AIM:To assess the success rate of lacrimal sac hydrostatic pressure application(HPA)maneuver,a conservative office procedure for treatment of congenital nasolacrimal duct obstruction(CNLDO).METHODS:The medical records...AIM:To assess the success rate of lacrimal sac hydrostatic pressure application(HPA)maneuver,a conservative office procedure for treatment of congenital nasolacrimal duct obstruction(CNLDO).METHODS:The medical records of pediatric patients,36mo old or younger,diagnosed with CNLDO between the years 2016-2022,were retrospectively reviewed.In all children,HPA was performed by a pediatric ophthalmologist.Success was defined as the resolution of epiphora and discharge within 48h of the intervention.RESULTS:A total of 281 eyes(194 patients)with CNLDO underwent HPA.Follow-up data were available for 261 eyes(179 patients,50.3%male)and these patients were included in the analysis.The mean follow-up time was 11.6±13mo.Ninety-seven patients(54.2%)had unilateral nasolacrimal duct obstruction,while 82 patients(45.8%)had bilateral CNLDO.The mean age at the time of HPA was 5.8±5.9mo.Complete resolution of symptoms was achieved in 102(39.1%)eyes.Patients 6mo old or younger at the time of HPA had a significantly higher success rate compared to patients older than 6mo(43.7%vs 30.9%,P=0.04).Younger age at the time of pressure application was associated with a higher resolution rate of CNLDO(OR 0.93,P=0.004).Sex assigned at birth,prematurity,laterality of the obstruction and type of symptoms(epiphora,discharge)were not correlated with success.A second HPA was performed in 46 eyes,with resolution of symptoms in 12 eyes(26.1%).CONCLUSION:Hydrostatic pressure applied on the lacrimal sac by an experienced ophthalmologist or an experienced pediatrician may be an effective treatment for CNLDO.We recommend HPA as an initial active conservative approach in all pediatric patients with CNLDO,especially those younger than 6mo.展开更多
AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation se...AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure（IOP） 〉21 mm Hg or 〈5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS： A total of 64 eyes from 57 patients were included： 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP（P =0.005）,lower baseline mean visual acuity（VA）（P =0.02）,and higher proportion of patients with history of previous trabeculectomy（P 〈0.0001）.Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group（P =0.0229）.CONCLUSION： Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.展开更多
AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with poste...AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with posterior fixation sutures for sixth cranial nerve palsy from January 2003 to December 2018,were retrospectively reviewed.For each patient,pre-and post-operatively,the largest measured angle was used for the calculations,usually resulting with the angle for distance,except in young infants,where measurements were made at near fixation using the Krimsky test.RESULTS:Fifteen patients met the inclusion criteria for the study,of them 9(60.0%)had also medial rectus muscle recession at the time of surgery.Mean follow-up period was 21.4±23.2mo(range 1.5-82mo).Preoperative mean esotropia was 51.3±19.7 prism diopter(PD;range 20-90 PD).Postoperative mean deviation on final follow-up was 7.7±20.2 PD(range-40 to 35 PD;P=0.018).In all patients with preoperative abnormal head position,improvement was noted.Ten(66.7%)patients had improvement in abduction and 10(66.7%)patients reported improvement in their diplopia,by final follow-up.The addition of medial rectus recession was correlated with a larger change in postoperative horizontal deviation compared to baseline(P=0.026).Two(13.3%)patients developed a vertical deviation in the immediate postoperative period which had resolved in one of them.CONCLUSION:Half-width VRT augmented with posterior fixation suture,with or without medial rectus muscle recession,is an effective and safe procedure for esotropia associated with sixth cranial nerve palsy.A major improvement in the angle of deviation is expected.Most patients will have improvement in their abnormal head position and diplopia.展开更多
To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients （mean age： 13.0y） who had undergone limbal dermoid excision with lamell...To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients （mean age： 13.0y） who had undergone limbal dermoid excision with lamellar corneosclerai graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm （6.0-12.0 mm）. Mean visual acuities （in IogMAR units） before and after surgery were 1.8 and 1.7, respectively （P=0.29）. Spherical equivalents were 1.3 diopter （D） before surgery and 0.7 D after surgery （P=0.40）. The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively （P=0.17）. Vector analysis revealed a mild change in astigmatism with a mean ＂d＂ of 3,2 （0,56-6.89）, No intra- or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.展开更多
文摘AIM:To assess the success rate of lacrimal sac hydrostatic pressure application(HPA)maneuver,a conservative office procedure for treatment of congenital nasolacrimal duct obstruction(CNLDO).METHODS:The medical records of pediatric patients,36mo old or younger,diagnosed with CNLDO between the years 2016-2022,were retrospectively reviewed.In all children,HPA was performed by a pediatric ophthalmologist.Success was defined as the resolution of epiphora and discharge within 48h of the intervention.RESULTS:A total of 281 eyes(194 patients)with CNLDO underwent HPA.Follow-up data were available for 261 eyes(179 patients,50.3%male)and these patients were included in the analysis.The mean follow-up time was 11.6±13mo.Ninety-seven patients(54.2%)had unilateral nasolacrimal duct obstruction,while 82 patients(45.8%)had bilateral CNLDO.The mean age at the time of HPA was 5.8±5.9mo.Complete resolution of symptoms was achieved in 102(39.1%)eyes.Patients 6mo old or younger at the time of HPA had a significantly higher success rate compared to patients older than 6mo(43.7%vs 30.9%,P=0.04).Younger age at the time of pressure application was associated with a higher resolution rate of CNLDO(OR 0.93,P=0.004).Sex assigned at birth,prematurity,laterality of the obstruction and type of symptoms(epiphora,discharge)were not correlated with success.A second HPA was performed in 46 eyes,with resolution of symptoms in 12 eyes(26.1%).CONCLUSION:Hydrostatic pressure applied on the lacrimal sac by an experienced ophthalmologist or an experienced pediatrician may be an effective treatment for CNLDO.We recommend HPA as an initial active conservative approach in all pediatric patients with CNLDO,especially those younger than 6mo.
文摘AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure（IOP） 〉21 mm Hg or 〈5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS： A total of 64 eyes from 57 patients were included： 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP（P =0.005）,lower baseline mean visual acuity（VA）（P =0.02）,and higher proportion of patients with history of previous trabeculectomy（P 〈0.0001）.Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group（P =0.0229）.CONCLUSION： Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.
文摘AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with posterior fixation sutures for sixth cranial nerve palsy from January 2003 to December 2018,were retrospectively reviewed.For each patient,pre-and post-operatively,the largest measured angle was used for the calculations,usually resulting with the angle for distance,except in young infants,where measurements were made at near fixation using the Krimsky test.RESULTS:Fifteen patients met the inclusion criteria for the study,of them 9(60.0%)had also medial rectus muscle recession at the time of surgery.Mean follow-up period was 21.4±23.2mo(range 1.5-82mo).Preoperative mean esotropia was 51.3±19.7 prism diopter(PD;range 20-90 PD).Postoperative mean deviation on final follow-up was 7.7±20.2 PD(range-40 to 35 PD;P=0.018).In all patients with preoperative abnormal head position,improvement was noted.Ten(66.7%)patients had improvement in abduction and 10(66.7%)patients reported improvement in their diplopia,by final follow-up.The addition of medial rectus recession was correlated with a larger change in postoperative horizontal deviation compared to baseline(P=0.026).Two(13.3%)patients developed a vertical deviation in the immediate postoperative period which had resolved in one of them.CONCLUSION:Half-width VRT augmented with posterior fixation suture,with or without medial rectus muscle recession,is an effective and safe procedure for esotropia associated with sixth cranial nerve palsy.A major improvement in the angle of deviation is expected.Most patients will have improvement in their abnormal head position and diplopia.
基金Supported by the Research to Prevent Blindness Unrestricted Grant(New York,USA)the National Eye Institute core grant(No.P30-EY14801)(Bethesda,Maryland,USA)
文摘To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients （mean age： 13.0y） who had undergone limbal dermoid excision with lamellar corneosclerai graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm （6.0-12.0 mm）. Mean visual acuities （in IogMAR units） before and after surgery were 1.8 and 1.7, respectively （P=0.29）. Spherical equivalents were 1.3 diopter （D） before surgery and 0.7 D after surgery （P=0.40）. The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively （P=0.17）. Vector analysis revealed a mild change in astigmatism with a mean ＂d＂ of 3,2 （0,56-6.89）, No intra- or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.
