Anophthalmic patients may experience pain and discomfort for a variety of reasons. The treating physician needs to recognize this as treatment options are distinctly different.
Orbital implant replacement with DFG was effective at relieving chronic ASP, and pain resolution was sustained in all cases. This surgical intervention may be a useful management option for patients in whom all detectable causes of chronic pain have been excluded and have failed medical pain management.
The Catquest-9SF is a valid measure of visual disability in patients with epiphora. Epiphora patients experience visual disability to the same degree as patients awaiting 2nd eye cataract surgery.
Purpose: The role of silicone stent intubation in dacryocystorhinostomy (DCR) is not clear, and conclusions presented in the literature are contradictory both regarding if intubation should be recommended and if so, the appropriate duration of intubation. This paper reports on the longterm outcome of a comparatively short duration of silicone stent intubation, one week, and discusses the possibility of an optimal duration of intubation where the benefit of the silicone stent is utilized but with minimal risk of complications. Methods: A total of 70 cases of DCR were followed in 67 patients for four years in a descriptive case series of uncomplicated external DCR with one-week silicone stent intubation. Pre-and perioperative findings, complications, and the need for additional surgery were recorded. At end of follow-up, a questionnaire was sent to the patients asking them to grade the frequency of epiphoric problems. If graded often/constant, a follow-up visit was offered. Results: One patient received additional surgery during follow-up due to persistent epiphora caused by synechiae between the middle turbinate and lateral nasal wall. The response rate to the questionnaire was 88%, with 93% of the respondents reporting epiphora never/seldom. Four patients reported persistent problems: one declined further examination, the tear duct was anatomically patent in two, and one was referred to the ENT department due to inflamed nasal mucosa and extensive adhesions. The long-term functional or anatomical success rate was 97%. Conclusions: This study shows that a high long-term success rate for uncomplicated DCR is possible with only one-week silicone stent intubation.
Purpose: To investigate long-term outcome and report reoperation rate of noninfected, complete acquired lacrimal drainage obstruction (ALDO) treated with canaliculodacryocystoplasty (CDCP) depending on site of stenosis. Method: Consecutive adult patients with non-infected, complete ALDO treated with CDCP were followed for 76 months. Location of stenosis at preoperative visit and intraoperative probing was recorded, and during follow-up, recurrence of stenosis prompting additional surgery and complications were noted. Survival analysis was applied to compare reoperation rate depending on site of stenosis. A follow-up questionnaire was sent to patients not requiring reoperation asking to grade current epiphora problems. Results: Among 85 included cases (71 patients), 57 were classified as canalicular stenosis and 28 as nasolacrimal duct obstruction (NLDO) preoperatively. At the end of follow-up, 39% (33/85) of cases had required additional surgery due to persistent/recurrent symptoms. No statistical difference was found between these groups.During CDCP, 25 of the 57 preoperatively classified canalicular stenosis were found to have an additional obstruction below the sac. The group with only canalicular stenosis had a statistically significant higher survival compared with cases with NLDO or multiple obstructions (p = 0.03). Of patients responding to the follow-up questionnaire, 11/37 cases experienced epiphora often or constant. Conclusion: Treating complete NLDO with CDCP results in a high reoperation rate and seems an insufficient alternative. Canaliculodacryocystoplasty (CDCP) may be discussed if preoperative examination indicates canalicular stenosis and dacryocystorhinostomy is not desirable. However, the patient needs to be aware of the higher risk for additional surgery, especially if a second stenosis is found during probing.
Purpose: Current hypothesis regarding the mechanism of active tear drainage is based on studies performed ex vivo or under nonphysiological conditions. Novel ultra-high-frequency ultrasound has the advantage of generating images with superior resolution, enabling measurements of low flow in small vessels, and the tracking of tissue motion in real time. The purpose of this study was to investigate the lacrimal drainage system and active drainage using this modality. Methods: The upper lacrimal drainage system was investigated with 40–70 MHz ultrasound in 22 eyes in 13 patients. Irrigation confirmed a lacrimal obstruction in 10 eyes. Motion tracking was used to map movement of the lateral lacrimal sac wall and to measure flow when possible. Results: The anatomy of the upper lacrimal drainage system was mapped in vivo, including the proximal canaliculi, which have not previously been imaged. The lacrimal sac lumen is slit shaped in its resting state but is distended when irrigated or if a nasolacrimal duct obstruction is present. Thus, the healthy lacrimal sac is not a cavity, and the medial retinaculum does not act against a stretched structure. Motion tracking visualized the “lacrimal pump,” showing that the direction of motion of the lateral lacrimal sac wall is mainly in the sagittal plane during blinking. Conclusions: Ultra-high-frequency ultrasound allows detailed physiological monitoring of the upper lacrimal drainage system in vivo. Our findings suggest that current theories of active tear drainage need to be reappraised.
Purpose: The aim of this study was to monitor how the blood perfusion in human upper eyelids is affected during full-thickness blepharotomy. Methods: Seven eyelids in 5 patients with upper eyelid retraction due to Graves’ disease underwent full-thickness blepharotomy. Perfusion was measured using laser speckle contrast imaging in the eyelid margin and in the conjunctival pedicle. Results: Immediately following the procedure, a nonsignificant reduction in perfusion was observed in the skin of the pretarsal eyelid margin, being 66% of the initial value (p = n.s.). However, a statistically significant decrease in perfusion, to 53% of the initial value (p < 0.01), was seen in the central pedicle of the conjunctiva. There were no surgical complications such as infection, signs of ischemia, or bleeding. Conclusions: In this study, eyelid perfusion was mapped during full-thickness blepharotomy for the first time using laser speckle contrast imaging. The results showed that perfusion is sufficiently preserved during surgery, probably due to the rich vascular supply in the periocular region, which may explain the low risk of postoperative complications such as ischemia and infection.
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