FCI Ophthalmics Research Articles

Effect of surgical microscope and illuminated chopper on anterior chamber temperature

BackgroundTo evaluate the effect of the light intensity of the surgical microscope and illuminated chopper on the anterior chamber temperature.Study designExperimental study.MethodsA model eye (Kitaro WetLab System; FCI Ophthalmics, Pembroke, MA, USA) was used in this experimental study. The illuminance of a surgical microscope (Leica M300; Leica Microsystems, Wetzlar, Germany) and illuminated chopper (iChopper NAM-25 GB; Oculight, Korea) with a light source (iVision; Oculight) was measured using an illuminometer. In addition, the temperature in the anterior chamber of the model eye filled with balanced salt solution when using the surgical microscope with a light intensity from level 1 to level 6 and the illuminated chopper at 99% light intensity was measured for 10 min.ResultsThe anterior chamber temperature was increased by 0.2, 0.5, 1.0, and 1.4 ℃ when using the surgical microscope at level 3 (10050 lux), 4 (16490 lux), 5 (24900 lux), and 6 (32500 lux), respectively, for 10 min. The illuminated chopper at 99% light intensity (14893 lux) positioned in the anterior chamber increased the anterior chamber temperature by 0.2° C after 10 min, which was equal to the increase in the temperature caused by the surgical microscope at level 3.ConclusionThe photothermal effect of the illuminated chopper directly positioned in the anterior chamber appeared to be similar to that of a microscope with similar illuminance. Therefore, the illuminated chopper is safe in terms of anterior chamber temperature changes in cataract surgery.

Pattern of Presentation and Surgical Outcomes of Canalicular Laceration Repair in a Pediatric Population.

To evaluate demographic data, clinical profile, and factors responsible for the success of anatomical and functional outcomes of canalicular laceration repair with the Mini Monoka stent (FCI Ophthalmics) in children younger than 10 years. This was a retrospective cohort observational study involving children younger than 10 years who underwent canalicular tear repair with the Mini Monoka stent with a minimum follow-up of 6 months. A total of 18 patients (9 boys and 9 girls) with a mean age of 5.39 ± 3.05 years were included. Twelve and 6 patients had lower and upper canalicular tear, respectively. Six (33.4%) patients had associated ocular comorbidity. The common mode of trauma was direct injury in 77.8% of the patients. The blouse hook of the mother was noted as the most common object causing canalicular laceration. Early repair (< 48 hours) and delayed repair were done in 7 (38.9%) and 11 (61.1%) patients, respectively. Anatomical and functional success was achieved in 88.9% and 94.4% of patients, respectively. The odds ratio (95% CI) for anatomical and functional success with the time since injury was 0.6 (CI: 0.03 to 11.47) and 0.19 (CI: 0.01 to 5.33), respectively. There was no significant difference between the early and delayed repair groups in terms of the distribution of anatomical (P = 1.000) and functional (P = .389) success. There was no significant difference between the various groups in terms of the distribution of complications (P = .224). Canalicular laceration repair with the Mini Monoka stent in children younger than 10 years has shown good outcomes in terms of anatomical and functional success irrespective of time lag since injury to repair. [J Pediatr Ophthalmol Strabismus. 2021;58(1):42-47.].

The Effect of Two Different Frontalis Sling Approaches on Postoperative Eyelid Contour: A Comparative Study.

To compare two different frontalis sling approaches, tarsal fixation and orbicular muscle fixation, using silicone rod (FCI Ophthalmics, Marshfield Hills, MA, USA) in terms of postoperative upper eyelid contour in patients with poor levator muscle function. Retrospective, comparative, case series. Ten eyes of seven patients who received frontalis sling surgery with orbicularis muscle fixation (group 1), eight eyes of seven patients who received frontalis sling surgery with tarsal fixation (group 2) and 30 eyes of 15 age and sex-matched healthy controls (control group) were included. Postoperative photographs of all the participants were taken in the primary gaze, and each photograph was viewed on a computer. The distance between the upper lid margin and pupillary center (MCD), nasal limbus (MND), and temporal limbus (MTD) was measured, respectively, using the ruler in Microsoft Paint Software and compared with each other for each participant. Both nasal, central and temporal margin distance values in group 1 and group 2 were significantly lower than those of the control group (p<0.05 for all values). The ratio of MTD/MCD in the control group was significantly higher than group 1 (p = 0.04) besides the ratio of MND/MTD in the control group was significantly lower than group 1 (p = 0.01). Frontalis sling approach with tarsal fixation using silicone rod might provide improved cosmetic results including more symmetrical upper eyelid contour compared with orbicularis muscle fixation approach. Moreover, the novel measuring technique presented in the current study provides a simple and effective assessment of the upper lid contour in daily practice setting. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Mini-monoka stenting for patients with perennial allergic conjunctivitis

ABSTRACTPurpose: To assess the effectiveness of mini-monoka (MM) stenting in treating patients with perennial allergic conjunctivitis (PAC) and punctal stenosis.Methods: A retrospective case analysis was performed on 20 patients (40 eyes) who suffered from PAC with punctal stenosis who underwent MM (FCI Ophthalmics, Pembroke, MA, USA) stenting.Results: Nineteen patients (95%) were females, with an age range of 19–66 years (average 40.6 ± 25.4 years). All 20 patients (100% of eyes) had signs of PAC and punctal stenosis. All 20 patients (40 eyes) had received previous topical treatment including steroids. Nineteen patients (95% of eyes) had significant improvement in their allergy symptoms (tearing and conjunctival inflammation) following MM stenting.Conclusions: Stenosis of the punctum may play a role in the relapsing symptoms in PAC. MM stenting is a simple, safe, effective, and relatively non-invasive treatment option for the management of PAC in the presence of punctal stenosis.

The short-term efficacy and psycological influence of elastic silicon punctal plugs on severe dry eye patients

Objective: To evaluate the short-term efficacy and psycological influence of elastic silicon punctal plugs on severe dry eye patients. Methods: Prospective case series study. Twenty-eight severe dry eye patients (56 eyes) treated with elastic silicon punctal plugs (Snug Plugs(TM), FCI Ophthalmics, France) during January to September 2017 at the ophthalmology department of Peking Union Medical College Hospital were included. All the examination results were collected at baseline and 3 months after insertion. Uncorrected visual acuity (UCVA), silt lamp examination, conjunctiva grading (CG), lower tear meniscus height (TMS), tear break-up time (BUT), Schirmer Ⅰ test (SⅠt, without anesthesia), corneal fluoresce staining (FS) were recorded to evaluate the efficacy of the plugs. Meanwhile, Ocular Surface Disease Index (OSDI), Self-Rating Anxiety Scale (SAS) and Center for Epidemiological Survey-Depression Scale (CES-D) were collected to assess the changes of patients' symptoms and psychological status. Results: At baseline and 3 months after punctal plugs insertion, mean OSDI score was 65.77±21.28 and 42.85±20.08; mean UCVA was 0.10 (0.30) and 0.06 (0.27), mean TMS was (0.17±0.09) and (0.35±0.17) mm;mean CG score was 2.96±1.13 and 1.57±0.99; mean BUT was (3.23±2.62) and (5.09±3.36) s;mean FS score was 7.32±4.46 and 5.15±4.02; mesn SⅠt was (4.09±3.48) and (8.15±5.96) mm; mean SAS score was 46.70±9.73 and 40.59±8.98, respectively. All the above differences between results of baseline and 3 months after insertion were of statistical significance (t=6.11, -6.31, 8.91, -8.97, -3.83, 5.06, -6.14, 3.04, P<0.01). The mean CES-D score at baseline was 21.25±10.82, which was statistically different from the result of 15.00±10.53 at 3 months after insertion (t=2.38, P<0.05). The number and the severity of patients with anxiety or depression were reduced after insertion. OSDI score was negatively correlated with UCVA, TMH and SⅠt (r=-0.42, -0.61, -0.31, P<0.05), and was positively correlated with FS, SAS and CES-D score (r=0.36, 0.31, 0.28, P<0.05). The main complication identified during this study was spontaneous loss of the punctal plugs (3 eyes, 8.82%). Conclusions: Short term elastic silicon punctal plugs are effective for treating moderate to severe dry eye, and such treatment can partly alleviate the anxiety and depression of the patients. Still, more attentions to the psychological status of dry eye patients should be paid. (Chin J Ophthalmol, 2018, 54: 437-444).

Microscope-Assisted Reconstruction of Canalicular Laceration Using Mini-Monoka

A canalicular laceration is the most common injury of the lacrimal drainage system and can result from direct or indirect injury to the canalicular system. If the wounds are not managed properly, they can lead to scarring, stenosis, and inflammation, which may lead to symptomatic epiphora. We successfully reconstructed canalicular lacerations using Mini-Monoka tubes (FCI Ophthalmics, Marshfield Hills, MA) under microscopic magnification.We treated 14 patients for canalicular lacerations at the Soonchunhyang University Bucheon Hospital between August 2009 and October 2012. All patients underwent placement of a Mini-Monoka tube and a mucosal canalicular anastomosis microscopically to reconstruct monocanalicular lacerations. The tubes were removed at 6 to 8 months postoperatively, and follow-up was 8 to 12 months. No complications related to the Mini-Monoka tube, such as punctual plug migration, eye irritation, inflammation, granuloma formation, or erosion, occurred during the follow-up period.The goal of reconstructing a lacerated canaliculus is accurate approximation of the injured end of the canaliculus to facilitate mucosal healing and to prevent a canalicular obstruction. We believe that microscopic canalicular reconstruction with a Mini-Monoka tube is a safe, reliable, and straightforward method with fewer complications and is more effective for preventing iatrogenic injury in the unaffected canaliculus and minimizing patient discomfort.

Comparison of Retention Rates and Complications of 2 Different Types of Silicon Lacrimal Punctal Plugs in the Treatment of Dry Eye Disease

To investigate the retention rate and complications of 2 different types of silicon lacrimal punctal plugs with the focus on the relationship to punctum size. A prospective, nonrandomized, interventional, comparative study. Forty-four patients with dry eye syndrome received lacrimal punctal plug insertion with the Punctal Plug F (FCI Ophthalmics) and 30 patients received plug insertion with the Super Flex plug (Eagle Vision; Softplug-Oasis Medical Inc). In total, 110 plug insertion regions were performed using the Punctal Plug F (group A) and 110 insertion regions were carried out using Super Flex plug (group B). The gauging system of Eagle Vision was used before the lacrimal punctal plug insertion in all subjects. Plug conditions (retention rates, spontaneous plug loss, and removal) and complications related to lacrimal punctal sizes were compared between the 2 groups. Retention rates were 70.4% in group A and 30.1% in group B at 6months. Spontaneous plug loss occurrence was significant with the larger lacrimal punctum size in group A (P < .05), whereas no significant differences were observed between lacrimal punctum sizes and spontaneous loss in group B. Spontaneous plug loss occurrence was significant in elderly patients in group B (P < .05). Granuloma and injector troubles were observed in 1 and 2 cases in group A, respectively. The Punctal Plug F seems to be more applicable for insertion into the smaller punctal sizes. Punctum size and age seem to be important factors in determining the appropriate types of lacrimal punctal plugs.

Punctum-Sparing Canaliculotomy for the Treatment of Canaliculitis

Canaliculitis is an uncommon condition presenting with epiphora, medial eyelid swelling, pouting punctum, and punctal discharge. Surgical treatment with canaliculotomy with incision of the punctum is the treatment of choice when medical management fails. The risk of epiphora and functioning of the healed canaliculus is unknown. We describe a modification to the standard technique by leaving the punctum intact, incising the canaliculus along its full extent, and intubating the upper system with a silicone monocanalicular stent. The lower punctum is dilated, and a Bowman probe inserted into the canaliculus. A no. 11 Bard-Parker blade is used to incise the canaliculus along its full extent, beginning 2 mm medial to the punctum, leaving the punctum intact. The contents of the canaliculus are curetted, and purulent material, drained. The wound is left open, and a mini-Monoka silicone monocanalicular stent (FCI Ophthalmics, Marshfield Hills, MA) is inserted to bridge the gap between the intact punctum and lacrimal sac. The incision is left to heal by secondary intention. This modified punctum-sparing canaliculotomy was performed on 3 patients. In one patient, the upper and lower canaliculi were treated. The other 2 patients had involvement of the lower canaliculus only. All 3 patients tolerated the procedure well with full resolution of symptoms. No complaints of postoperative epiphora were made, and the system was patent to irrigation postoperatively. Punctum-sparing canaliculotomy with monocanalicular intubation is an effective treatment for canaliculitis and may be particularly useful in cases in which both upper and lower canaliculi are involved and the risk of postoperative epiphora and canalicular scarring is unknown.

Monocanalicular Intubation in External Dacryocystorhinostomy

To examine the feasibility of monocanalicular intubation in external dacryocystorhinostomy (EX-DCR).Monocanalicular intubation using the mini-Monoka tube (S1-1500u, FCI Ophthalmics, Marshfield Hills, MA, U.S.A.) was performed in 18 patients undergoing EX-DCR. The tube was placed at the superior canaliculus in 16 cases and at the inferior canaliculus in 2 cases and was removed 3 months postoperatively. All cases were followed for at least 6 months postoperatively.The mini-Monoka was well tolerated in all patients. One case of spontaneous tube dislocation and 2 cases of presumed tube migration were recorded on the 15-day interval. Success rates on the 6-month interval were 88.88% (16/18), 94.44% (17/18), and 66.66% (12/18), concerning patency upon irrigation, resolution of mucopurulent epiphora, and resolution of watery epiphora, respectively.Monocanalicular intubation using mini-Monoka in EX-DCR is safe and effective. The technique may have advantages over bicanalicular intubation, such as easier insertion and removal, easier probing and irrigation though the unintubated canaliculus and, more importantly, less risk of punctal or corneal damage.

Canalicular Lacerations: Repair with the Mini-Monoka ® Monocanalicular Intubation Stent

There are different techniques for reconstructing traumatic canalicular lacerations. The aim of this study is to report the surgical outcome with the Mini-Monoka monocanalicular stent (FCI Ophthalmics, Issy-Les Moulineaux, France). Patients with traumatic canalicular lacerations who underwent surgical reconstruction using the Mini-Monoka monocanalicular stent were included. The surgical outcome was based on subjective (epiphora) and objective (tear meniscus level, dye disappearance test, and lacrimal irrigation) findings after stent removal. Nineteen patients (15 males, 4 females; mean age: 34 years) were included. The upper canaliculus was injured in 5 cases and the lower in 14 cases. Successful stenting was accomplished in all cases. Postoperative eyelid position was satisfactory in most patients. The mean period of stenting was 5 months and the mean postoperative follow-up period was 13 months. There were no cases of premature stent extrusion. Functional drainage after stent removal was normal in 94.7% of patients. Syringing showed full patency with no narrowing or reflux. The Mini-Monoka monocanalicular stent is an effective tool in reconstructing traumatic canalicular lacerations. It is easy to use, carries a minimal risk of injury to the non-lacerated canaliculus, and results in high anatomical and functional success rates.

Microsurgical Reconstruction for Canalicular Laceration Using Monostent® and Mini-Monoka®

Many surgical techniques are available for repairing a lacerated canaliculus, such as, Worst pigtail probing, and monocanalicular or bicanalicular procedures involving silicone intubation. Despite this, controversy still exists regarding the best surgical method in terms of subjective and objective outcomes. We report the experience of microscopic canalicular repair using monocanalicular stents; Monostent (Eagle Vision Inc., Memphis, TN) and Mini-Monoka stents (FCI Ophthalmics, Marshfield Hills, MA) and compare these 2 products. Seventeen cases of canalicular lacerations in 15 consecutive patients underwent microscopic canalicular repair using a monocanalicular procedure with either a Monostent (Eagle Vision Inc.) (5 cases) or a Mini-Monoka stent (FCI Ophthalmics) (12 cases). Microscopic anastomosis of the canalicular mucosa was performed following the placement of a juxta canalicular suture to reduce tension. Subjective and objective flows of repaired lacrimal drainage systems were checked by saline injection using a Healon needle (Advanced Medical Optics, Inc., Santa Ana, CA) and dacryocystogram. Patent lacrimal drainage systems were achieved in 16 of the 17 cases, and mild epiphora was acceptable in 14 patients during follow-up. No cases of spontaneous punctal plug migration, stent displacement, eyeball irritation or inflammation, or granuloma formation were encountered. However, in one case, a Mini-Monoka stent (FCI Ophthalmics) was repeatedly extruded or clogged internally and replaced by Monostent (Eagle Vision Inc.). Although the latter had a larger conduit diameter, it was more flexible and had potentially folded on itself in the lacrimal sac, thus, obstructing flow in this case. Microscopic canalicular reconstruction using a Monostent (Eagle Vision Inc.) or Mini-Monoka stent (FCI Ophthalmics) offers a safe, effective, and straightforward means of acute lacrimal system injury treatment.

Effectiveness of canalicular laceration repair using monocanalicular intubation with Monoka tubes

This study aimed to evaluate the clinical efficacy of canalicular laceration repair using monocanalicular intubation with Monoka tubes. A total of 36 single lacerated canaliculi were repaired using monocanalicular intubation with Monoka tubes, without mucosal anastomosis of the canaliculi, and were retrospectively reviewed. Demographic information, injury locations, associated ocular injuries, complications and outcomes were analysed. Mean patient age was 34 years (range 1-64 years). Tubes were removed at a mean of 4.2 months (range 3-6 months). There were 26 lower canalicular lacerations (72%) and 10 upper canalicular lacerations (28%). Overall, 34 of 36 cases (92%) showed improvement in symptoms and exhibited positivity on the dye disappearance test at 4-12 months after the procedure (mean 7.8 months). In total, 21 patients (58%) achieved complete success, 13 patients (36%) achieved partial success and two patients (6%) suffered surgical failure. Complications were seen in five cases and included two early tube protrusions, two punctal slits and one punctal granuloma. Monocanalicular intubation with Monoka tubes leads to successful outcomes without significant complications and offers an alternative to bicanalicular intubation in the treatment of monocanalicular lacerations.

Long-term Retention Rates and Complications of Silicone Punctal Plugs in Dry Eye

To evaluate long-term retention rates and complications of silicone punctal plugs among dry eye patients. Prospective, observational cohort study. Ninety-five silicone punctal plugs (FCI plugs; FCI Ophthalmics, Issy-les-Moulineaux Cedex, France) were placed in 93 eyes of 47 dry eye patients. Within the observation period of up to eight years, this survey included recording of the retention rate, spontaneous loss, removal, canalicular permeability after loss or removal, as well as other complications such as infection, intrusion, and granuloma. The retention rate of the plugs was 84.2% after three months, 69.5% after one year, and 55.8% after a median of two years (range, 17 to 93 months). No infection was observed, but granulomatous formation occurred in three eyes (one with extrusion, two with intrusion). Three plugs had to be removed for local discomfort or epiphora, and one piece of a broken plug intruded. Canalicular stenosis after spontaneous loss occurred in 14.3% after three months, in 26.9% after one year, and in 34.2% after a median of two years. The retention rate after a median of two years of FCI punctal plugs was satisfactory with few complications. The major observation concerned canalicular stenosis after spontaneous loss.

Transcanalicular Endoscopic Laser-assisted Dacryocystorhinostomy (TELA-DCR)

Summary Objective: To assess the results in combined dacryoendoscopy followed by lacrimal drainage surgery with a transcanalicular laser-assisted approach combined with microsurgical endonasal DCR (TELA-DCR). Methods: Retrospective follow-up of a case series between 1998 and 2003. 82 patients were included in the study (43 females/39 males, age 47.8 years). All patients underwent a combined examination by an ophthalmologist (GVA) and an otorhinolaryngologist (AS/KL) consisting of a routine clinical examination of the eyes, the lacrimal system and the nasal cavity as well as the paranasal sinuses with probing and syringing of the lacrimal drainage system, a radiological examination with digital subtraction dacryocystography (dsDCG) and computerized tomography (CT) of the bony structures. Of 122 lacrimal systems with dacryoendoscopy (Schwind Vitroptic®, Germany), 68 had a bicanalicular silicone intubation without surgery, 12 had a transcanalicular laserdacryoplasty (Erb:YAG-Laser; Schwind-Sclerostome®, Germany) with bicanalicular silicone intubation (Ritleng; FCI Ophthalmics, France) and 42 had TELA-DCR with a silastic-sheet inlay in the bony window for two to three days. 7 of these 42 have already had lacrimal surgery elsewhere. 2 had external lacrimal surgery (Toti procedure) and 5 had endonasal surgery (West procedure). Dacryoendoscopy was used to review the diagnosis of digital subtraction dacryocystography (dsDCG) and for surgical intervention in the same session. Surgery was done in general anesthesia. All patients were admitted to the inpatient department for 24 hours and were discharged the day after surgery. Follow-up (4–65 months) was done by the surgeons only. The silicone tubes were left for three to six months and removed endonasally by the same surgeons again. Results: Of 122 interventions with dacryoendoscopy 68 needed a bicanalicular stenting with a silicone tube for relative stenosis only. 12 of these needed further intervention by DCR (17.6%) due to restenosis. 12 out of 122 had primary laserdacryoplasty and 2 (16.6%) of these needed DCR later. 42 of 122 had primary TELA-DCR. 5 out of these 42 primary TELA-DCR were revision-DCR after external or endonasal DCR elswhere and 2 of these needed a 2 nd TELA-DCR for restenosis (4.8%). Anatomically all lacrimal systems are still patent ever since. 76 patients (92.7%) are free of symptoms. Overall anatomic patency rate was 82.4% in tubing as single intervention, 83.4% in laser-dacryoplasty and 95.2% in TELA-DCR. Conclusions: Combined dacryoendoscopy and TELA-DCR is an efficient, safe and successful method in the managment of lacrimal obstructive disease. Our experience suggests that TELA-DCR may be considered as a treatment option in selected patients with lacrimal obstructive disease.