Purpose. This study aimed to evaluate long-term results of external dacryocystorhinostomy (DCR) at a tertiary eye care center specializing in lacrimal duct surgery in Germany. Methods. The medical records of 1010 patients with acquired nasolacrimal duct obstruction (NLDO), who had undergone lacrimal duct surgery at a tertiary eye care center, were reviewed. Only adult patients who had undergone external DCR were included. The evaluation included the following parameters: age, gender, duration of symptoms, patient satisfaction, previous dacryocystitis, complication rates, and surgical outcome. Results. 154 eyes of 146 patients (14.5%) could be included in the study. The average age was 64.1 ± 29.7 years. 66.4% of patients were females and 33.6% were males. Acute or chronic dacryocystitis was found in 81 patients (55.5%). Overall, 82.8% of patients had full resolution of symptoms. The success rate of external DCR for patients with previous episodes of dacryocystitis was 82.7% compared to 83.4% for patients without dacryocystitis in their medical history. Conclusion. In cases in which transcanalicular microendoscopic techniques are contraindicated (e.g., after dacryocystitis) or in complex cases where microendoscopic procedures have failed (revision surgery), external DCR is still the surgical treatment of choice with very good postoperative success.

Purpose To evaluate changes in flow density after the implantation of a trabecular microbypass stent (iStent) in combination with cataract surgery. Methods A total of 48 eyes of 48 patients, who underwent either cataract surgery alone (cataract group) or cataract surgery with implantation of two iStent inject devices (iStent group), were prospectively included in this study. Intraocular pressure (IOP) and flow density data before and after surgery were extracted and analyzed. Results In the iStent group, the mean IOP was 18.2 ± 3.3 mmHg prior to surgery and 13.2 ± 2.3 at follow-up, and this difference was statistically significant (p < 0.001). The mean IOP in the cataract group also improved significantly after surgery (before: 17.1 ± 2.4; after: 15.1 ± 2.7 p = 0.003). The flow density (whole en face) in the superficial and deep retinal OCT angiogram of the macula (superficial: p = 0.002; deep: p = 0.034) and in the ONH (p = 0.011) improved significantly after surgery in the iStent group. The differences in the cataract group were not significant. Conclusions Flow density of the macula and ONH, as measured by OCTA, improved significantly after cataract surgery with iStent. Noninvasive quantitative analyses of flow density provide a new parameter, which can help for the monitoring of therapy success after glaucoma surgery.

Background/AimDacryocystorhinostomy (DCR) remains the gold standard therapy for nasolacrimal duct obstruction (NLDO), but is invasive and does not maintain the physiology of the lacrimal pathway. With transcanlicular microdrill dacryoplasty (MDP), there is a minimally invasive alternative surgical approach. This study aimed to present this modern lacrimal duct surgery technique and to evaluate its long-term success rate in a large study population.MethodsThe medical records of 1010 patients with acquired NLDO were retrospectively reviewed. Adult patients who had undergone transcanalicular MDP were included. The evaluation included the following parameters: age, gender, success rate, complication rate, obstruction grade and patient satisfaction. Long-term results regarding patient satisfaction and success rate were evaluated by a telephone survey. Only a complete resolution of symptoms was defined as success.Results793 eyes of 576 patients after transcanalicular MDP could be included in the study. The mean follow-up time was 8.7±0.9 years. Initial surgical success rate was 84.0%. At the time of the follow-up, 57.5% (n=229) still had full resolution of symptoms. The mean patient satisfaction with the procedure was 6.9±3.2 out of 10 points. Heavy bleeding occurred in two cases only (0.25%).ConclusionThis is the first study to show the success rate of microendoscopic lacrimal duct surgery after such a long follow-up period and in such a large study population. Transcanalicular MDP is a minimally invasive technique with a very low complication rate and can be used as an alternative procedure before performing more invasive lacrimal duct surgery such as DCR.

Selective muscles can be paralysed or weakened for a limited time period using botulinum toxin type A. The upper eyelid muscles can be a target, leading to a temporary protective ptosis. In this report we discuss indications for this application, describe how to perform the injection, and present results. The procedure is safe and effective.

Traumatic lacrimal stenosis is more common in men, and has a poorer prognosis than lacrimal duct stenosis from other causes.