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.

Uso de una guía de punta flexible (FlexTip) para manejar el fallo del primer intento de intubación con el videolaringoscopio C-MAC D-Blade en la unidad de cuidados intensivos: serie prospectiva de casos / Use of a flexible tip bougie (FlexTip) in the management of the first-attempt failure intubation with the C-MAC D-Blade videolaryngoscope in the intensive care unit: A prospective, case series

Describimos una serie de 11 casos en los que hemos utilizado la nueva guía de punta flexible (FlexTip) como rescate tras el fallo de un primer intento de intubación con el videolaringoscopio C-MAC D-Blade en nuestra UCI. Durante un periodo de 16 meses se recogieron datos de todas las intubaciones donde se utilizó el videolaringoscopio C-MAC D-Blade. Noventa y un pacientes fueron incluidos en el estudio, donde 79 (86,8%) fueron intubados al primer intento, 11 (12,1%) necesitaron 2 intentos, y un paciente necesitó 3 intentos. Entre los 12 pacientes que necesitaron más de un intento de intubación, en un paciente se utilizó una guía «Frova», y en el resto, la nueva guía de punta flexible (FlexTip). En la presente investigación observamos que la nueva guía de punta flexible (FlexTip) puede ser una buena opción para aquellos casos en los que con un videolaringoscopio no somos capaces de intubar en el primer intento.(AU)

We describe a series of 11 cases in which we used the new flexible tip (FlexTip) bougie as a rescue device following first-attempt failure at intubation with the C-MAC D-Blade video laryngoscope in our UCI. We collected data from all intubations performed using the C-MAC D-Blade video laryngoscope over a 16-month period. Ninety six patients were included in the study: 79 (86.8%) were intubated at the first attempt; 11 (12.1%) required 2 attempts; and one patient required 3 attempts. The Frova Intubating Introducer was used in one of the 12 patients requiring more than one intubation attempt, and the FlexTip was used in the remaining 11. This study shows that the new FlexTip bougie is a good rescue device when the first attempt at video laryngoscope intubation fails.(AU)

Retrospective radiological analysis to establish anatomical variation in angulation between medial canthus and the middle turbinate, for optimal positioning of Lester Jones Lacrimal bypass tubes in treatment of Epiphora.

PURPOSE: To determine the optimum angle for placement of Lester Jones lacrimal bypass tube using fixed radiological markers on CT scan head with axial and coronal cuts, as well as analysing the anatomical variation and range of angulation between individuals within our local population. METHODS: A retrospective radiological study conducted on a randomly selected sample of 384 adult patients in a UK Teaching Hospital. The angle between the medial canthus and the middle turbinate was measured on CT scans of the head using fixed radiological anatomical landmarks and analysed using the IMPAX software. Patients with orbital or nasal fractures, as well as those with history of surgical procedures involving the facial bones, were excluded. The accuracy of our measurements was validated using three dimensional (3D) CT head reconstruction technology. RESULTS: Analysis of the results showed a range of angulation between 28-45 degrees, with a mean angle of 36.99 ± 4.78 SD. There was no significant correlation found when comparing the different age groups using the One Way ANOVA test. Furthermore, a non-significant correlation was found between males and females when their mean angles were compared using the independent t-test. CONCLUSION: Our study showed that the ideal angle for insertion of Lester Jones tube would be between 30-45 degrees, with a mean of 37 degrees. No significant correlation was found between the age of the patient and the ideal angle of insertion of Lester Jones tube. Moreover, no significant difference was found in the angle measurements between males and females.

High incidence and recurrence of tympanostomy tube procedures in children who underwent nasolacrimal duct probe and intubation for congenital nasolacrimal duct obstruction.

PURPOSE: To determine the incidence of tympanostomy tube (T-tube) insertion in children who required probing and intubation for congenital nasolacrimal duct obstruction (CNLDO) at a single academic institution and to analyze success rates. METHODS: The medical records of 92 patients who underwent nasolacrimal probing and intubation for CNLDO over a 9-year period were reviewed retrospectively. A preoperative questionnaire was given to the patient's guardian concerning laterality of CNLDO, history of otitis media (OM) antibiotic therapy, history of T-tube placement and number placed. At least 12 months following the initial nasolacrimal duct P&I, a second questionnaire was administered regarding resolution of CNLDO symptoms, additional measures taken to relieve postoperative symptoms if present, and any further history regarding OM episodes or T-tube insertion. RESULTS: Of the 92 children with CNLDO, 37 (40%) required T-tubes either prior to or following nasolacrimal duct probing and intubation, a rate higher than in the general population (P < 0.00001). 21 (56%) of CNLDO probing and intubation patients who required T-tubes required at least two sets, at different times, to relieve OM symptoms. Six of 37 patients (16%) with a history of T-tube placement and 1 of 55 (2%) with no history of T-tube placement had persistent epiphora after nasolacrimal probing and intubation (relative risk, 8.92; P = 0.0388). CONCLUSIONS: In our study cohort, pediatric patients with CNLDO who required nasolacrimal probing and intubation were at higher risk of needing T-tubes for chronic OM than the general population, and those needing T-tubes were at increased risk of residual epiphora.

Periocular Infection With Nocardia nova Following Dacryocystorhinostomy With Silicone Stent Intubation.

Nocardia species are aerobic, rod-shaped, Gram-positive bacteria that are ubiquitous throughout the environment. Nocardia nova has been reported as the second most prevalent Nocardia species. However, reports of ocular and periocular infection caused by this organism are rare. The authors present a case of a 58-year-old woman with a medical history of acquired nasolacrimal duct obstruction of the left eye who underwent a revision dacryocystorhinostomy with silicone stent intubation and developed a surgical site infection that was culture-positive for N. nova . Treatment consisted of removal of the silicone stent and a prolonged course of oral antibiotics, resulting in the patient's full recovery. This is the second reported case of postoperative periocular N. nova infection after dacryocystorhinostomy and silicone stent intubation.

A Modified Bicanalicular Crawford Placement Method for Congenital Nasolacrimal Duct Obstruction: Reducing Need for Operative Room Removal.

PURPOSE: This study introduces a method for Crawford bicanalicular stent placement for congenital nasolacrimal duct obstruction by looping the ends to themselves which are tied together with dissolvable sutures to ease in-office removal. METHODS: This is a single institution, retrospective study that evaluates outcomes of patients aged 5 years and under who underwent bicanalicular stenting for congenital nasolacrimal duct obstruction by a single surgeon (G.S.E.) between 2004 and 2020. Only primary surgeries were included in the analysis. Stenting could be accompanied by balloon dilatation and/or turbinate infracture. Age, sex, follow-up time, complications, type of intervention, extrusion, recurrence, and operative room removal were recorded. RESULTS: This study included 56 eyes from 54 patients with a mean age of 19.0 ± 9.5 months (range, 8-50 months). There was a 30.3% extrusion rate, a 5.4% rate of recurrence of disease, and a 3.6% rate of operative room removal. The average follow-up time was 25.1 ± 39.8 months (range, 1-132 months). For patients with or without extrusion, there were no significant differences between age, sex, laterality, type of intervention, follow-up time, or rate of recurrence. Each eye that had recurrence (3 total) or needed operative room removal (2 total) underwent only bicanalicular stenting without accompanying procedures, although the difference in rates between procedures was also not statistically significant. CONCLUSIONS: This method had a low recurrence and operative room removal rate, with similar extrusion and complication rates to other bicanalicular stent and intubation methods for the treatment of congenital nasolacrimal duct obstruction.

Mini-invasive Therapy for Primary Chronic Canaliculitis without Damaging Lacrimal Punctum.

This study aimed to introduce a mini-invasive surgical approach without damaging lacrimal punctum for treating primary chronic canaliculitis (PCC). A retrospective analysis of 35 patients (35 eyes) suffering from PCC were recruited in the study. The surgery method is described briefly below: After making a conjunctival incision about 3-mm in length along the horizontal canaliculus at about 3-mm to the nasal of punctum, a curette of 2-mm diameter was used to evacuate the concretions through the incision of canaliculus. After evacuating all concretions, a silicon tube was inserted into the lacrimal duct through canaliculus to nasal cavity. With a follow-up of 12 months, all patients had resolution of symptoms of inflammation and no recurrent case was found. The anatomical success was achieved in 34 cases (97.1%). The functional success was achieved in 32 cases (91.4%). Key Words: Primary chronic canaliculitis, Mini-invasive, Silicone tube.

Success rate of external, endonasal, and transcanalicular laser DCR with or without silicone stent intubation for NLD obstruction: a network meta-analysis of randomized controlled trials.

PURPOSE: To define and compare the effectiveness of external dacryocystorhinostomy (EX-DCR), endonasal (EN-DCR), and transcanalicular laser-assisted (TL-DCR) with or without silicone stent (S) intubation. METHODS: Studies were retrieved from PubMed, Scopus, and WoS. Frequentist and Bayesian network meta-analyses were performed and pooled estimations were expressed as risk ratio (RR). We included all original investigations of prospective, randomized controlled trials comparing success rate for any two of the following six surgical procedures: standard EX-DCR with or without S, cold EN-DCR with or without S, and TL-DCR with or without S. The primary outcome measure was the objective success rate. RESULTS: Thirty-two studies with 3277 cases were included in the final quantitative analysis. TL-DCR with S was inferior to EN-DCR with S (RR: 1.20; 95% CI: 1.05-1.37), EX-DCR with S (RR: 1.17 95% CI: 1.05-1.29), EN-DCR without S (RR: 1.18; 95% CI: 1.03-1.35), and EX-DCR without S (RR: 1.15; 95%CI: 1.05-1.26) in frequentist statistics. No other statistical difference was found between other surgeries. When we excluded studies with additional interventions (nasal and revision surgery) for sensitivity analysis, 23 studies with 2468 cases were included to analysis. The success rates of TL-DCR with S and EN-DCR without S became similar (RR: 1.14 95% CI: 0.99-1.30) but there was no change in other outcomes. Similar results were found in Bayesian statistics. The surface under the cumulative ranking curve was higher for EN-DCR with S (0.75), whereas it was higher for EX-DCR with S (0.56) after sensitivity analysis. CONCLUSION: Between endoscopic and external and transcanalicular laser without S procedures, there is no statistical difference. The rank probability showed that EN-DCR with S was a more appropriate surgical option when patients with nasal disease were included, whereas EX-DCR with S was a more appropriate surgical option when patients with nasal disease were excluded from the analysis.

Importance of etiology in canalicular obstruction surgery.

PURPOSE: The treatment options for canalicular obstruction remain controversial, and there are different approaches. In this study, we aimed to evaluate the success of balloon dilatation and silicon tube intubation according to the etiology in patients with canalicular obstruction. METHODS: The files of 91 patients with isolated monocanalicular obstruction were retrospectively reviewed. Patients were grouped according to surgical methods (Group A: both balloon dilatation and silicon tube intubation; Group B: Only balloon dilatation) and etiologies (topical anti-glaucomatous usage-related, inflammatory, chemotherapy-related, radiotherapy-related, trauma-related, idiopathic). Preoperative and postoperative Munk scores and lacrimal irrigation results were noted in all cases. RESULTS: Munk score was found to be statistically significantly lower in the 1st year in both groups. The patency rate with lacrimal syringing was found to be statistically significantly higher in group A. Success rates both in the munk score and lacrimal passage patency were found to be statistically significantly lower in inflammatory etiology than other etiologies. CONCLUSIONS: Both techniques can be used as first-line therapies for canalicular obstruction. It should be considered that recurrence may develop in stenosis of inflammatory origin and more invasive surgery may be required.

Estenosis traqueal postintubación después de neumonía grave por coronavirus / Postintubation Tracheal Stenosis after Severe Coronavirus Pneumonia

Introducción: La rápida propagación del SARS­CoV­2 ha provocado una pandemia mundial. Si bien puede salvar vidas, la intubación traqueal presenta el riesgo inherente de inducir daño en la mucosa traqueal con estenosis, con una incidencia estimada de 4,9 casos por millón cada año. Objetivo: Caracterizar la presentación de una estenosis traqueal por intubación prolongada en un paciente que sufrió neumonía grave por coronavirus. Presentación del caso: Se asiste a un paciente de 55 años que sufrió neumonía grave por coronavirus y necesitó intubación orotraqueal prolongada. Una vez recuperado comienza con disnea de empeoramiento progresivo. Se diagnostica una estenosis traqueal y se decide tratamiento quirúrgico donde se realiza resección y anastomosis. El paciente no presentó complicaciones y evolucionó satisfactoriamente. Conclusiones: La estenosis traqueal debe reconocerse como una complicación potencial, aun cuando los pacientes se recuperan de una neumonía grave por COVID-19. El diagnóstico definitivo de estenosis traqueal se realiza mediante fibrobroncoscopia. La resección traqueal con anastomosis entre tráquea y tráquea es el procedimiento más comúnmente realizado(AU)

Introduction: The rapid spread of SARS-CoV-2 has resulted in a global pandemic. Although tracheal intubation can save lives, it presents the inherent risk of inducing tracheal mucosal damage with stenosis, with an estimated annual incidence of 4.9 cases per million. Objective: To characterize a case of tracheal stenosis due to prolonged intubation in a patient with severe coronavirus pneumonia. Case presentation: A 55-year-old patient who suffered severe coronavirus pneumonia and required prolonged orotracheal intubation was attended. Once recovered, the patient began with progressively worsening dyspnea. Tracheal stenosis was diagnosed and surgical treatment was decided, in which resection and anastomosis were performed. The patient did not present any complications and evolved satisfactorily. Conclusions: Tracheal stenosis should be recognized as a potential complication, even when patients recover from severe COVID-19 pneumonia. A definitive diagnosis of tracheal stenosis is made by fibrobronchoscopy. Tracheal resection with anastomosis between trachea is the most commonly performed procedure(AU)

Comparison Of Chula Formula With Standard 21/23 Rule For Estimation Of Orotracheal Tube Depth In Intubated Adult Patients: A Sindh Institute Of Urology And Transplantation Experience.

BACKGROUND: The proper estimation of depth of the orotracheal tube (OTT) in intubated patients is difficult. Several methods have been developed for proper estimation of the depth of OTT. The purpose of this study was to compare two commonly used formulae (21/23 rule and Chula formula) for proper estimation of depth of OTT in our Pakistani population. METHODS: In this randomized interventional study, we included 74 adult patients. The study was conducted in the Intensive care unit of a tertiary care hospital in Karachi, Pakistan, from October 2021 to April 2022. Patients were intubated using either the 21/23 rule (OTT was fixed at 21 cm in females and 23 cm in males from the right incisor) or the Chula formula (OTT was fixed at the right incisor according to the height based formula, {(height in cm/10)+4}). The distance between the carina and the OTT tip was measured using the digital chest x-ray with a PACS software. RESULTS: A total of 74 patients were intubated in which 32 were intubated using 21/23 rule and 42 were intubated using the Chula formula. Four female patients in 21/23 rule group encountered unsafe distance between the carina and the tip of the OTT (i.e., <2 cm) while no such complications were reported in Chula formula group (p-value 0.031). CONCLUSIONS: Chula formula was safe method for OTT placement in our study. Further studies with larger sample size are needed to assess the safety and efficacy of Chula formula for Pakistani Population.

A prospective study comparing mini-invasive and conventional canaliculotomy of punctum-sparing canaliculotomy for primary canaliculitis treatment.

PURPOSE: To compare outcomes of mini-invasive canaliculotomy with those of conventional canaliculotomy conducted using the punctum-sparing approach for the treatment of primary canaliculitis. METHODS: A prospective, comparative, and interventional case series study was conducted on 118 individuals with unilateral inferior primary canaliculitis. These patients were randomly divided into two groups, each with 59 cases. Group A underwent mini-invasive canaliculotomy (minor incision ~3 mm), whereas group B received conventional canaliculotomy (long incision ~6-8 mm). Punctum-sparing and canaliculus-reconstructing procedure was used to treat all patients. Both groups had silicone tube intubations and were retained in the lacrimal passages for one month. Both groups' surgical success rates and postoperative complications were measured at the last follow-up of 12 months after surgery. RESULTS: A total of 108 patients were finally included in the study, 53 in group A and 55 in group B. There were 79 females and 29 males with a median age of 57 ± 13.4 years. The anatomical success rates for groups A and B were 96.2% and 92.7% (P = 0.679), respectively. Functional success rate was accomplished by considerably more patients in group A (50/53, 94.3%) compared to group B (45/55, 81.8%) (P = 0.046). No recurrences were seen during follow-up visits in any of the participants. CONCLUSIONS: The two procedures employed in this study to treat primary canaliculitis achieves excellent clinical effects with no incidence of recurrence. The mini-invasive canaliculotomy is worthy to be recommended for its higher functional success rate with mini-invasion of canaliculus and intact lacrimal punctum.

Comparação dos marcadores de alteração na deglutição entre pacientes com e sem Covid-19 pós-intubação orotraqueal / Comparison of swallowing alteration markers between patients with and without Covid-19 post-orotracheal intubation

RESUMO Objetivo comparar os marcadores de alteração na deglutição de pacientes com e sem COVID-19 e estudar as variáveis preditivas de contraindicação da alimentação por via oral em pacientes com necessidade de intubação orotraqueal prolongada. Métodos estudo caso-controle, retrospectivo, com coleta de prontuário de variáveis clínicas e demográficas e da avaliação clínica da deglutição. As variáveis coletadas foram comparadas estatisticamente entre pacientes com COVID-19 (grupo estudo -GE) e sem COVID-19 (grupo-controle - GC). A análise de regressão de robusta de Poisson foi utilizada para avaliar o efeito da COVID-19 e das demais variáveis na contraindicação da alimentação por via oral. Resultados foram incluídos 351 pacientes, 269 no GE e 82 no GC. Pacientes do GE apresentaram menor idade, quando comparados ao GC (50,7 ± 12,8). O tempo total de intubação orotraqueal foi significativamente maior no GE. Os pacientes do GE apresentaram maior prevalência de tosse fraca, disfonia, piores graus de disfagia e maior ocorrência de contraindicação da alimentação por via oral. Na análise bivariada, verificou-se que os pacientes com COVID-19 apresentaram 65% maior probabilidade dessa contraindicação. Entretanto, quando a COVID-19 foi ajustada com outras variáveis clínicas e demográficas, verificou-se que as estas apresentaram maior influência sobre a contraindicação de alimentação por via oral do que a COVID-19. Conclusão a intubação orotraqueal prolongada teve pior efeito nos marcadores de alteração na deglutição e na reintrodução da via oral de pacientes com COVID-19. A idade maior que 60 anos, tempo de intubação orotraqueal maior que cinco dias, reintubação e delirium demonstraram ser preditivas de contraindicação da alimentação por via oral em pacientes intubados.

ABSTRACT Purpose To compare the swallowing alteration markers in patients with and without COVID-19 and to study the predictive variables of oral feeding contraindication in patients requiring prolonged orotracheal intubation. Methods Retrospective case-control study, with medical record data collection of clinical and demographic variables and the clinical evaluation of swallowing. The collected variables were statistically compared between patients with COVID-19 (SG) and without COVID-19 (CG). Robust Poisson regression analysis was used to evaluate the effect of COVID-19 and other variables on oral feeding contraindication. Results 351 patients were included, 269 in the SG and 82 in the CG. Patients in the SG were younger when compared to the CG (50.7 ± 12.8). The total time of orotracheal intubation was significantly longer in the SG. The patients in the SG had a higher prevalence of weak cough, dysphonia, worse degrees of dysphagia and higher occurrence of contraindication of oral feeding. In the bivariate analysis, it was found that patients with COVID-19 were 65% more likely to have oral feeding contraindication. However, when COVID-19 was adjusted with other clinical and demographic variables, it was found that these variables had a greater influence on the contraindication of the oral feeding than the COVID-19. Conclusion Prolonged orotracheal intubation had a worse effect on alteration markers in swallowing and reintroduction of the oral feeding in COVID-19 patients. Age over 60 years, orotracheal intubation time greater than 5 days, reintubation, and delirium were shown to be predictive of oral feeding contraindication in intubated patients.

Dacryoendoscopic Findings in the Failed Silicone Tube Intubations without Dacryoendoscopy.

PURPOSE: To investigate the clinical characteristics and dacryoendoscopic findings and clinical efficacy of silicone tube intubation (STI) in the patients who referred to our center due to failed with conventional STI. METHODS: We retrospectively reviewed the medical records of 61 cases from 50 patients who underwent STI or endoscopic dacryocystorhinostomy using dacryoendoscopy from January 2016 to May 2021. Clinical characteristics, tear meniscus height, lacrimal irrigation test, dacryocystographic findings, dacryoendoscopic findings and surgical outcomes were evaluated. RESULTS: The study included 12 male and 38 female patients (mean age, 64.1 ± 13.2 years). In the preoperative lacrimal irrigation test, passage was found in 33 eyes (54.1%) and no passage in 28 eyes (45.9%). The causes of lacrimal duct obstruction were in the order of stenosis (31.1%), mucus (27.9%), membrane (24.6%), granulation (13.1%), and stone (3.3%), and the location were in the order of nasolacrimal duct (39.3%), lacrimal sac (36.1%), canaliculus (21.3%), and inferior meatus (3.3%). As for the characteristics of obstruction, the secretory type was 21 eyes (34.4%), and structural change type was 40 eyes (65.6%). The STI group consisted of 57 eyes (93.4%) and endoscopic dacryocystorhinostomy consisted of four eyes (6.6%). The overall success rate was 83.9%. Clinical results were correlated with dacryoendoscopic finding (p = 0.015), but not with lacrimal irrigation test or dacryocystography. The structural change type had a higher surgical success rate than the secretory type (84.4% vs. 66.7%, p = 0.015). In particular, the structural change type showed higher success rate than the secretory type below the lacrimal sac (95.5% vs. 61.9%, p = 0.034). CONCLUSIONS: STI using dacryoendoscopy has a higher surgical success rate than conventional STI since dacryoendoscopy provides direct visualization of nasolacrimal duct obstruction. It could be useful in increasing the surgical success rate in patients with structural changes below lacrimal sac.

Long-term outcomes of lacrimal canalicular trephination with viscoelastic-assisted monocanalicular stenting for canalicular obstructions.

Purpose: To study the long-term outcomes of lacrimal canalicular trephination (LCT) with viscoelastic-assisted monocanalicular stenting (VAMS) for the treatment of epiphora secondary to lacrimal canalicular obstructions (LCO). Methods: Our study was a retrospective interventional work. All patients diagnosed with LCO, having morbid epiphora (Munk's scale ≥ 2), were included. The LCO was divided as proximal (< 6mm from punctum) and distal (≥ 6mm from punctum). Sisler's lacrimal trephine (21 gauge) was used to recanalize the LCO with monocanalicular stent (0.64mm diameter) insertion, which was kept for a minimum of 6 weeks and a post-stent removal follow-up of 12 months was ensured. Fluorescein dye disappearance test and lacrimal irrigation were used as functional and anatomical tests for evaluation, respectively. Results: We included 73 eyes of 52 patients having a mean age of 44.5 years. Of the total, the proximal LCO was seen in 38 eyes (52.1%) and distal in 35 eyes (47.9%). The preoperative Munk's score of 5 was noted in the majority (n=57 eyes, 78.1%). The majority (n=32 eyes, 43.8%) had chronic blepharitis or meibomian gland disease as etiology. Monocanalicular stent was kept in place for a mean of 13.5 weeks. At a mean follow-up of 14.5 months, complete response was noted in 35.6% cases, while 50.7% had partial and 13.7% had a failure of the procedure. Conclusions: LCT (without DCR) is a minimally invasive, simple, and effective technique for the treatment of LCO in the long term. VAMS is a helpful innovation to facilitate the insertion of the flexible silicone stent.

Assessment of Lacrijet monocanalicular intubation for congenital nasolacrimal duct obstruction.

PURPOSE: To assess the success rate and complications of Lacrijet monocanalicular stent (FCI S.A.S, Paris, France) intubation in children treated for congenital nasolacrimal duct obstruction (CNLDO). METHODS: Retrospective review study which included children with CNLDO that were intubated with Lacrijet monocanalucilar silicone tube.The Lacrijet tube remained in place for 11-15 weeks post operatively and was removed in the clinic with topical anesthesia. Operative time was recorded for each case. All children were evaluated using the following parameters preoperatively and postoperatively: tear meniscus height, Fluorescein dye disappearance test (FDDT), and MUNK score. RESULTS: The study included 20 eyes with mean age of 26.25 ± 11.25 months. 17 eyes (85%) had undergone probing previously. Mean operation time of Lacrijet intubation was 8.5 min (95% CI 7.04-9.95). Mean follow-up period was 204.65 ± 105.27 days. Lacrijet intubation resulted in statistically significant improvements in tear meniscus height (P < .001), FDDT (P < 0.001), and MUNK score (P < 0.001) in all children. Two different sizes of Lacrijet intubations were used. Complete success was obtained in all cases. No complications were observed. CONCLUSIONS: Lacrijet lacrimal intubation has a high rate of success, shortens surgical time and has a low rate of complications in children with CNLDO.

The significance of primary monocanalicular silicone tube intubation in late surgical treatment in children.

PURPOSE: To evaluate the effect of monocanalicular silicone tube intubation outcomes as an initial surgical treatment in children older than 1 year old with primary nasolacrimal obstruction. METHODS: Probing or monocanalicular silicone tube intubation was performed as primary surgical treatment on 12-48 months old children with primary nasolacrimal obstruction. Probing was performed on 53 eyes of 43 patients and silicone tube intubation on 45 eyes of 39 patients. Treatment was considered successful after improvement in patient complaints, the presence of normal tear meniscus, and normal results of fluorescein disappearance time test. Retrospective treatment success was compared between two groups according to age groups. RESULTS: Treatment success was 79.1% in the probing group and 92.3% in the silicone tube intubation group. The success of the treatment was evaluated separately in the groups of 12 to <24 months, 24 to <36 months, and 36 to <48 months, and although the success level of the silicone tube intubation group was consistently found to be higher, the difference was not statistically significant. Treatment success decreased statistically significantly in the probing group with increased age of the patients, especially after 24 months. There was no such statistically significant decrease in the silicone tube intubation group. CONCLUSION: The choice of monocanalicular silicone tube intubation for primary surgical treatment in children with primary nasolacrimal obstruction provides success without the need for repetitive surgical interventions, especially in children older than 24 months.

Video-based reflection on neonatal interventions during COVID-19 using eye-tracking glasses: an observational study.

OBJECTIVE: The aim of this study was to determine the experience with, and the feasibility of, point-of-view video recordings using eye-tracking glasses for training and reviewing neonatal interventions during the COVID-19 pandemic. DESIGN: Observational prospective single-centre study. SETTING: Neonatal intensive care unit at the Leiden University Medical Center. PARTICIPANTS: All local neonatal healthcare providers. INTERVENTION: There were two groups of participants: proceduralists, who wore eye-tracking glasses during procedures, and observers who later watched the procedures as part of a video-based reflection. MAIN OUTCOME MEASURES: The primary outcome was the feasibility of, and the proceduralists and observers' experience with, the point-of-view eye-tracking videos as an additional tool for bedside teaching and video-based reflection. RESULTS: We conducted 12 point-of-view recordings on 10 different patients (median gestational age of 30.9±3.5 weeks and weight of 1764 g) undergoing neonatal intubation (n=5), minimally invasive surfactant therapy (n=5) and umbilical line insertion (n=2). We conducted nine video-based observations with a total of 88 observers. The use of point-of-view recordings was perceived as feasible. Observers further reported the point-of-view recordings to be an educational benefit for them and a potentially instructional tool during COVID-19. CONCLUSION: We proved the practicability of eye-tracking glasses for point-of-view recordings of neonatal procedures and videos for observation, educational sessions and logistics considerations, especially with the COVID-19 pandemic distancing measures reducing bedside teaching opportunities.

Long-Term Quality of Life in Patients Following Minimally Invasive Conjunctivodacryocystorhinostomy With StopLoss Jones Tube.

PURPOSE: To assess the long-term quality of life outcomes of minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes. METHODS: A retrospective interventional case series was performed on all patients diagnosed with proximal bicanalicular obstruction who underwent a minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes over a period of 5 years from October 2014 to September 2019. The procedure was performed as per standard published protocols of minimally invasive conjunctivodacryocystorhinostomy and StopLoss Jones tubes. Patients were followed for a minimum of 1 year after surgery. The tools employed to study were the "Jones tube satisfaction questionnaire" and the "Nasolacrimal duct obstruction-symptom score." These tools were employed at every step from the preoperative stage to each of the follow ups. Statistical analysis was performed using the R 4.0.4 (R Project, R Foundation). RESULTS: A total number of 44 eyes of 42 patients were studied. Of these, 73.81% (31/42) were females. The mean age of patients was 61.81 years. Approximately 87% and 64% of the patients completed 2 and 3 years of follow up, respectively. For up to 2 months postoperative period, the outcomes were excellent, with the majority (76.74%, 33/43) reporting "moderately satisfied" outcomes on Jones tube satisfaction questionnaire. The dissatisfaction began at the 3-month follow up (4.55%, 3/44) and peaked at 6-month follow up (25%, 11/44), owing to tube-related complications. The mean ± standard deviation nasolacrimal duct obstruction-symptom score scores dipped from 19.98 ± 2.88 at baseline to 5.58 ± 2.99 at the 2-month follow up. Similar to Jones tube satisfaction questionnaire, the scores began worsening at 3-month follow up (9.8 ± 5.86) with the poorest scores at 6 months (12.34 ± 5.96), and these changes were significant as compared with the baseline (p < 0.001). The Jones tube satisfaction questionnaire and the nasolacrimal duct obstruction-symptom score scores showed significant improvements at 1-year follow up, owing to appropriate management of complications. The good outcomes were maintained for up to 3 years of postoperative period. CONCLUSIONS: The long-term quality of life outcome following minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes was good. The quality of life significantly suffers between 3 and 6 months following the surgery and improves equally well following appropriate management of complications.