Nasolacrimal duct rhinostomy for low-level nasolacrimal duct obstruction:long-term outcomes and surgical selection paradigm.

PROPOSE: This study aims to present long-term outcomes in a specific patient population experiencing epiphora due to low-level nasolacrimal duct obstruction (NLDO) following endonasal endoscopic nasolacrimal duct rhinostomy, and to propose a surgical selection paradigm for varying locations of NLDO. METHODS: Between September 1, 2017 and February 28, 2023, a retrospective analysis was conducted on 26 patients diagnosed with primary acquired nasolacrimal duct obstruction (PANDO) who underwent endonasal endoscopic nasolacrimal duct rhinostomy for low-level NLDO (defined as obstruction below the plane of the superior border of the inferior turbinate attachment). The study assessed surgical success through objective measures of anatomical patency and subjective measures of functional patency during a postoperative follow-up period of at least six months. Additionally, any complications that arose during this follow-up period were documented. RESULTS: The study included a cohort of 26 patients, consisting of 24 women and 2 men, with a mean age of 47.58 ± 3.09 years (range: 8-75). All patients underwent endoscopic nasolacrimal duct rhinostomy, with 10 eyes having previously undergone tear duct recanalization procedures. Anatomical patency was achieved in 88.5% (23/26) of cases, while functional patency was achieved in 80.8% (21/26) after an average follow-up period of 41.9 ± 22.1 months. No significant complications were observed in any of the patients during the follow-up period. CONCLUSION: Endonasal endoscopic nasolacrimal duct rhinostomy is effective in treating epiphora in over 80% of cases with low-level NLDO. Tailoring the surgery to the location of the obstruction can improve outcomes and minimize damage.

Modified Conjoint Fascial Sheath and Levator Muscle Complex Suspension for the Correction of Simple Severe Congenital Ptosis in Pediatrics and the Effect on Refractive Status.

PURPOSE: To evaluate the outcomes of modified combined fascia sheath and levator muscle complex suspension to correct severe congenital ptosis in pediatrics and the effect on refractive status. METHODS: This prospective, case series study enrolled patients (aged ≤18 years) with simple severe congenital ptosis at Zhongshan Ophthalmic Center. All patients were treated with combined fascia sheath + levator muscle suspension and followed up for 3 months. Preoperative and postoperative cycloplegic refraction and the best-corrected visual acuity were performed. The types of astigmatism include with-the-rule, against-the-rule, and oblique. RESULTS: Thirty-six patients (50 eyes) were enrolled. The mean age was 7.11 ± 3.72 years. The surgery success rate was 90.0%. Following surgery, the eyelid contour of all eyes exhibited natural symmetry and satisfactory curvature. The eyelid height difference in OUs was ≤1 mm for 42 eyes. For 47 eyes, the eyelid crease was symmetry. Two eyes had conjunctival prolapse, and 1 eye developed trichiasis. After surgery, cylinder power changed from mean -1.14 ± 1.27 D to -1.54 ± 1.25 D ( p < 0.001) and best-corrected visual acuity improved from mean 0.205 ± 0.217 logarithm of the minimum angle of resolution to 0.168 ± 0.176 logarithm of the minimum angle of resolution ( p = 0.048). The quantities of with-the-rule increased from 35 eyes to 41 eyes, oblique from 4 eyes to 6 eyes, while against-the-rule decreased from 11 eyes to 3 eyes ( p = 0.01). CONCLUSIONS: Combined fascia sheath + levator muscle suspension under general anesthesia is effective and safe for severe congenital ptosis in pediatrics. However, astigmatism increased and the types of astigmatism changed after surgery.

Dry eye and decreased tear film stability in primary acquired nasolacrimal duct obstruction patients.

PURPOSE: Exploring the prevalence of dry eye (DE) and the changes of tear film stability in patients with primary acquired obstruction of the nasolacrimal duct (PANDO). METHODS: In this cross-sectional, observational study, 370 eyes in 223 patients with PANDO were assessed. The ocular surface disease index (OSDI) was used to evaluate ocular surface symptoms, and the Keratograph 5M non-invasive ocular surface analyser was used to assess ocular surface parameters. According to the TFOS DEWS II criteria, patients with OSDI ≥ 13 and NIKBUT < 10 s were diagnosed with DE. RESULTS: Of the 223 PANDO patients, 65 (29.1%) met the diagnostic criteria for DE. Compared with patients without DE, PANDO patients with DE were significantly older (p < 0.001), had a longer duration of epiphora (p = 0.023), and more likely to have a positive regurgitation on pressure over the lacrimal sac (ROPLAS) sign (p = 0.003). Multifactorial analysis showed that older age, positive ROPLAS and hypertension were significant independent predictors of DE (p < 0.05). Among the 147 unilateral PANDO patients without DE, the TMH, NIKBUT-first, NIKBUT-average and bulbar erythema scores were significantly higher in the PANDO sides. CONCLUSIONS: This study illustrated the prevalence of DE in PANDO patients was 29.1% and DE is more likely to occur in those who are older, have hypertension and are positive for ROPLAS. In addition, in patients with unilateral nasolacrimal duct obstruction, a decrease in tear film stability was observed in the healthy eye.

Efficacy and safety of super pulse CO2 laser-assisted punctoplasty with canalicular curettage in primary canaliculitis.

The objective of this study was to evaluate the efficacy and safety of super pulse CO2 laser-assisted punctoplasty with canalicular curettage in primary canaliculitis. In this retrospective serial case study, the clinical data of 26 patients who underwent super pulse CO2 laser-assisted punctoplasty for the treatment of canaliculitis were collected from January 2020 to May 2022. The clinical presentation, intraoperative and microbiologic findings, surgical pain severity, postoperative outcome, and complications were studied. Of the 26 patients, most were females (female:male 20:6), with a mean age of 60.1 ± 16.1 years (range, 19-93). Mucopurulent discharge (96.2%), eyelid redness and swelling (53.8%), and epiphora (38.5%) were the most common presentations. During the surgery, concretions were present in 73.1% (19/26) of the patients. The surgical pain severity scores ranged from 1 to 5, according to the visual analog scale, with a mean score of 3.2 ± 0.8. This procedure resulted in complete resolution in 22 (84.6%) patients and significant improvement in 2 (7.7%) patients, and 2 (7.7%) patients required additional lacrimal surgery with a mean follow-up time of 10.9 ± 3.7 months. The surgical procedure of super pulse CO2 laser-assisted punctoplasty followed by curettage appears to be a safe, effective, minimally invasive, and well-tolerated treatment for primary canaliculitis.

A simple and efficient technique for suturing and knotting during endoscopic dacryocystorhinostomy.

PURPOSE: This study evaluated the long-term outcomes of endoscopic suturing and knotting-dacryocystorhinostomy (eSK-DCR) without the use of a stent or mitomycin C. METHODS: A prospective interventional case series was performed on patients with nasolacrimal duct obstruction (NLDO) who underwent eSK-DCR at Zhongshan Ophthalmic Center from October 2019 to December 2019. The surgeon sutured the lacrimal sac mucosa with the nasal mucosa by tying knots under endoscopic DCR. Subject demographics, preoperative data and postoperative data were collected, including clinical presentation, Munk score for epiphora, surgical indications, operation time, duration of knotting, number of knots, endoscopic ostium size, complications, and anatomical and functional success. Anatomic success was defined as patent ostium on lacrimal irrigation, and functional success was defined as subjective improvement in symptoms. Statistical analysis was performed by IBM SPSS software (Version 20.0; SPSS Inc., Chicago, IL, USA). RESULTS: A total of 60 patients (71 eyes) underwent pure eSK-DCR. Of these, 95.0% (57/60) were females. The mean age of the patients was 54.7 years. The mean surgical time was 37.60 min, and the average time for each knotting was 2.86 min. Endoscopic evidence found that all patients showed patent ostium and normal healing of the flaps after 4 weeks. The Munk scores dropped significantly at 6 months postoperatively compared to preoperative scores (P < 0.0001). Although 4 patients (7 eyes) were lost to follow-up at the end of the 2-year period, the anatomical and functional success remained stable during the 2-year follow-up period (anatomical, 100%; functional, 87.5%). No serious complications were detected during the follow-up period. CONCLUSION: Pure eSK-DCR is a simple and reliable therapeutic method for the management of NLDO. The surgical outcomes were good and remained stable beyond 6 months postoperatively.

Microbial distributions in the conjunctiva and lacrimal sacs of patients with chronic dacryocystitis in a tertiary hospital.

BACKGROUND: The aim was to clarify the distributions of bacteria in the conjunctival sac and lacrimal sac in patients with chronic dacryocystitis. METHODS: In total, 297 (322 eyes) chronic dacryocystitis patients who underwent nasal endoscopic dacryocystorhinostomy (EN-DCR) were included. Conjunctival sac secretions from the affected eye were collected preoperatively, and lacrimal sac retention fluid from the affected side in the same patient was collected intraoperatively. Bacterial culture and drug sensitivity testing were performed to determine bacterial distributions. RESULTS: In total, 127 bacterial isolates (49 species) were detected in 123 eyes in the conjunctival group, with a positivity rate of 38.2% (123/322); 85 bacterial isolates (30 species) were detected in 85 eyes in the lacrimal sac group, with a positivity rate of 26.4% (85/322). The positivity rates were significantly different (P = 0.001) between two groups. The gram-negative bacilli proportion in the lacrimal sac group (36/85, 42.4%) was significantly higher than that in the conjunctival sac group (37/127, 29.2%) ( P = 0.047). Positive conjunctival sac secretion culture (123/322) was significantly associated with increased ocular secretion (281/322, 87.3%) (P = 0.002). Among the culture-positive bacteria in the conjunctival sac group and the lacrimal sac group, 30/127, 23.6% and 43/127, 26.7% and 21/85, 24.7% and 20/85, 23.5% were resistant to levofloxacin and tobramycin, respectively. CONCLUSIONS: This study illustrated differences in bacterial distributions between conjunctival sac secretions and retained lacrimal sac fluid in chronic dacryocystitis patients, with a higher proportion of gram-negative bacilli in lacrimal sac secretions. The ocular surface flora in chronic dacryocystitis patients is partially resistant to levofloxacin and tobramycin, which need to be considered by ophthalmologists.

Large amplitude vibration of a cantilever actuated by a high-frequency pulsed laser.

Laser excitation based on the thermoelastic principle is effective for micro-scale actuation, enabled energy conversion from optical to mechanical. The major advantages lie in non-contact actuation, easy miniaturization, and integration. To avoid surface damage, the laser power per unit is limited, leading to several micrometers of the vibration. In this study, a pure nickel millimeter-sized cantilever is successfully actuated at a low-frequency resonance (around Hz) via a nanosecond pulsed laser. By modal interaction, the energy is transferred from a low-intensity, high-frequency (around kHz) excitation to a low-frequency response with millimeter amplitude. The stable low-frequency resonance of the cantilever was maintained by changing the laser pulse parameters and the illumination locations. We also present a method to control the vibration of the cantilever using a modulated wave (MW: the laser wave modulated by a rectangular wave). The cantilever's amplitude can be efficiently adjusted by changing the laser power or duty cycle of the MW. The resonance frequency of the cantilever also can be altered by optimizing the geometries to meet various actuation requirements. This study enables large actuation (up to tens of millimeters) by laser excitation, facilitating applications in precision manipulation, microfluidic mixing, lab-on-a-chip device, and other related micro actuation devices.

On the knowledge of solitary juvenile xanthogranuloma of the eyelid: a case series and literature review.

PURPOSE: Solitary eyelid juvenile xanthogranuloma (JXG) is extremely rare, and there is limited literature on its clinical features and treatment outcomes. Here, we present a case series and comprehensive review of the literature on patients with isolated eyelid JXG. METHODS: We systematically extracted data from our institution's records of isolated eyelid JXG cases and conducted a search for additional cases from the literature utilising the PubMed, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. Patients with JXG were analysed with respect to age, sex, clinical presentation, therapy, and outcome. Group comparisons were performed. RESULTS: Thirty-two patients (including 13 at our institution and 19 from prior publications) were identified. The median age at first presentation was higher in current patients than in the patients from the published cases (median 9 years, range 1.2 to 47.0 years; median 2 years, range 0.5 months to 46.0 years, respectively, P = 0.014). Of the patients who had known characteristics, no significant differences were observed between the two groups in terms of sex, affected eye, eyelid site, type of cutaneous involvement, or duration of symptoms (each P > 0.05). Seventeen (54.8%) patients were male. The most common lesion location was the upper eyelid (n = 10, 62.5%). Twenty-four (75.0%) cutaneous lesions had full-thickness skin involvement; 8 (25.0%) subcutaneous masses had a chalazion-like appearance. Histologically, the JXG masses were characterised by Touton giant cells with inflammatory cells. Additionally, there was no significant difference in treatment modalities between the two groups (P = 0.072), and 24 (75.0%) patients underwent surgical excision. The overall recurrence-free survival was 3.6 to 52.8 (median 27.0) months in the current patients. For published cases with available follow-up information, there was no recurrence in 10 cases and improvement in 1 case, with a median follow-up of 9.5 months. CONCLUSION: Solitary eyelid JXG is a rare clinical entity and should be included in the differential diagnosis of eyelid mass lesions in patients of all age groups. Surgical excision is often selected for efficient treatment and to obtain an excisional biopsy.

Identification of Sex Differentiation-Related microRNAs in Spinach Female and Male Flower.

Sex determination and differentiation is an important biological process for unisexual flower development. Spinach is a model plant to study the mechanism of sex determination and differentiation of dioecious plant. Till now, little is known about spinach sex determination and differentiation mechanism. MicroRNAs are key factors in flower development. Herein, small RNA sequencing was performed to explore the roles of microRNAs in spinach sex determination and differentiation. As a result, 92 known and 3402 novel microRNAs were identified in 18 spinach female and male flower samples. 74 differentially expressed microRNAs were identified between female and male flowers, including 20 female-biased and 48 male-biased expression microRNAs. Target prediction identified 22 sex-biased microRNA-target pairs, which may be involved in spinach sex determination or differentiation. Among the differentially expressed microRNAs between FNS and M03, 55 microRNAs were found to reside in sex chromosome; one of them, sol-miR2550n, was functionally studied via genetic transformation. Silencing of sol-miR2550n resulted in abnormal anther while overexpression of sol-miR2550n induced early flowering, indicating sol-miR2550n was a male-promoting factor and validating the reliability of our small RNA sequencing data. Conclusively, this work can supply valuable information for exploring spinach sex determination and differentiation and provide a new insight in studying unisexual flower development.

Comparative transcriptome analysis of male and female flowers in Spinacia oleracea L.

BACKGROUND: Dioecious spinach (Spinacia oleracea L.), a commercial and nutritional vegetable crop, serves as a model for studying the mechanisms of sex determination and differentiation in plants. However, this mechanism is still unclear. Herein, based on PacBio Iso-seq and Illumina RNA-seq data, comparative transcriptome analysis of male and female flowers were performed to explore the sex differentiation mechanism in spinach. RESULTS: Compared with published genome of spinach, 10,800 transcripts were newly annotated; alternative splicing, alternative polyadenylation and lncRNA were analyzed for the first time, increasing the diversity of spinach transcriptome. A total of 2965 differentially expressed genes were identified between female and male flowers at three early development stages. The differential expression of RNA splicing-related genes, polyadenylation-related genes and lncRNAs suggested the involvement of alternative splicing, alternative polyadenylation and lncRNA in sex differentiation. Moreover, 1946 male-biased genes and 961 female-biased genes were found and several candidate genes related to gender development were identified, providing new clues to reveal the mechanism of sex differentiation. In addition, weighted gene co-expression network analysis showed that auxin and gibberellin were the common crucial factors in regulating female or male flower development; however, the closely co-expressed genes of these two factors were different between male and female flower, which may result in spinach sex differentiation. CONCLUSIONS: In this study, 10,800 transcripts were newly annotated, and the alternative splicing, alternative polyadenylation and long-noncoding RNA were comprehensively analyzed for the first time in spinach, providing valuable information for functional genome study. Moreover, candidate genes related to gender development were identified, shedding new insight on studying the mechanism of sex determination and differentiation in plant.

Development and validation of a nomogram for predicting the need for concomitant endoscopic septoplasty during endonasal endoscopic dacryocystorhinostomy.

Background: Simultaneous endoscopic septoplasty is often required during endonasal endoscopic dacryocystorhinostomy (En-DCR) to improve access to the lacrimal sac and potentially optimize surgical success rates. In current practice, the decision to proceed to concomitant endoscopic septoplasty during En-DCR in patients with primary acquired nasolacrimal duct obstruction (PANDO) is determined by anterior rhinoscopy and nasal endoscopic examination. However, none of these methods can be used to quantitatively assess the severity of septal deviation to determine the need for concomitant endoscopic septoplasty during En-DCR. This study was thus conducted to develop and validate a radiological prediction model based on computed tomography (CT) to predict the necessity of concomitant endoscopic septoplasty during En-DCR. Methods: Data from 225 patients with PANDO and nasal septal deviation (NSD) who had undergone unilateral En-DCR in a single center from January 2022 to June 2023 were retrospectively analyzed. Least absolute shrinkage and selection operator (LASSO) was used to select predictors for concomitant endoscopic septoplasty during En-DCR. The ultimate model was developed through the application of multivariable logistic regression and subsequently confirmed through assessment with an internal validation cohort. The final model was then visually represented using a nomogram and an online calculator. Results: In this retrospective study of 225 eyes from 225 patients with PANDO and NSD, the training cohort included 157 eyes, and the validation cohort included 68 eyes. CT imaging characteristics including NSD angle [odds ratio (OR) 1.54; 95% confidence interval (CI): 1.32-1.87], NSD location (OR 4.49; 95% CI: 1.25-18.77), NSD direction (OR 5.38; 95% CI: 1.48-24.52), and middle nasal passage width (MNPW) at the surgical side (OR 0.61; 95% CI: 0.43-0.82) were identified as independent predictors for concomitant endoscopic septoplasty during En-DCR. A novel nomogram constructed from these CT signs showed high predictive performance. The area under the curves (AUCs) of the training set and internal validation set were 0.913 and 0.909, respectively. Conclusions: A CT-based radiological prediction model was created to help surgeons determine if concomitant endoscopic septoplasty is needed during En-DCR in patients with PANDO and NSD.

A fast multi-residue analysis of twenty-four classes of pesticide in sesame (Sesamum indicum L.) and their migration into processed products.

Sesame is widely used as a nutritional supplement or condiment because of its nutritious properties and palatable flavor. However, the extensive use of pesticides in sesame fields has paradoxically decreased the nutritional vantage. The current study used QuEChERS with a low-temperature freezing method to develop a multi-residue analytical approach to detect target analytes (pesticides) in sesame seed, sesame oil, sesame paste, and sesame meal. The migration ability of target pesticides during oil processing was investigated using HPLC-MS/MS and GC-MS: 35% of pesticides decreased, with processing factors (PFs) lower than 0.98, whereas 65% migrated from the seed to the oil during processing. The migration success of methoxyfenozide was the highest, while clothianidin and pymetrozine demonstrated a significantly lower rate of transfer. The results provide insight into the types of pesticides that should be used in farming practices of sesame to decrease the impact on human health.

Quality of Vision in Eyes with Chronic Dacryocystitis After Endoscopic Dacryocystorhinostomy.

Purpose: To assess the quality of vision (QOV) of patients with chronic dacryocystitis and explore the impact of endoscopic dacryocystorhinostomy (En-DCR) on patients' QOV, with the aim of increasing clinicians' attention to the potential QOV changes in patients with chronic dacryocystitis. Patients and Methods: Chronic dacryocystitis patients who attended the Department of Oculoplastics, Zhongshan Ophthalmic Center, Sun Yat-sen University from January 2022 to June 2022 and had En-DCR were included. The QOV was evaluated preoperatively and postoperatively using the Quick-contrast sensitivity function test (qCSF) and the OPD ScanIII comprehensive visual quality analyser, and the contrast sensitivity function (CSF), higher-order aberrations (HOAs), and modulation transfer function (MTF) data were recorded. Results: Thirty-eight patients with chronic dacryocystitis were included. QOV analysis of those with monocular chronic dacryocystitis revealed that HOAs were significantly higher in affected eyes than in contralateral eyes (P < 0.05), and CSF and MTF were significantly lower in affected eyes than in contralateral eyes (P < 0.05). One month after En-DCR, patients' HOAs, CSF, and MTF were significantly improved (P < 0.05), and there was no statistically significant difference in the effect of intraoperative combined silicone intubation versus no intubation on QOV (P > 0.05). Conclusion: Chronic dacryocystitis can significantly affect the QOV of patients. Successful En-DCR significantly improves the CSF, HOAs and MTF, which can effectively improve the QOV.

Retinal Nerve Fiber Layer Thickness in Children: The Gobi Desert Children Eye Study.

Purpose: Because there is a paucity of population-based data on retinal nerve fiber layer thickness (RNFLT) for children, we measured the RNFLT and its associations in schoolchildren. Methods: The population-based Gobi Desert Children Eye Study included all schoolchildren aged 6 to 21 years living in Ejina, Inner Mongolia. The children underwent a comprehensive ocular examination with cycloplegic refractometry and spectral-domain optical coherence tomography of the optic nerve head. The peripapillary RNFLT was measured on the optical coherence tomography images of a circular scan with a diameter of 3.4 mm. Results: Out of 1565 participants, RNFLT data were available for 1440 (92.5%) children. The mean global RNFLT was 101.3 ± 9.2 µm in right eyes. The RNFLT was thickest in the temporal inferior sector (157.3 µm), followed by the temporal superior sector (143.8 µm), the nasal inferior sector (109.7 µm), the nasal superior sector (106.9 µm), temporal sector (85.2 µm), and the nasal sector (61.7 µm). In multivariate analysis, the RNFLT decreased with higher myopic refractive error (P < 0.001), male sex (P = 0.001), higher intraocular pressure (P = 0.002), and lower birth weight (P = 0.03). It was not significantly associated with age (P = 0.19), body mass index (P = 0.57), mean arterial blood pressure (P = 0.33), pulse rate (P = 0.28), and subfoveal choroidal thickness (P = 0.11). Conclusions: The RNFLT in children showed a regional distribution, with the thickest part in the temporal inferior sector and the thinnest part located in the nasal sector. The overall RNLFT significantly decreased with higher myopic refractive error and male sex. In schoolchildren, in contrast to adults, the RNFLT did not decrease with older age. These findings may be considered when interpreting RNFLT data in children.