Anatomical Success Research Articles

Delayed closure of highly myopic macular holes combined with retinoschisis after inverted internal limiting membrane flap.

To assess functional and anatomical outcomes of internal limiting membrane (ILM) inverted flap in highly myopic macular holes (HMMHs) with outer-retinoschisis (O-RS). Retrospective interventional analysis of 19 eyes with HMMH and O-RS undergoing vitrectomy and ILM inverted flap. At baseline and every follow-up visit (1, 3, 6, 12months and the most recent) we performed best-corrected visual acuity (BCVA, Snellen) and optical coherence tomography (OCT), collecting several parameters: minimum linear diameter (MLD), basal diameter (BD), peri-HMMH nasal and temporal retinal thickness (RTNAS and RTTEM), peri-HMMH nasal and temporal O-RS height (O-RSNAS and O-RSTEM). The ratios O-RSNAS/ RTNAS and O-RSTEM/RTTEM were defined as %O-RSNAS and %O-RSTEM. Postoperatively, we distinguished classic HMMH closure (n = 14) from a newly described "delayed" closure pattern (n = 5). Primary anatomical closure was obtained in 89% of eyes. Mean BCVA improved from 0.23 ± 0.17 to 0.44 ± 0.20 and 0.46 ± 0.25 at 6-months and final follow-up (p = 0.009 and p = 0.001, respectively). At every follow-up, "classic" vs. "delayed closure" did not influence BCVA (all p > 0.05). Baseline O-RSNAS (p = 0.026), O-RSTEM (p = 0.04), %O-RSNAS (p = 0.04) and %O-RSTEM (0.004), were significantly associated with the "flap closure" pattern, differently from MLD and BD. In the "delayed closure" subgroup we reported a 100% closure rate, but 65.8 ± 64.4days after first surgery. Meantime, OCT showed an inverted ILM flap covering an area of persistent tissue loss. O-RSNAS and O-RSTEM progressively reduced until HMMH closure. Inverted flap is useful to close HMMH with O-RS. In case of "delayed closure" pattern, watchful-waiting allows for HMMH self-sealing, without impact on BCVA. What is known Inverted internal limiting membrane (ILM) flap showed favorable anatomic success in cases of highly myopic macular holes (HMMH). What is new HMMHs with outer retinoschisis (class 2c of the staging system) may close following a classic or "delayed closure" pattern. In cases of delayed closure, it took a variable range of 30-179days to seal the HMMH but no further surgery was advisable. Post-operative BCVA improvement was not impacted at any follow-ups when comparing "delayed" and "classic" closure subgroups.

Post-Cataract Surgery Fungal Endophthalmitis: 6-Year Experience in Management and Outcomes at a Tertiary Eye Care Center.

This study aimed to describe the functional and anatomical outcomes of post-cataract surgery fungal endophthalmitis at King Khaled Eye Specialist Hospital (KKESH). A retrospective analysis of clinical data from a single institution was performed. This study included 29 patients with post-cataract surgery endophthalmitis with suspected or confirmed fungal etiology who presented between January 1, 2017, and December 31, 2022. We evaluated demographics, clinical features, microbiological assessments, and treatment strategies. The effects of various treatments on outcomes were analyzed. The need for additional treatment and functional and anatomical outcomes was also investigated. The mean time from surgery to the onset of ocular symptoms was 52.1 (SD ± 59.9; range, 3-210) days, and the mean time from surgery to the first visit to KKESH was 81.4 (SD ± 103.5; range, 2-510) days. Low culture positivity was noted in four samples, with two revealing Aspergillus sp. and two revealing Cladosporium sp. Of the 29 patients, 6 underwent pars plana vitrectomy (PPV) and received intravitreal antimicrobial/antibiotic injections. Two of the six patients also underwent simultaneous intraocular lens removal. The average number of additional treatments, regardless of visual acuity, was lower in the PPV group than in the conservative group (0.5 [SD ± 1.1; range, 0-3] and 1.48 [SD ± 1.47; range, 0-6], respectively). In the PPV group, 50% (n=3) of the eyes achieved functional success and 83.3% (n=5) of the eyes achieved anatomical success. In contrast, in the conservative group, 43.5% (n=10) of the eyes achieved functional success and 69.6% (n=16) of the eyes achieved anatomical success. For post-cataract surgery fungal endophthalmitis, a high index of suspicion and prompt PPV with empirical administration of intravitreal antifungal agents are required to achieve a favorable prognosis.

Clinical outcomes and prognostic factors in patients with nasolacrimal duct obstruction or stenosis using dacryoendoscopy.

To evaluate the effectiveness of dacryoendoscopic-assisted laser dacryoplasty with silicone intubation (DLDI) for the management of nasolacrimal duct obstruction (NLDO) or stenosis, and to identify the factors associated with DLDI failure. This study was designed as a prospective, single-centre cohort study. Patients with NLDO or stenosis who underwent DLDI from December 2019 to December 2021 at Tianjin Eye Hospital were considered for enrolment. The Kaplan-Meier estimator was used to assess the anatomical and functional success rate of DLDI within 2 years follow-up after removal of the silicone stent. Cox proportional hazards regression models were used to identify risk factors for treatment failure. 170, 174 and 178 eyes were included in Groups A (proximal NLDO), B (distal NLDO) and C (nasolacrimal duct stenosis), respectively. The overall anatomical success rate was 84.8% for the entire cohort at the 2-year follow-up. The cumulative anatomical or functional success rate for Groups B and C was significantly higher than that for Group A. In the multivariable model, a higher risk of failed DLDI surgery was associated with a history of chronic dacryocystitis (HR=3.07; p<0.001) and a longer duration of epiphora than 1 year (HR=2.67; p<0.001). Of the 522 eyes, 37 patients (7.1%) had surgery-related complications. DLDI is an effective minimally invasive technique for treatment in patients with distal NLDO or stenosis. Factors associated with a higher risk of reoperation include a longer duration of epiphora and a history of chronic dacryocystitis. NCT05999058.

Modified laparoscopic sacrocolpopexy for advanced posterior vaginal wall prolapse: a 3-year prospective study.

To evaluate and validate the safety and efficacy of modified laparoscopic sacrocolpopexy for advanced posterior vaginal wall prolapse at up to 3 years of follow-up. As a prospective observational study, we collected 56 cases with advanced posterior vaginal wall prolapse and performed modified laparoscopic sacrocolpopexy (MLSC) with self-cut mesh. The main improvement is the cutting and fixing of the mesh. Patients were followed up at 6, 12, 24 and 36 months. The main indicators of follow-up were postoperative anatomic success rate and Pelvic organ prolapse quantitation (POP-Q) score, and secondary indicators were related to quality-of-life scales and postoperative complication rates. All patients completed the operation through minimally invasive surgery, and there were no vital organs and blood vessel damage during the operation. The mean age was (58.32 ± 7.63) years. There was no recurrence of stage I or lower during the follow-up maximum of 36 months (median 24 months), and the anatomic success rate was 100%. The quality-of-life scores improved significantly (p < 0.001) and the quality of sexual life was not affected (p = 0.5). There was 1 case of continuous vaginal mesh exposure at 12 months (2.86%) and 1 case of severe infection with poor healing of vaginal stump within 6 months (1.79%). No one had urinary incontinence (UI) requiring reoperation. In patients with advanced posterior vaginal wall prolapse, MLSC can provide good and durable pelvic floor anatomical recovery and functional outcomes with no specific complications.

Multilayered Inverted Internal Limiting Membrane Flap Technique in Optic Disc Pit Maculopathy.

To evaluate the anatomical and visual outcomes of the multilayered inverted internal limiting membrane (ML-ILM) flap technique in the treatment of optic disc pit maculopathy (ODPM). In this retrospective interventional case series, medical records and macular spectral-domain optical coherence tomography images of patients who underwent combined pars plana vitrectomy with ML-ILM flap surgery for ODPM were analyzed. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) at postoperative 6 months were compared with baseline findings. Intraoperative and postoperative complications, fluid resolution time, and recurrence during follow-up were recorded. Five eyes of 5 patients with ODPM were included in the study. According to the preoperative macular fluid characteristics, 2 patients had only intraretinal fluid, while 3 patients had intraretinal and subretinal fluid. The preoperative median BCVA was 1.0 logarithm of the minimum angle of resolution (logMAR) (range, 1.0-1.3 logMAR), and the CMT was 560 μm (range, 452-667 μm). At the 6-month postoperative follow-up, the median BCVA was 0.40 logMAR (range, 0.1-0.7 logMAR), and CMT was 315 μm (range, 265-326 μm) (p=0.042 and p=0.043, respectively). During the 6-month follow-up period, no recurrence or full-thickness macular hole formation was observed. The ML-ILM flap technique is a preferable surgical option to achieve both high anatomical and functional success and flap stabilization.

Does the suturing technique (barbed continuous versus conventional interrupted) impact the outcome of anastomotic urethroplasty?

To evaluate and compare continuous suture (CS) and interrupted suture (IS) techniques applied in excision and primary anastomosis (EPA) urethroplasty in terms of surgical success and complication rates. A retrospective evaluation was conducted on patients with bulbar urethral strictures measuring ≤ 2.5cm who underwent EPA between April 2020 and December 2022. Patients with a history of urethral reconstruction, multiple strictures, a history of pelvic radiotherapy, a diagnosis of Lichen sclerosis, a history of surgery due to congenital penile curvature or Peyronie's disease, and a follow-up period of less than 12months were excluded. The patients were divided into two groups according to the suture technique used (CS or IS), and the groups were compared for demographic and perioperative data. A total of 97 patients (CS n = 52, IS n = 55) were included in the sample. The mean age of the entire patient group was calculated to be 56.2years and the mean stricture length was 19.3mm. Operation time and postoperative catheter time were shorter in the CS group (94.7 ± 7.3 vs. 117.2 ± 5.7min and 9.9 ± 1.6 vs. 15.8 ± 1.9min, p < 0.001, respectively). The groups were similar regarding anatomical success, stress urinary incontinence, penile numbness, curvature, and postoperative infection (p > 0.05). No significant difference was observed in terms of success or complications between the CS and IS techniques employed during EPA urethroplasty. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier.

Long-term surgical outcomes and prognostic factors for advanced-stage retinopathy of prematurity after vitrectomy

Background/aimsThe aims of this study is to evaluate the anatomic, visual outcomes and associated prognostic factors in patients with advanced retinopathy of prematurity (ROP) following vitrectomy.MethodsA retrospective cohort study of...

Epidemiology of Pediatric Retinal Detachment and the Surgical Anatomy of Pediatric Eyes

Retinal detachment (RD) is a common cause of blindness across the adult population in comparison to the pediatric population. Pediatric retinal detachment (PRD) is a rare and compelling clinical entity and is different in comparison to adult RD, due to different etiology, anatomical features, management, and prognosis. Pediatric retinal detachments can be challenging even for expert vitreoretinal surgeons because of the higher prevalence of total retinal detachment (RD), bilateral involvement and late diagnosis. Furthermore, even if anatomical success is achieved with surgery, it is not always related to a full functional recovery. This review handles the epidemiology and surgical anatomy of pediatric retinal detachments.

Effectiveness of surgical approach in the management of non-traumatic corneal perforations

ABSTRACT Clinical relevance Non-traumatic aetiologies are one of the leading causes of corneal perforations. The management of corneal perforation is quite challenging and complex for anterior segment surgeons. The appropriate surgical approach for each case is usually determined on the basis of a combination of many different parameters. Background The study aimed to evaluate surgical approach options and outcomes in the treatment of non-traumatic corneal perforations. Methods Patient data who underwent surgery for non-traumatic corneal perforation between 2016 and 2023 were retrospectively evaluated. Medical records were assessed in terms of age, gender, perforation aetiology, the first and last examination notes, surgical approach, follow-up time, and additional surgeries and outcomes according to anatomical, therapeutic and functional success. Anterior segment photographs were investigated for thorough explanation of the examinations. Results Forty-five eyes of 45 patients were included (mean age 61.2 ± 22.4 (90-2), female/male ratio 20/25). Surgical approaches applied according to the size and location of the perforation site included fibrin glue application (6), amniotic membrane transplantation (AMT) (9), corneal patch graft application(15), and tectonic keratoplasty (15). The ratio of inflammatory and infectious causes as the two main indications was 29/16. Globe integrity was ensured with the first surgery in 27 eyes. However, 17 eyes required secondary surgical attempts due to failure of the first approach and 1 eye underwent evisceration. AMT was the least successful method among other methods in anatomical, therapeutic, and functional assessment. Conclusion There are various surgical approaches for repairing non-traumatic corneal perforations, each with its own advantages and disadvantages. These include high tissue resistance, the ability to remove necrotic tissue, ease of access, and anti-inflammatory activity. It is possible to successfully repair corneal perforations with single and combined methods, considering the above-mentioned features, especially depending on the size and location of the defect. While AMT is a viable and time-saving choice − especially in the lack of donor tissues − further interventions are necessary in most circumstances.

Surgical Treatment Of Coats Disease

In the treatment of Coats' Disease, conservative ablation methods such as laser photocoagulation and cryotherapy are preferred in the early stages and more comprehensive surgical interventions are required for advanced stages (Stage 3 and 4). At these stages, the expanding subretinal fluid and exudates limit the effectiveness of vascular ablation, necessitating the addition of drainage for subretinal fluid and exudates to the treatment. The most commonly accepted method is the transscleral external drainage of subretinal fluid, which is relatively safe as it preserves retinal integrity. However, the development of epiretinal membrane (ERM) are seen quite frequently, especially in patients who have received multiple ablative treatments. In patients with significant ERM, adding pars plana vitrectomy (PPV) and membrane peeling to the external drainage surgery can increase anatomical success by reducing the VEGF load in the vitreous and relieving retinal tractions, potentially reducing the need for additional ablation treatments. Considering the low visual expectations in Stage 3A-4 Coats' disease, the focus of post-surgical treatment expectations in these patients should shift from improving vision to preserving the globe and controlling the disease activity.

The use of amniotic membrane injection as an adjunct in endoscopic urethral stricture management

ABSTRACT Introduction: Endoscopic urethral stricture treatment has high recurrence rates. Due to research supporting amniotic membrane’s (AMs) anti-inflammatory and anti-fibrotic properties reducing scar tissue formation, AM has generated interest in reconstructive urethral surgery. To the best of our knowledge, we performed the first investigation of the success rate of urethral dilation when combined with micronized AM injection for the treatment of urethral stricture. Methods: Eligible patients were adult males with anterior strictures meeting strict criteria for diameter, length, International Prostate Symptom Score (IPSS), and flow rate. Micronized AM was injected in the stricture region during urethral dilation. The primary study endpoint was an anatomical success (≥14Fr) at 6 months. Secondary endpoints were evaluated with the IPSS, urethral stricture surgery – patient-related outcome measure, International Index of Erectile Function, flow rate, and postvoid residual. Outcomes were assessed at baseline and multiple points postinjection. Injection safety was analyzed. Results: Ten men with a mean age of 52 years were included in the study. At 6 months, 7 of 10 patients demonstrated recurrence of the urethral stricture on cystoscopy. Improvements in secondary endpoints were noted in 10 of 10 patients at 3 months and 3 of 10 patients at 6 months. No adverse events were observed. Conclusions: To the best of our knowledge, this is the first study evaluating micronized AM injection as an adjunct treatment at the time of urethral dilation. The urethral stricture recurrence rate did not improve with the injection of AM despite the hypothesized benefits of anti-fibrotic and anti-inflammatory properties.

The Wisconsin silicone oil study (report #1): anatomical and functional outcomes of repair of retinal detachment with proliferative vitreoretinopathy.

Silicone oil (SO) is a long-term tamponade for repair of complex retinal pathology but has limitations including late redetachment. This study describes our experience with SO tamponade for repair of retinal detachment with proliferative vitreoretinopathy (PVR), with attention to anatomic and functional outcomes. Retrospective consecutive case series of eyes with retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR) receiving SO tamponade at the University of Wisconsin between 2013 and 2019. Group 1 defined as primary SO placement; Group 2 had SO placed after failing prior retinal detachment repair. Inclusion criteria of SO placement for repair of RD with PVR was met for 117 eyes. The final reattachment rate was 84% for all eyes, with no difference between Groups 1 and 2. Vision improvement was 2.1 lines for Group 1 (p = 0.06 from baseline) and 4.6 lines for Group 2 (p < 0.0001). The mean number of silicone oil placements was 1.4. Less improvement in vision was noted with repeat SO placement, though overall functional vision of 5/200 or better was achieved in 63.2% of patients. SO tamponade allows long-term anatomical stabilisation and substantial vision recovery in eyes with retinal detachment complicated by PVR. Rates of anatomic and functional success have improved significantly when compared to prior studies using oil tamponade for repair of PVR.

MENISCUS MICROPYON: An Ophthalmoscopic Sign Possibly Associated With Epiretinal Proliferation After Retinal Surgery With Gas Tamponade.

To describe an ophthalmoscopic sign, termed a meniscus micropyon, and its possible association with proliferative vitreoretinopathy/epiretinal membrane (ERM) formation after retinal surgery with gas tamponade. Patients with intravitreal gas were examined postoperatively by one of six vitreoretinal surgeons from four institutions. A micropyon was defined as a white-yellow, solid-appearing consolidation along the meniscus (i.e., the fluid-gas interface). A micropyon was visualized and photographed in 49 patients who received intravitreal gas. Preoperatively, retinal breaks were present in all 49 eyes and rhegmatogenous retinal detachment in 45 (92%). Postoperatively, 39 eyes (80%) developed epiretinal proliferation: 16 eyes (33%) developed recurrent rhegmatogenous retinal detachment from proliferative vitreoretinopathy, 6 eyes (12%) re-detached without frank proliferative vitreoretinopathy, 9 eyes (18%) developed postoperative ERM/worsening, and 8 eyes (16%) had postoperative ERM but no preoperative optical coherence tomography to determine if the postoperative ERM was new or worsening. The single-operation anatomical success in eyes with a micropyon was 51%, which was lower than that of a contemporaneous rhegmatogenous retinal detachment control group (91%) in which no micropyon was detected. In two patients, micropyons were biopsied during pars plana vitrectomy and examined histopathologically; they consist predominantly of white blood cells. The meniscus micropyon is an ophthalmoscopic sign that can occur after retinal surgery with gas tamponade. Features that distinguish a micropyon from postvitrectomy fibrin/fibrinoid syndrome include delayed appearance, hyperautofluorescence, absence of translucent strands or sheets in the anterior chamber or vitreous cavity, and the histopathologic identification of white blood cells. A clinically detectable micropyon may be a biomarker of proliferative vitreoretinopathy/ERM formation.

Transplantation of human pluripotent stem cell-derived retinal sheet in a primate model of macular hole

Macular hole (MH) is a retinal break involving the fovea that causes impaired vision. Although advances in vitreoretinal surgical techniques achieve >90% MH closure rate, refractory cases still exist. For such cases, autologous retinal transplantation is an optional therapy showing good anatomic success, but visual improvement is limited and peripheral visual field defects are inevitable after graft harvesting. Here, using a non-human primate model, we evaluated whether human embryonic stem cell-derived retinal organoid (RO) sheet transplantation can be an effective option for treating MH. After transplantation, MH was successfully closed by continuous filling of the MH space with the RO sheet, resulting in improved visual function, although no host-graft synaptic connections were confirmed. Mild xeno-transplantation rejection was controlled by additional focal steroid injections and rod/cone photoreceptors developed in the graft. Overall, our findings suggest pluripotent stem cell-derived RO sheet transplantation as a practical option for refractory MH treatment.

Management of adult focal nasolacrimal duct stenosis: long-term outcomes of 3D CT-DCG-assisted and endoscopically guided coronary catheter balloon dacryoplasty.

The purpose was to evaluate the use of 3D CT-DCG-assisted and endoscopically guided coronary catheter balloon dacryoplasty (CC-BDCP) in adults with focal stenosis of the nasolacrimal duct (NLD) and report their long-term outcomes. A prospective, non-randomized, single-center clinical study was performed, and the patients underwent endoscopy-guided CC-BDCP using percutaneous transluminal coronary angioplasty (PTCA) balloon catheters. 25 patients were enrolled in the study. The CC-BDCP procedure was performed in 21 of 25 (84%) patients, and the remaining 4 (16%) patients had significant procedural difficulties due to unfavorable anatomical conditions. Of the 21 patients, 10 (47.6%) were procedurally assessed as "easy" (eCC-BDCP) and in 11 (52.4%) as procedurally "difficult" (dCC-BDCP). Values on Munk's epiphora intensity scale changed overall from 4.0 preoperatively to 1.4 ± 1.6 (p = 0.00001) postoperatively overall. FDDT changed overall from 2.9 ± 0.3 to 1.1 ± 1.2 after treatment (p = 0.00008) (from 2.8 ± 0.4 to 0.3 ± 0.6 in the eCC-BDCP group and from 2.9 ± 0.3 to 1.4 ± 1.2 in the dCC-BDCP group (p = 0.01352). The anatomical and functional success rate was 77% overall, 90% in the eCC-BDCP group, and 64% in the dCC-BDCP group. The CC-BDCP led to a statistically significant decrease in epiphora in a particular group of adult patients with demonstrable focal stenosis of the NLD.

The efficacious combined treatment of rhegmatogenous retinal detachment (PVR ≤ C2) with inferior breaks using 25-gauge pars plana vitrectomy and air tamponade.

To examine the surgical results of 25-gauge (25-G) pars plana vitrectomy (PPV) with air tamponade for the repair of primary rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. A retrospective consecutive study was conducted from March 2019 to February 2023 on 27 patients with primary RRD with inferior breaks who underwent 25-G PPV with air tamponade. Once the surgery was completed, the patients were monitored for a minimum of 6 months. Postoperative best-corrected visual acuity (BCVA), postoperative complications, and the rate of single surgery anatomical success were the primary outcome measures. The average age of the 12 female and 15 male study participants was 50.2 ± 12.8 years. The follow-up period was 10.3 ± 3.9 months on average. On average, the affected clock hours were 5.6 ± 2.1 hours, and the average number of retinal breaks was 2.2 ± 1.8. Moreover, the final anatomical success rate was 100%, compared to the estimated initial anatomical success rate of 96.30% following a single surgery. At 6 months, we also noticed a significant change in the mean BCVA, which went from 1.62 ± 0.71 logMAR (preoperative) to 0.89 ± 0.61 logMAR (postoperative) (P < .001). On the first day and the week following surgery, the mean intraocular pressure (IOP) was similar (all P > .05). One patient experienced postoperative complications such as retinal redetachment, which was addressed with the same procedure. After surgery, 2 patients had IOP of 35 and 28 mm Hg for 1 week. Two weeks following surgery, their IOP essentially returned to normal after receiving antihypertensive medication. No other notable postoperative complications were observed. According to this research, 25-G PPV with air tamponade has a satisfactory success rate in repairing primary RRD with inferior breaks. This procedure also produces quicker visual recovery and is linked to fewer complications.

Creation of neovagina in women with Müllerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) using fresh human amnion.

Several graft options can be used to construct a neovagina. This study aimed to evaluate the efficacy of creating a neovagina using a fresh human amnion in women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Ten patients were analyzed retrospectively. Anatomical success was defined by a postoperative vaginal length ≥5 cm, and a width sufficient to comfortably accommodate the insertion of two fingers. Functional success was achieved when a score of >26.5 was attained on the Arabic validated version of the functional sexual function index (FSFI). The mean vaginal length before surgery was 2.15±0.85 cm (range, 1.5-4.5). The mean vaginal length after surgery was 5.5±0.53 cm (range, 5-6), and all patients (n=10) achieved anatomical success. The FSFI score after surgery was 29.2±2.4, and eight patients achieved functional success. The mean operative time and estimated blood loss were 83.5±50.31 minutes (range, 42-210) and 122.0±75.69 mL (range, 20-250), respectively. None of the patients required intraoperative blood transfusion or experienced injury to vital organs. Four patients developed postoperative leukocytosis within 48 hours, and one patient experienced chronic pelvic pain that lasted more than 6 months postoperatively. No major postoperative complications, such as pelvic abscesses, open wounds, chronic vaginal discharge, or reoperation, were reported. Surgical dissection of the vesicorectal space and utilization of fresh human amnion to create a neovagina over a vaginal mold are technically feasible and safe, and are linked to favorable anatomical and functional outcomes in MRKH patients with vaginal agenesis.

Comparison of preoperative and postoperative results of "canalicular triangular flap" and "triangular three-snip" punctoplasty techniques in patients with punctum stenosis using anterior segment optical coherence tomography.

To compare the results and success rates of patients with epiphora due to punctal stenosis operated with the "canalicular triangular flap punctoplasty" and the "triangular three -snip punctoplasty" using anterior segment optical coherence tomography (AS-OCT). This study is a retrospective cohort analysis of patients who were diagnosed with punctal stenosis and underwent canalicular triangular flap or triangular three-snip punctoplasty between September 2021 and June 2022. The study included 80 eyes of 43 patients consisting of 15 males and 28 females. Forty eyes underwent canalicular triangular flap punctoplasty (Group A) and 40 eyes underwent triangular three-snip punctoplasty (Group B) technique. The mean age of the patients was 63.9 ± 10.9 years (37-88 years). In Group A, the anatomic success was 100% and functional success was 95% at 6 months. In Group B, 77.5% functional success and 75% anatomic success were achieved at 6 months. The canalicular triangular flap technique was more successful in providing punctal patency both anatomically and functionally than the triangular three-snip punctoplasty. AS-OCT is a method that provides objective, quantitative results in the diagnosis and follow-up of punctal stenosis and may be used more widely in punctum and vertical canaliculi pathologies.

Endoscopic dacryocystorhinostomy in acute dacryocystitis: a multicenter study in China.

To report the clinical profile, endoscopic dacryocystorhinostomy (En-DCR) management, and acute dacryocystitis (AD) outcomes in China. Clinical data of 554 adult AD patients (554 eyes) who presented in 7 tertiary eye care centers for 10y from Jan 2010 to Mar 2020 were retrospectively analyzed. Clinical profile, En-DCR management, and outcomes of all cases were recorded. The anatomical and functional success were evaluated for 12mo post-operation. The analysis included 149 males and 368 females with a median age of 55.2y (range: 18-84y). There were 459 eyes with a history of epiphora or purulent secretion. The time between a symptom of lacrimal duct obstruction and acute onset was 1 to 540 (66.1±58.2)mo. Fifty-nine eyes had a history of the previous acute attack. Seventy-four eyes developed a cutaneous fistula, while 11 eyes had post septal cellulitis pre-operation. En-DCR with an anatomical success of 91.7% and functional success of 90.1%. The success rate of the patients with a history of acute episodes and the preoperative fistula was lower than the overall success rates. En-DCR can be performed during an acute episode in AD with a success rate of over 90%.

Clinical Outcomes of Stage 2 (Pivotal) Use of a Modified Keratoprosthesis Device (ORC-KPro) in Patients with End-stage Corneal Blindness.

To investigate the short-term results and performance of a modified Boston keratoprosthesis device manufactured by the Ophthalmic Research Center (ORC-KPro) in patients with end-stage corneal blindness. This prospective interventional case series was conducted on patients with corneal blindness who were candidates for KPro. The inclusion criterion comprised patients with a best-corrected visual acuity (BCVA) of less than 20/200 in both eyes, in whom the main reason for vision loss was corneal pathology. The ORC-KPro was implanted using the method previously described for Boston KPro. This study focused on 12 eyes of 12 patients with an average age of 45.9 16.8 (range, 19 to 70) years. Eleven patients were male. The KPro indication was corneal blindness due to chemical burns in nine patients (75%) and failure of multiple previous corneal grafts in three patients (25%). Anatomical success was achieved in all patients. The preoperative BCVA was light perception (LP) in 10 eyes and hand motion in 1 eye. Except for one patient who was diagnosed with grade C proliferative vitreoretinopathy during the surgery, the vision of all other patients (91.6%) improved after surgery. The retroprosthetic membrane (RPM) was formed in two eyes (18.1%) after six months. Of the 12 patients, 10 (83.3%) were under treatment with two antiglaucoma medications before surgery. The intraocular pressure of three eyes (25%) was estimated to be high by tactile palpation; however, it decreased in two eyes to the acceptable range. One patient underwent retinal surgery due to total retinal detachment, and two patients (16.7%) underwent vitrectomy due to endophthalmitis. The current study showed that, in the short term, the use of ORC-KPro achieved favorable anatomical success in patients with corneal blindness. However, the functional success rate was limited by the low visual potential due to advanced glaucoma in most patients.