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Aim: Despite advances in cataract surgery, postoperative ocular inflammation and pain occurs. To address compliance issues with topical corticosteroid administration, a hydrogel-based dexamethasone insert was developed for intracanalicular administration. The objective is to understand the anatomy to best administer the insert and learn how the anatomy and hydrogel properties help retain the insert in the canaliculus over time. Materials & methods: Human cadavers (n = 5) were dissected to assess dimensions of punctum and canaliculus as part of drug discovery and development. Results & conclusions: Mean measures for punctal diameter was 0.5 ± 0 mm and vertical canaliculi length was 2.4 ± 0.5 mm and width was 1.6 ± 0.5 mm. Vertical canalicular width was larger than the punctal opening, a critical understanding for placing and retaining intracanalicular inserts.

Purpose: To evaluate safety and review techniques of ultrasound (US)-guided percutaneous transsplenic (TS) access and Gelfoam tract closure utilized for portosystemic interventions. For the purpose of this study only transjugular intrahepatic portosystemic shunt placement (TIPS) procedures were retrospectively reviewed. Materials: Cases of TIPS procedure where TS access was employed were reviewed between 1/2012 to 12/2017. Patient demographics, indication for transsplenic access, clinical status and adverse events (AE) were reviewed. Summary of tools and techniques employed were tabulated from operative reports. TS access was gained under US guidance using a 20-gauge Inrad needle and a Neff Percutaneous Access Set (Cook Medical, Bloomington, IN). A 6 Fr vascular sheath was placed in the splenic vein. 63% (22/35) of cases employed the "gun site" technique for TIPS creation; 10-20 mm loop snares utilized for this technique. Techniques for TS closure included Gelfoam slurry (Upjohn, Kalamazoo, MI) injected through 6 Fr short sheath in 85.7% (30/35), n-BCA/histoacryl and ethiodol mixture injected through the inner stylet of the Neff set in 11.4% (4/35), Interlock detachable coils (Boston Scientific, Natick, MA) deployed through the 6 Fr sheath in 2.8% (1/35). Results: 35 patients (20 female, 15 male, mean age 49 (range 16-72) were treated with TS TIPS. Median MELD score was 7.5 (0.2-20.8). Indications for TS intervention included refractory variceal bleeding (17%, 6/35), recurrent ascites (23%, 8/35), or abdominal pain (14%, 5/35) associated with technically challenging anatomy. Portal vein, hepatic vein and prior TIPS thrombosis was present in 57% (20/35), 8.6% (3/35) and 5.7% (2/35) respectively. No evidence of bleeding complications related to TS access was observed. 2.85% (1/35) AE included small splenic peripheral infarcts related to venous access. Technical success was achieved in 100% of the cases. Conclusions: Transsplenic approach is a safe and feasible technique for transjugular intrahepatic portosystemic shunt creation. It can be theorized that a decrease in portosystemic gradient coupled with a low pressure venous system grants Gelfoam tract embolization as a viable option for TS access closure.