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A new method using xenogeneicacellular dermal matrix in the reconstruction of lacrimal drainage.

Chen L, Gong B, Wu Z, Jetton J, Chen R, Qu C - Br J Ophthalmol (2014)

Bottom Line: Patency was confirmed by pressing in the area of the lacrimal sac and visualising air bubbles in the nasal cavity.Five tear ducts proved to be effective through irrigation testing and epiphora symptoms were alleviated in all cases.The newly reconstructed lacrimal duct, formed by the shift of autogenous conjunctival petal and the attachment of acellular dermal matrix, was successful in all five cases and suggests a new solution for the complex lacrimal duct lesion and congenital anomalies of the lacrimal duct.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, Sichuan, China.

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Photograph of the opening end of the newly-built lacrimal ducts. The intra-operative picture shows the opening of newly-rebuilt lacrimal duct in the lacrimal caruncle (A). The amplification figure of the newly-rebuilt lacrimal duct in the lacrimal caruncle (B). The appearance of the tear conduit on the lacrimal caruncle 5 days after surgery. The arrow refers to the opening point with suture and swollen conjunctiva (C). The appearance of the lacrimal caruncle 1 year later after surgery. The arrow refers to the area, where it is difficult for us to find the opening point (D). The opening point of the new duct was observed above the middle turbinate under nasal endoscopy. When we pressed the lacrimal sac area, we could see the air bubbles flow out from the new duct vianasal endoscope (the green arrow, E). The arrow refers to the staining on the tear duct opening nasally visualized by nasal endoscopy after the JDT1 test (F).
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BJOPHTHALMOL2014304932F3: Photograph of the opening end of the newly-built lacrimal ducts. The intra-operative picture shows the opening of newly-rebuilt lacrimal duct in the lacrimal caruncle (A). The amplification figure of the newly-rebuilt lacrimal duct in the lacrimal caruncle (B). The appearance of the tear conduit on the lacrimal caruncle 5 days after surgery. The arrow refers to the opening point with suture and swollen conjunctiva (C). The appearance of the lacrimal caruncle 1 year later after surgery. The arrow refers to the area, where it is difficult for us to find the opening point (D). The opening point of the new duct was observed above the middle turbinate under nasal endoscopy. When we pressed the lacrimal sac area, we could see the air bubbles flow out from the new duct vianasal endoscope (the green arrow, E). The arrow refers to the staining on the tear duct opening nasally visualized by nasal endoscopy after the JDT1 test (F).

Mentions: The average duration of follow-up for the five patients was 7.2 months (ranging from 6 to 12 months). Epiphora symptoms disappeared after surgery (table 1). The opening side of the newly reconstructed lacrimal duct could be seen in the lacrimal caruncle after surgery (figure 3A,B). It often appears half closed 1 week later (figure 3C) and is difficult to visualise under slit lamp exam in the subsequent period of observation (figure 3D). The nasal side of the conduit was visualised above the middle turbinate by nasal endoscopy. When the lacrimal sac area was pressed, air bubbles flowing out from the new duct were visualised on nasal endoscopy (figure 3E). For the Jones dye test 1 (JDT 1), an entire fluorescein 2% dose was dropped in eyes. After 5 min, the nasal mucosa was gently swabbed and fluorescein presence was confirmed (table 1), on nasal endoscopy the lacrimal duct meatus was noted to be stained with fluorescein, thus confirming its location (figure 3F). All patients felt bitter after 5 min when dropped 0.25% chloramphenicol eyedrops in the conjunctival sac.


A new method using xenogeneicacellular dermal matrix in the reconstruction of lacrimal drainage.

Chen L, Gong B, Wu Z, Jetton J, Chen R, Qu C - Br J Ophthalmol (2014)

Photograph of the opening end of the newly-built lacrimal ducts. The intra-operative picture shows the opening of newly-rebuilt lacrimal duct in the lacrimal caruncle (A). The amplification figure of the newly-rebuilt lacrimal duct in the lacrimal caruncle (B). The appearance of the tear conduit on the lacrimal caruncle 5 days after surgery. The arrow refers to the opening point with suture and swollen conjunctiva (C). The appearance of the lacrimal caruncle 1 year later after surgery. The arrow refers to the area, where it is difficult for us to find the opening point (D). The opening point of the new duct was observed above the middle turbinate under nasal endoscopy. When we pressed the lacrimal sac area, we could see the air bubbles flow out from the new duct vianasal endoscope (the green arrow, E). The arrow refers to the staining on the tear duct opening nasally visualized by nasal endoscopy after the JDT1 test (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215284&req=5

BJOPHTHALMOL2014304932F3: Photograph of the opening end of the newly-built lacrimal ducts. The intra-operative picture shows the opening of newly-rebuilt lacrimal duct in the lacrimal caruncle (A). The amplification figure of the newly-rebuilt lacrimal duct in the lacrimal caruncle (B). The appearance of the tear conduit on the lacrimal caruncle 5 days after surgery. The arrow refers to the opening point with suture and swollen conjunctiva (C). The appearance of the lacrimal caruncle 1 year later after surgery. The arrow refers to the area, where it is difficult for us to find the opening point (D). The opening point of the new duct was observed above the middle turbinate under nasal endoscopy. When we pressed the lacrimal sac area, we could see the air bubbles flow out from the new duct vianasal endoscope (the green arrow, E). The arrow refers to the staining on the tear duct opening nasally visualized by nasal endoscopy after the JDT1 test (F).
Mentions: The average duration of follow-up for the five patients was 7.2 months (ranging from 6 to 12 months). Epiphora symptoms disappeared after surgery (table 1). The opening side of the newly reconstructed lacrimal duct could be seen in the lacrimal caruncle after surgery (figure 3A,B). It often appears half closed 1 week later (figure 3C) and is difficult to visualise under slit lamp exam in the subsequent period of observation (figure 3D). The nasal side of the conduit was visualised above the middle turbinate by nasal endoscopy. When the lacrimal sac area was pressed, air bubbles flowing out from the new duct were visualised on nasal endoscopy (figure 3E). For the Jones dye test 1 (JDT 1), an entire fluorescein 2% dose was dropped in eyes. After 5 min, the nasal mucosa was gently swabbed and fluorescein presence was confirmed (table 1), on nasal endoscopy the lacrimal duct meatus was noted to be stained with fluorescein, thus confirming its location (figure 3F). All patients felt bitter after 5 min when dropped 0.25% chloramphenicol eyedrops in the conjunctival sac.

Bottom Line: Patency was confirmed by pressing in the area of the lacrimal sac and visualising air bubbles in the nasal cavity.Five tear ducts proved to be effective through irrigation testing and epiphora symptoms were alleviated in all cases.The newly reconstructed lacrimal duct, formed by the shift of autogenous conjunctival petal and the attachment of acellular dermal matrix, was successful in all five cases and suggests a new solution for the complex lacrimal duct lesion and congenital anomalies of the lacrimal duct.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, Sichuan, China.

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Related in: MedlinePlus