Inject® W-Both in Combination with Cataract Surgery-In Open-Angle Glaucoma.

We compare the short- and mid-term postoperative outcomes of the iStent inject® with its successor, the iStent inject® W. A retrospective monocentric study was performed to compare the iStent inject® used for cataract surgery with the iStent inject® W, also used for cataract surgery. The primary study endpoint was intraocular pressure (IOP) reduction six months after surgery. Six-month follow-up results were available for 35 eyes from 27 patients in the iStent inject® group and for 32 eyes from 25 patients in the iStent inject® W group. IOP reduction at six months post surgery was significantly greater in the iStent inject® W group (-2.2 mmHg [iStent inject® W] vs. -0.06 mmHg [iStent inject®], p = 0.037). There was a statistically greater decrease in glaucoma medication administration at six months in the iStent inject® group than in the iStent inject® W group (-1.28 agents vs. -0.62 agents, p = 0.007). These findings support the hypothesis that the superior positioning of the iStent inject® W (due to its larger base diameter) compared to the iStent Inject® leads to greater IOP reduction. Because of the short follow-up period, small study cohort, and differences in the number of glaucoma patients, the study results must be interpreted carefully.

The Preserflo MicroShunt Affects Microvascular Flow Density in Optical Coherence Tomography Angiography.

Intraocular pressure (IOP) lowering surgery has been shown to alter microvascular density in glaucoma patients. The aim of this study is to report changes in retinal flow density (FD) over the course of treatment with the Preserflo MicroShunt, using optical coherence tomography angiography (OCTA). 34 eyes from 34 patients who underwent Preserflo MicroShunt implantation were prospectively enrolled in this study. OCTA imaging was conducted at the superficial (SCP), deep (DCP) and radial peripapillary plexus (RPC) levels. The progression of FD and IOP was assessed at different time points from baseline to six months postoperatively for the entire patient population, as well as disease severity subgroups. The Preserflo MicroShunt achieved a significant reduction in IOP over the course of six months (median: 8 mmHg; p < 0.01). FD values of the SCP and DCP did not show significant fluctuations, even after adjusting for disease severity. FD of the RPC decreased significantly over the course of six months postoperatively from 42.31 at baseline to 39.59 at six months postoperatively (p < 0.01). The decrease in peripapillary FD was strongest in patients with advanced glaucoma (median: -3.58). These observations hint towards dysfunctional autoregulatory mechanisms in capillaries surrounding the optic nerve head in advanced glaucoma. In comparison, the microvascular structure of the macula appeared more resilient to changes in IOP.

Position of the ISTENT Inject® Trabecular Micro-Bypass System Visualized with the NIDEK GS-1 Gonioscope-A Postoperative Analysis.

Glaucoma is one of the leading causes of irreversible blindness globally and is characterized by the gradual loss of retinal ganglion cells. The primary risk factor for the development and progression of glaucoma is increased intraocular pressure (IOP). Numerous surgical interventions exist to lower IOP should conservative therapy fail. One trend in recent years has been minimally invasive glaucoma surgery (MIGS) as an alternative to traditional methods. The ISTENT inject® is an ab interno trabecular micro-bypass implant designed to be implanted through the trabecular meshwork into the Schlemm's canal to lower IOP. The aim of the study was the postoperative visualization and description of the positioning of the ISTENT inject® using automated circumferential goniophotography. Patients with symptomatic cataracts and mild to moderate primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigment-dispersion glaucoma were included who underwent combined cataract surgery with the ISTENT inject® and received postoperative automated gonioscopy with the NIDEK Gonioscope GS-1 to visualize the location of the implant. Twenty-four implants of 14 eyes in 11 patients could be visualized. Out of the implants, 14.3% were in the trabecular meshwork, 46.4% were at the border between the trabecular meshwork and scleral spur, 25% were below the trabecular meshwork, and 14.3% of the implants were not detectable in the gonioscopy. In the overall cohort, a statistically significant IOP reduction was found over the 12-month postoperative observation period. Even in three eyes, in each of which both stents were located below the trabecular meshwork, an IOP reduction over 12 months was observed compared to the baseline IOP. In this study, vertical two-dimensional positioning of the ISTENT inject® was performed for the first time using NIDKE GS-1 automated 360° goniophotography. The method is suitable for postoperative visualization, control, and documentation of positioning after ISTENT inject® implantation. Further studies are needed to analyze the correlation between positioning of the ISTENT inject® in the chamber angle and postoperative IOP reduction.

Long-Term Outcomes of the PRESERFLO MicroShunt Implant in a Heterogeneous Glaucoma Cohort.

The Preserflo MicroShunt represents a novel glaucoma treatment device, necessitating long-term follow-up data to accurately assess its efficacy. The aim of this study is to report real-world data of a heterogenous glaucoma cohort who received Preserflo implantation at a specialized glaucoma clinic. A total of 160 eyes of 160 patients who underwent Preserflo MicroShunt implantation were retrospectively enrolled in this study. Patient characteristics, as well as success and failure rates, were assessed. The numbers of adverse events and revision procedures were recorded, along with any reduction in supplementary medication. The progression of intraocular pressure (IOP) was assessed over the course of 12 months, and fluctuations were analyzed. The overall success rate was 61.9% (complete success: 51.3%, qualified success: 10.6%). Revision surgery was performed in 25% of cases. Excessive hypotony occurred postoperatively in 54.4% of patients and regressed after 7 days in 88.8% of all cases. Median IOP decreased from 22 (interquartile range (IQR): 17-27) mmHg preoperatively to 14 (IQR 12-16) mmHg at 12 months postoperatively (p < 0.01). The median number of antiglaucomatous agents decreased from three to zero at latest follow-up. The Preserflo MicroShunt achieved a noticeable reduction in IOP over the course of 12 months in glaucoma patients, irrespective of disease severity or disease subtype. The frequency of postoperative adverse events and number for revision surgeries over the course of the follow-up period were low.

Nasolacrimal intubation in transcanalicular endoscopic dacryoplasty: a long-term follow-up study.

Nowadays, transcanalicular endoscopic dacryoplasty represents the majority of lacrimal duct surgery procedures performed in adults in specialised centers. However, there are still hardly any data available regarding the intra- and postoperative care, particularly regarding the duration of silicone tube intubation (STI). Our aim was to evaluate the relation between tube duration and recurrence of symptoms in patients who underwent transcanalicular microdrill dacryoplasty (MDP) in a long-term setting. Medical records of 576 adult patients after MDP were retrospectively reviewed. A total of 256 eyes of 191 patients could be included. The median follow-up time was 7.83 [7.08; 9.25] years. In 57.0% of the cases there was still full resolution of symptoms at the time of the survey. The median duration of the STI was 6 [3.00; 6:00] months. When distinguishing between a tube duration < 3 months and ≥ 3 months there was a significant difference in the long-term success rate (< 3 months: 38%; ≥ 3 months: 61%; p = 0.011). In conclusion, an early removal of the STI (< 3 months) after transcanalicular MDP seems to be associated with a higher incidence of recurrence of symptoms. This should be considered in the intra- and postoperative care of patients following this minimally invasive first-step procedure.

Long-Term Outcomes of Canaliculotomy with Silicone Tube Intubation in the Management of Canaliculitis.

As a rare and often misdiagnosed disease of the lacrimal apparatus, only limited data exist on long-term outcomes of surgical methods for the treatment of primary canaliculitis. The aim of this study was to evaluate canaliculotomy with silicone tube intubation (STI) as a surgical procedure for canaliculitis in a long-term follow-up setting. A total of 25 eyes of 25 patients with canaliculitis treated with canaliculotomy and STI at the University of Muenster Medical Center, Germany, from 2015 to 2021 were included in this study. Data analysis involved clinical symptoms, complications, duration of STI and rate of recurrence. Mean patient age was 63.7 ± 17.2 years. After a follow-up time of 3.7 ± 1.5 years, 88% of cases showed no recurrence of inflammation. The mean duration of STI was 5.8 ± 3.4 months. Complications such as post-operative hemorrhage, spread of infection, obstruction of the canaliculus or migration of the STI were not observed in any of the patients. However, tube dislocation occurred in four cases, a pyogenic granuloma in two cases and a fistula formation in one case. The management of canaliculitis by canaliculotomy with STI showed very good postoperative outcomes and low complication rates in the long-term and can therefore be considered a safe and successful surgical approach.

Application Possibilities of a New Preloaded Nasolacrimal Duct Intubation System. / Anwendungsmöglichkeiten eines neuartigen vorgeladenen Intubationssystems für Tränenwege.

INTRODUCTION: The LacriJet (FCI S. A. S. - France Chirurgie Instrumentation, Paris, France) represents a novel, simplified and preloaded system for monocanalicular or monocanaliculonasal nasolacrimal duct intubation. It is a further development of the Masterka and shall reduce the intubation time during the surgical procedure. The aim of the present study was to present first experiences with this system for different indications. MATERIAL AND METHODS: All patients who underwent nasolacrimal duct intubation with the LacriJet at the University of Muenster Medical Center in the period from March to November 2019 were included. The postoperative outcome was evaluated 3 to 6 months later. RESULTS: In total, 12 nasolacrimal duct intubations with the LacriJet were performed at our center in the above-mentioned period. The main indication for intubation was congenital nasolacrimal duct obstruction (CNLDO). In addition, intubation was performed in cases with eye lid tumors involving the nasolacrimal duct, in a case of canalicular laceration and in a case of canaliculitis. In 3 cases, there was an early dislocation or a complete loss of intubation. Of these, 2 were cases with CNLDO and the third dislocation was due to manipulation by the patient. All in all, the functional results were satisfying. SUMMARY: The use of the LacriJet is highly suitable for the treatment of CNLDO, stenting in canalicular laceration or lid tumours involving the lacrimal drainage system. However, the known disadvantages of monocanalicular intubation (dislocation, early loss of intubation) also occur with this type of system and a system briefing seems useful. The LacriJet therefore represents a modern and simple method for nasolacrimal duct intubation and can be used for various indications.

Long-term outcome of transcanalicular microdrill dacryoplasty: a minimally invasive alternative for dacryocystorhinostomy.

BACKGROUND/AIM: Dacryocystorhinostomy (DCR) remains the gold standard therapy for nasolacrimal duct obstruction (NLDO), but is invasive and does not maintain the physiology of the lacrimal pathway. With transcanlicular microdrill dacryoplasty (MDP), there is a minimally invasive alternative surgical approach. This study aimed to present this modern lacrimal duct surgery technique and to evaluate its long-term success rate in a large study population. METHODS: The medical records of 1010 patients with acquired NLDO were retrospectively reviewed. Adult patients who had undergone transcanalicular MDP were included. The evaluation included the following parameters: age, gender, success rate, complication rate, obstruction grade and patient satisfaction. Long-term results regarding patient satisfaction and success rate were evaluated by a telephone survey. Only a complete resolution of symptoms was defined as success. RESULTS: 793 eyes of 576 patients after transcanalicular MDP could be included in the study. The mean follow-up time was 8.7±0.9 years. Initial surgical success rate was 84.0%. At the time of the follow-up, 57.5% (n=229) still had full resolution of symptoms. The mean patient satisfaction with the procedure was 6.9±3.2 out of 10 points. Heavy bleeding occurred in two cases only (0.25%). CONCLUSION: This is the first study to show the success rate of microendoscopic lacrimal duct surgery after such a long follow-up period and in such a large study population. Transcanalicular MDP is a minimally invasive technique with a very low complication rate and can be used as an alternative procedure before performing more invasive lacrimal duct surgery such as DCR.

[Vogt-Koyanagi-Harada-like uveitis under immune checkpoint inhibitor treatment for metastasized malignant melanoma]. / Vogt-Koyanagi-Harada-artige Uveitis unter Immun-Checkpoint-Inhibitor-Therapie beim metastasierten malignen Melanom.

This article presents the case of a 68-year-old female patient who reported bilateral progressive visual loss over 4 weeks. The patient had a known metastatic malignant cutaneous melanoma, which was treated with the immune checkpoint inhibitors nivolumab and ipilimumab. The ophthalmological examination revealed a bilateral anterior chamber flare with endothelial precipitates as well as choroidal folds, an orange-red discoloration of the retina and a serous retinal/choroidal detachment in the left eye. In the course of time the patient developed poliosis and vitiligo. Systemic and local steroid treatment resulted in a distinct improvement of the findings. An intravitreal triamcinolone injection led to complete regression of the progressive macular edema. In rare cases immune checkpoint inhibitors can cause Vogt-Koyanagi-Harada-like uveitis. As ocular inflammation can be well controlled by local and systemic steroids, checkpoint inhibitor treatment should be continued in cases with good treatment response whenever possible. Interdisciplinary cooperation with close controls is absolutely necessary in these cases.

[Masquerade lacrimal duct stenosis: prevalence of lacrimal sac tumors]. / Maskerade Tränenwegsstenose: Prävalenz von Tränensacktumoren.

BACKGROUND: Tumors of the lacrimal sac are a rare entity. Malignancies are often associated with a high mortality rate. Lacrimal sac tumors often present as lacrimal duct stenosis with dacryocystitis and are often only diagnosed after an intraoperative biopsy. The aim of this study was a retrospective analysis of all cases with lacrimal sac tumors, which presented with a lacrimal duct stenosis at this medical center in the past 10 years. METHODS: All patients who were treated by external dacryocystorhinostomy (DCR) at the University Medical Center Münster during the period January 2009-December 2018 were retrospectively analyzed for the presence of a lacrimal sac tumor. Symptoms, clinical and histopathological findings, diagnostic and therapeutic procedures as well as long-term follow-up were analyzed. RESULTS: A total number of 878 patients underwent an external DCR at the University Medical Center Münster during the study period. Of these patients 13 were diagnosed with a lacrimal sac tumor and included 9 malignant lymphomas, 2 squamous cell carcinomas, 1 oncocytic adenoma and 1 transitional cell papilloma. CONCLUSION: Neoplasms of the lacrimal sac can masquerade as lacrimal duct stenosis or dacryocystitis and must be considered as a differential diagnosis in cases with an atypical clinical course. A lacrimal sac biopsy during an (external) DCR with subsequent histopathological examination is strongly recommended in such cases.

[Treatment Options for Adenoid Cystic Lacrimal Gland Carcinoma - A Case Series and Literature Review]. / Therapieoptionen bei adenoidzystischem Tränendrüsenkarzinom ­ Fallserie und aktueller Literaturüberblick.

Adenoid cystic carcinoma of the lacrimal gland (ACC) is a rare malignant orbital tumour with a poor overall prognosis. Current therapeutic approaches like radical and local surgery, adjuvant radiation and neoadjuvant intra-arterial chemotherapy are controversial. We present three cases of patients with ACC with different therapy concepts and discuss these with current recommendations from the literature.

Changes in Flow Density Measured Using Optical Coherence Tomography Angiography after iStent Insertion in Combination with Phacoemulsification in Patients with Open-Angle Glaucoma.

PURPOSE: To evaluate changes in flow density after the implantation of a trabecular microbypass stent (iStent) in combination with cataract surgery. METHODS: A total of 48 eyes of 48 patients, who underwent either cataract surgery alone (cataract group) or cataract surgery with implantation of two iStent inject devices (iStent group), were prospectively included in this study. Intraocular pressure (IOP) and flow density data before and after surgery were extracted and analyzed. RESULTS: In the iStent group, the mean IOP was 18.2 ± 3.3 mmHg prior to surgery and 13.2 ± 2.3 at follow-up, and this difference was statistically significant (p < 0.001). The mean IOP in the cataract group also improved significantly after surgery (before: 17.1 ± 2.4; after: 15.1 ± 2.7 p = 0.003). The flow density (whole en face) in the superficial and deep retinal OCT angiogram of the macula (superficial: p = 0.002; deep: p = 0.034) and in the ONH (p = 0.011) improved significantly after surgery in the iStent group. The differences in the cataract group were not significant. CONCLUSIONS: Flow density of the macula and ONH, as measured by OCTA, improved significantly after cataract surgery with iStent. Noninvasive quantitative analyses of flow density provide a new parameter, which can help for the monitoring of therapy success after glaucoma surgery.