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.

Determination of vitreous interleukin-1 (IL-1) and tumour necrosis factor (TNF) levels in proliferative diabetic retinopathy.

We measured interleukin-1 beta (IL-1beta) and tumour necrosis factor-alpha (TNF-alpha) in the vitreous humour and serum of patients with proliferative diabetic retinopathy (PDR), in order to determine the role of these cytokines in the pathogenesis of the disease. Vitreous and serum samples were collected from 21 patients with PDR who were undergoing pars plana vitrectomy. Control vitreous samples were obtained from cadavers and control serum samples from healthy subjects. The cytokines were measured by enzyme-linked immunosorbent assay. Vitreous IL-1beta and TNF-alpha concentrations in patients with PDR exceeded those of controls (P<0.05), as did serum IL-1beta and TNF-alpha. We suggest that increased vitreous IL-1beta and TNF-alpha levels may play a significant role in the pathogenesis of PDR, which features abnormal cell proliferation and neovascularisation.

Intraocular pressure, quality of block, and degree of pain associated with ropivacaine in peribulbar block: a comparative randomized study with bupivacaine-lidocaine mixture.

PURPOSE: To compare the effects of ropivacaine and bupivacaine-lidocaine combination on intraocular pressure, quality of block, and degree of postoperative pain in peribulbar block. METHODS: The study group involved 32 patients undergoing elective cataract surgery under peribulbar block. Patients were divided into two groups according to the local anesthetic used: Group 1 (n = 16), ropivacaine 0.75%; and Group 2 (n = 16), bupivacaine 0.5%-lidocaine 2% mixture. Intraocular pressure was measured at four time points: before block (control), 1 min after block, 5 min after block, and 15 min after block with Tonopen. Quality of block was evaluated using a three-point scoring system based on the reduction of globe motility. Patients were asked their degree of intraoperative pain by using a five-point verbal rating score after the surgery. RESULTS: Mean values of intraocular pressure after block were significantly lower in Group 1 in comparison to Group 2 (p < 0.05, Mann Whitney test). The quality of block was better in Group 2, and the degree of postoperative pain was lower in Group 1 (p < 0.05, Mann-Whitney test). CONCLUSIONS: Ropivacaine used in peribulbar block is better than bupivacaine-lidocaine mixture under the same standard conditions in terms of reducing intraocular pressure and postoperative pain in intraocular surgery.