Name: transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of primary acquired nasolacrimal duct obstruction
Uploaded: 2017-10-13T12:30:00.000+00:00
Duration: 7 min 30 s
Description: Watch this Scientific Journal Video about Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction at JoVE.com

Deutsche Forschungsgemeinschaft (Asociación alemana de la investigación; PARA 2240 "Angiogénesis (linfa) e inmunidad celular en las enfermedades inflamatorias del ojo" a LMH; ÉL 6743/2-1 y él 6743/3-1 a LMH), programa GEROK de la Universidad de Colonia a KRK y LMH. Nuestro agradecimiento al Dr. Kühner para soporte técnico.

para este procedimiento, el consentimiento informado es necesario y se ha obtenido para cada paciente que ha experimentado la cirugía en el Departamento de Oftalmología, Universidad de Colonia, Colonia, Alemania. Todos los exámenes y las intervenciones quirúrgicas fueron ejecutadas conforme a las leyes nacionales y la declaración de Helsinki de 1975 en su versión actual.
 Nota: a menos que se indique lo contrario, será siempre sólo instrucciones de al lado en el que se está llevando a cabo el procedimiento. Use equipo esterilizado.
 1. preparación del paciente <ol><li>realizar una exhaustiva examinación oftálmica (con especial atención a los párpados, punctum superior e inferior y drenaje de la lágrima) incluyendo riego y sondeo para PANDO 10 .
	<ol><li>Para riego estandarizado, inserte una sonda de Bangerter en la parte superior y, posteriormente, bajar punctum. Comienza introduciendo verticalmente, luego inclinar hacia el templo a una posición horizontal para seguir la formación fisiológica de la pequeño. Cuando la sonda está en posición, cuidadosamente inyectar solución salina para poner a prueba por obstrucción del conducto lacrimal. 
		Nota: En infrasaccal PANDO, la cánula de Bangerter podrán llegar fácilmente a la pared nasal lateral sin una resistencia hinchable (&#34; duro parada &#34;). Tratando de regar se traducirá en reflujo contralateral a través del punctum enfrente sin ningún líquido que alcanza el paciente &#39; s faringe 10.</li>
	</ol></li> <li>Descartar infecciones agudas, tumores del sistema de drenaje lagrimal así como traumático, congénito o presaccal la obstrucción.
	<ol><li>Para descartar infecciones agudas, busque para enrojecimiento doloroso, hinchazón o purulenta la descarga del drenaje lagrimal. Para descartar tumores, buscar indolente inflamación, ulceración o pigmentación. Presaccal obstrucción resulta en una resistencia animosa al intentar avanzar la sonda de Bangerter en el saco lacrimal (&#34; paro suave &#34;). Se debe descartar obstrucción congénita y traumática tomando historia paciente 10 , 19 , 20.</li>
	</ol></li> <li>Descartar patologías rhinological intranasales, desviación del tabique por ejemplo severo. Esto debe hacerse tomando la paciente &#39; historia en combinación con una inspección rhinological de la cavidad nasal 21.</li>
	<li>Poner al paciente bajo anestesia general, por ejemplo, por inyección intravenosa de propofol, remifentanilo y atracurio para la inducción y la inhalación de remifentanilo desfluran plus intravenosos de mantenimiento, adaptados al peso de dosificación estándar 10. la intubación debe ser realizada, pero también es posible el uso de una mascarilla laringe. 
	Nota: Los anestésicos, así como las dosis pueden variar entre clínicas. Ningún protocolo específico de la anestesia se requiere para asistida por láser DCR.</li>
</ol> 2. Laser-asistida DCR <ol><li>Insertar el endoscopio video-asistida en la nasal cavidad cuidadosamente la avanzando a través de la fosa nasal. Visualizar el margen anterior del cornete medio inclinando ligeramente el endoscopio hacia la pared nasal lateral.</li>
	<li>Configurar los equipos de láser y láser ajustes a los valores correctos. Colóquese gafas de protección.
	<ol><li>Conecte el láser óptico de fibra (diámetro 400 μm) para el laser del diodo (longitud de onda 810 nm). Configuración de diodo láser para 6-8 W, duración de pulso de 200 ms, 100 ms exposición pausa.</li>
		<li>Introducir la fibra óptica de láser en la pieza de mano para maniobrar y a través de una cánula Roma. Dejar 2-3 mm de la fibra sobresalga en la punta de la cánula.</li>
		<li>Realizar carbonización de la punta de la fibra de láser manteniendo sobre una espátula de madera y aplicar energía de laser durante unos segundos hasta que la punta es lo suficientemente ennegrecida. 
		Nota: Esto limitará la distribución de la energía no deseada en el tejido del saco lacrimal.</li>
	</ol></li> <li>Posicionamiento correcto de la fibra láser en la pared nasal lateral.
	<ol><li>Uso un lacrimal sonda para dilatar el punctum inferior ( Figura 2a). Inserte la sonda en posición vertical al principio y luego poner en una orientación horizontal antes de avanzar más lejos lo hacia el saco lagrimal. Esto permitirá que para que la fibra de láser que se insertará suavemente en el paso siguiente.</li>
		<li>Introducir la fibra láser en el pequeño canal inferior ( figura 2b , 2C). Comienza introduciendo verticalmente, luego inclinar hacia el templo a una posición horizontal para seguir la formación fisiológica de la inferior pequeño.</li>
		<li>Avanzar cuidadosamente la fibra láser en el saco lagrimal hasta que toque la pared nasal lateral, es decir, la pared medial saccal lacrimal. Objetivo, la punta en sentido antero-inferior para que apunte al margen anterior del cornete medio.</li>
		<li>Verificar la colocación correcta endoscópicamente mediante el control de transluminescence de apuntar la viga a la altura del margen anterior del cornete medio ( Figura 2d).</li>
	</ol></li> <li>Crear una suficiente nasolacrimal de derivación mediante la aplicación de la energía de láser pulsado para la pared nasal.
	<ol><li>Aplicar energía láser (mediante el conjunto de parámetros arriba), manteniendo un constante contacto a la pared sin presión, con el objetivo del margen anterior del cornete medio. El láser que vaporiza el tejido directamente delante de él, creando un bypass nasolagrimal ( Figura 2d , 2e). 
		Nota: La energía total requerida oscila entre 0.9 - 1.8 kJ y suele variar entre los pacientes.</li>
		<li>Asegúrese de que la punta de la fibra no se presiona activamente contra la pared. Tenga cuidado de no dejar la hoja de la punta en la cánula de metal ya que esto causará lesiones térmicas debido al calentamiento del metal. También evitar movimientos hacia los lados, la punta puede romperse apagado</li>
		<li>Al interior de la pared nasal lateral, tire de la fibra láser un poco y ampliar el ostium por vaporización cuidadosamente los márgenes de forma circular. Tratar de crear tan grande un puente como sea posible ( figura 2f).</li>
		<li>Busca un diámetro total de 5 mm para el ostium.</li>
		<li>Pare aplicar energía y quite la fibra láser junto con la pieza de mano y la cánula retraiga cuidadosamente el equipo.</li>
	</ol></li> <li>Verificar la permeabilidad de lo ostium de una irrigación salina utilizando una sonda de Bangerter como se describe en 1.1.1. Si se creó un ostium patentes, irrigación exitosa debe ser visible endoscópicamente.</li>
	<li>Extraiga la sonda de Bangerter.</li>
	<li>Colocar el tubo de silicona ( figura 2 g).
	<ol><li>El punctum inferior, inserte un tubo de silicio de monocanalicular y avanzar con cuidado hasta que la punta metálica principal pasa la abertura ósea y sobresale en la cavidad nasal.</li>
		<li>Pinzas de Blakesley uso para tomar la punta desde dentro de la cavidad nasal y el tubo de silicona de la nariz y en la posición ( figura 2 h).</li>
		<li>Utilizar un par de tijeras para acortar el tubo de silicona. Al final no debe ser pegado de la nariz.</li>
		<li>Realizar intubación de silicio mediante el pequeño superior así (siguientes pasos 2.7.1 a 2.7.3) ( figura 2 h).</li>
	</ol></li> <li>Retire el endoscopio nasal.</li></ol>
 3. cuidado postoperatorio y seguimiento <ol><li>después de la cirugía, iniciar un tratamiento con antibiótico eye gotas (por ejemplo, ofloxacina), colirio descongestivo (e.g. xylometazolin) y colirio de esteroides (p. ej. prednisolona acetato). Antibióticos pueden suspenderse después de una semana, mientras que esteroides y gotas descongestivas lentamente deben ser destetadas apagado en el transcurso de un mes.</li>
	<li>Seguimiento a las seis semanas y tres meses después de la cirugía. Mira para la resolución de los síntomas, prolapso del tubo de silicona, infección y secreción de.</li>
	<li>Quitar los tubos de silicona a los tres meses después de la cirugía simplemente agarrando el extremo en forma de T a la altura de la puncta y con cuidado tirando de los mismos.</li>
</ol>

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Dacriocistorinostomía DCR láser-asistida como se describe anteriormente es una manera bastante rápida y mínimamente invasiva para tratar la infrasaccal absoluta obstrucción nasolacrimal del conducto con eficacia sin necesidad de incisión en la piel, ahorrando así no sólo la piel sino también el intermedio tendón Cantal y el mecanismo de la bomba con canalículos fisiológica. Mientras que el procedimiento es muy adecuado para los pacientes con obstrucción del conducto nasolagrimal adquirida primaria, patologí...

Infrasaccal obstrucción del conducto nasolacrimal adquirida primaria (PANDO) es un trastorno común en pacientes de mediana edad y mayores a epífora crónica y blefaritis y Dacriocistitis recurrente o crónica. Comúnmente, los pacientes desarrollan una obstrucción infrasaccal de uno o ambos conductos nasolagrimal, dando por resultado la lágrima insuficiente drenaje.
En el tratamiento de PANDO, dacriocistorrinostomía externa (DCR) es todavía considerado como el estándar de oro, aunque este procedimiento históricamente se remonta más de 100 años de cuando fue por primera vez1. Después de la incisión de la piel y la preparación de la pared nasal del saco lacrimal de un taladro se utiliza para crear un ostium óseo hacia la cavidad nasal, obviando el conducto obstruido. Se han reportado tasas de éxito funcional por encima del 85% para este método2,3. Estos resultados, sin embargo, llegan a costa de realizar un procedimiento relativamente invasivo que pone en riesgo las estructuras mediales del párpado incluyendo el mecanismo fisiológico con canalículos bomba4,5 y puede dejar a los pacientes con un no deseados la cicatriz, aunque moderna nasojugal incisiones de la piel han mejorado resultados. Estos riesgos son potencialmente evitables al realizar técnicas menos invasivas o elegir un enfoque endonasal.
Con el fin de evitar la cirugía invasiva, se ha realizado mucho trabajo en el campo de la recanalización de drenaje lagrimal mínimamente invasiva. Dos métodos en particular se han establecido como posibles procedimientos de primer paso: microdrill dacryoplasty y dacryoplasty asistida por láser. Estos procedimientos se basan en la Dacriocistorinostomía endoscopia del sistema de drenaje lagrimal y pueden realizarse para tratar la estenosis membranosas corto segmento del conducto nasolagrimal. Aunque sólo mínimamente invasiva y caracterizada por rápida convalecencia, un inconveniente común de estas técnicas de recanalizing son las tasas de éxito funcional relativamente baja con respecto a los resultados a largo plazo6,7, 8 , 9.
En un esfuerzo por llenar el vacío entre estos procedimientos de primer paso y DCR externa como tratamiento definitivo, recientemente se han desarrollado nuevos enfoques. El más prometedor de los cuales es DCR láser-asistida para el tratamiento de absoluta infrasaccal PANDO. Como con todos los enfoques mencionados, pacientes se recomiendan para ser sometido a anestesia general para este procedimiento. Una fibra de láser de diodo se inserta vía sea pequeño y luego se avanza en el saco lagrimal. A continuación, energía láser se aplica a la pared nasal lateral hasta que se crea una abertura ósea, conecta a la cavidad nasal a la altura de margen anterior10,11 el de cornete medio. Al mismo tiempo, se mantiene constante control visual mediante endoscopia endonasal. La anastomosis recién formada es un bypass para el drenaje de la lágrima. Después de la irrigación exitosa, intubación de silicio bicanalicular se realiza para prevenir la cicatrización temprana de la abertura recién formada. El tratamiento postoperatorio consiste en descongestionante, esteroide y colirio antibiótico para prevenir la hinchazón, inflamación e infección, respectivamente.
La duración de la cirugía y convalecencia es generalmente más corta que con la DCR externa (10-25 min en DCR láser-asistida vs 35-75 min en DCR externa). Las tasas de complicaciones son relativamente bajas, las más comunes siendo discreta hinchazón de los párpados y el prolapso del tubo de silicona. Infección con canalículos y lesiones térmicas son eventos raros10. Un año éxito funcional tipos de 74-88% han sido registrados10,11,12,13,14,15,16, 17,18, así que van muy detrás de los de DCR externa sin sufrir las desventajas de la vía de abordaje externo. Sin embargo, resultados a largo plazo siguen siendo aún ser proporcionado. Además, incluso después de fracaso de DCR láser-asistida, DCR externa secundaria puede todavía realizarse sin dificultad. En consecuencia, asistida por láser DCR califica como un procedimiento viable de segundo paso que debe realizarse óptimamente después de fracaso de la cirugía de recanalización y antes DCR externa.

<table><tbody><tr><td>C1.multi</td><td>LUT</td><td>05.0082h.1</td><td>Endoscope camera</td></tr><tr><td>HL 250</td><td>LUT</td><td>95.2048n</td><td>Endoscope light source</td></tr><tr><td>MD-19E</td><td>ACL GmbH</td><td>1119</td><td>Endoscope screen</td></tr><tr><td>FOX (laser)</td><td>A.R.C. Laser GmBH, N&amp;uuml;rnberg, Germany</td><td>n/a</td><td>Diode laser</td></tr><tr><td>Laser fiber</td><td>A.R.C. Laser GmBH, N&amp;uuml;rnberg, Germany</td><td>LL13001s</td><td>Laser fiber</td></tr><tr><td>Laser handpiece</td><td>A.R.C. Laser GmBH, N&amp;uuml;rnberg, Germany</td><td>n/a</td><td>Handpiece</td></tr><tr><td>Wide Collarette Monoka</td><td>Fa. FCL, Paris, France</td><td>S1.1630</td><td>monocanalicular silicon tube</td></tr><tr><td>Suction elevatorium</td><td>Storz</td><td>474015</td><td>For intranasal use</td></tr><tr><td>Forceps (Gr&amp;uuml;nwald)</td><td>Storz</td><td>426620</td><td>For intranasal use</td></tr><tr><td>Forceps (Blakesley-Wilde)</td><td>Storz</td><td>456502</td><td>To grab the silicon tube</td></tr><tr><td>Lacrimal canula</td><td>Storz</td><td>81071</td><td>Blunt cannula</td></tr><tr><td>Bangerter probe cannula</td><td>Storz</td><td>81055</td><td>Bangerter probe cannula</td></tr><tr><td>Wooden spatula</td><td>any</td><td>n/a</td><td>Wooden spatula</td></tr><tr><td>Xylometazolin 0.05% eye drops</td><td>GlaxoSmithKline Consumer Healthcare</td><td>n/a</td><td>Decongestant eye drops</td></tr><tr><td>Dexapos comod eye drops</td><td>Ursapharm</td><td>n/a</td><td>steroid eye drops</td></tr><tr><td>Floxal eye drops</td><td>Dr. Gerhard Mann</td><td>n/a</td><td>antibiotic eye drops</td></tr></tbody></table>

transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of primary acquired nasolacrimal duct obstruction

Estándar de oro de hoy en el tratamiento de la obstrucción del conducto nasolacrimal adquirida primaria infrasaccal (PANDO) es la dacriocistorrinostomía externa (DCR), un procedimiento relativamente invasivo que puede realizarse después de la falta de tratamientos de recanalizing. Sin embargo, con el progreso en el campo de la tecnología de láser de diodo, han surgido nuevos enfoques. Asistida por láser Dacriocistorinostomía DCR con bicanalicular subsecuente intubación de silicio es una nueva opción que muestra gran promesa como un procedimiento mínimamente invasivo viable. Bajo permanente control visual endoscópica de la cavidad nasal, una fibra de láser de diodo se inserta en el saco lacrimal y se aplica energía láser para crear una abertura ósea entre el saco lagrimal y la cavidad nasal. Puesto que no hay incisión cutánea debe realizarse, ventajas de este método incluyen la preservación de la piel, así como las estructuras palpebrales mediales y el mecanismo fisiológico bomba palpebral con canalículos. La duración de la cirugía y convalecencia es generalmente más corta que con la DCR externa. Las complicaciones incluyen prolapso de tubo de silicon, hinchazón leve y, raramente, infección canalicular y lesiones térmicas. Tasas de un año de éxito funcional, definidas como la resolución completa de los síntomas y la permeabilidad del ostium, son altas, aún así la gama detrás de la DCR externa. Sin embargo, DCR externa secundaria tras fracaso de DCR asistida por láser puede realizarse sin dificultad. Así, asistida por láser Dacriocistorinostomía DCR es una opción válida que debe considerarse como un segundo paso después de la falta de procedimientos de recanalización y antes DCR externa.

Resultado óptimo:
El procedimiento como se describe anteriormente tarda aproximadamente 10-25 minutos y generalmente se tolera muy bien. En el examen al día siguiente, una pequeña hinchazón de los párpados puede estar presente en aproximadamente el 60% de los casos. Esta hinchazón poco siempre resuelve totalmente en un plazo máximo de tres días. Pacientes no se quejan de dolor, prolapso de silicio o signos de lesión o infe...

Watch this Scientific Journal Video about Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction at JoVE.com

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

El objetivo de este protocolo es presentar Dacriocistorinostomía transcanalicular asistida por láser como un enfoque mínimamente invasivo en el tratamiento de la obstrucción del conducto nasolagrimal adquirida primaria.

Dacriocistorinostomía diodo dacriocistorrinostomía láser-asistida para el tratamiento de primaria adquirió la obstrucción del conducto nasolagrimal

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

transcanalicular-diode-laser-assisted-dacryocystorhinostomy-for

Research

JoVE Journal

Medicine

10.9K vistas.  University of Cologne. El objetivo de este protocolo es presentar Dacriocistorinostomía transcanalicular asistida por láser como un enfoque mínimamente invasivo en el tratamiento de la obstrucción del conducto nasolagrimal adquirida primaria.

Video: Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Canalostomy As a Surgical Approach to Local Drug Delivery into the Inner Ears of Adult and Neonatal Mice

Local delivery of therapeutic drugs into the inner ear is a promising therapy for inner ear diseases. Injection through semicircular canals (canalostomy) has been shown to be a useful approach to local drug delivery into the inner ear. The goal of this article is to describe, in detail, the surgical techniques involved in canalostomy in both adult and neonatal mice. As indicated by fast-green dye and adeno-associated virus serotype 8 with the green fluorescent protein gene, the canalostomy facilitated broad distribution of injected reagents in the cochlea and vestibular end-organs with minimal damage to hearing and vestibular function. The surgery was successfully implemented in both adult and neonatal mice; indeed, multiple surgeries could be performed if required. In conclusion, canalostomy is an effective and safe approach to drug delivery into the inner ears of adult and neonatal mice and may be used to treat human inner ear diseases in the future.

Here we describe canalostomy procedure which allows local drug delivery into the inner ears of adult and neonatal mice through the semicircular canal with minimum damage to hearing and vestibular function. This method can be used to inoculate viral vectors, pharmaceuticals, and small molecules into the mouse inner ear.

Canalostomy como un abordaje quirúrgico a la entrega del Local de la droga en los oídos interiores de ratones adultos y Neonatal

Local delivery of therapeutic drugs into the inner ear is a promising therapy for inner ear diseases. Injection through semicircular canals (canalostomy) ...

Investigación

Genética

Ultrasound Cyclo Plasty in Eyes with Glaucoma

Glaucoma is a chronic disease caused by the progressive degeneration of the optical nerve fibers, resulting in decreased visual field that can lead to severe visual impairment, and eventually blindness. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty (UCP), for reducing intraocular pressure (IOP) in glaucoma patients. The technique determines a selective coagulation necrosis of the ciliary body; in addition, the stimulation of supra-choroidal and trans-scleral portions of the uveo-scleral outflow pathway has been recently proposed. UCP shows several technical improvements in ultrasound technology compared to previous techniques, providing more precise focusing on the target zone. The procedure is performed in the operating room under peribulbar anesthesia. Briefly, the coupling cone is put in contact with the eye and the ring probe, that contains six piezoelectric transducers which produce the ultrasound beams, is inserted inside it. Their proper centering over the ocular surface represents a crucial step for the correct targeting of the ciliary body. Sterile balanced salt solution is used to fill the empty spaces to ensure ultrasound acoustic propagation. Surgical treatment consists in the sequential automatic activation of each of the six transducers, for a total duration of less than 3 min. The patient leaves the hospital 1 h after the procedure with the treated eye patched. In the present study, 10 patients with open-angle glaucoma were followed-up during at least 12 months after the procedure. IOP was reduced at each interval compared to pre-operative, as well as the number of hypotensive medications. Twenty percent of patients did not respond to the treatment, and needed subsequent surgery to better control IOP. Treatment tolerability was good, with no cases of hypotony or phthisis. The UCP procedure is simpler, faster, safer, and less invasive than traditional cyclodestructive procedures with similar results in reducing IOP.

Glaucoma is a chronic disease with progressive degeneration of optic nerve fibers resulting in decreased visual field. Elevated intraocular pressure is considered the most important and the only treatable risk factor. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty, for reducing intraocular pressure in glaucoma patients.

Ultrasonido Cyclo plastia en ojos con Glaucoma

Glaucoma is a chronic disease caused by the progressive degeneration of the optical nerve fibers, resulting in decreased visual field that can lead to ...

Comportamiento

Surgical Induction of Endolymphatic Hydrops by Obliteration of the Endolymphatic Duct

Surgical induction of endolymphatic hydrops (ELH) in the guinea pig by obliteration and obstruction of the endolymphatic duct is a well-accepted animal model of the condition and an important correlate for human Meniere's disease. In 1965, Robert Kimura and Harold Schuknecht first described an intradural approach for obstruction of the endolymphatic duct (Kimura 1965). Although effective, this technique, which requires penetration of the brain's protective covering, incurred an undesirable level of morbidity and mortality in the animal subjects. Consequently, Andrews and Bohmer developed an extradural approach, which predictably produces fewer of the complications associated with central nervous system (CNS) penetration.(Andrews and Bohmer 1989) 
The extradural approach described here first requires a midline incision in the region of the occiput to expose the underlying muscular layer. We operate only on the right side. After appropriate retraction of the overlying tissue, a horizontal incision is made into the musculature of the right occiput to expose the right temporo-occipital suture line. The bone immediately inferio-lateral the suture line (Fig 1) is then drilled with an otologic drill until the sigmoid sinus becomes visible. Medial retraction of the sigmoid sinus reveals the operculum of the endolymphatic duct, which houses the endolymphatic sac. Drilling medial to the operculum into the area of the endolymphatic sac reveals the endolymphatic duct, which is then packed with bone wax to produce obstruction and ultimately ELH. 
In the following weeks, the animal will demonstrate the progressive, fluctuating hearing loss and histologic evidence of ELH.

This video shows how to surgically obstruct the guinea pig's endolymphatic duct to produce endolymphatic hydrops.

Inducción quirúrgica de edema endolinfático por la obliteración del conducto endolinfático

Surgical induction of endolymphatic hydrops (ELH) in the guinea pig by obliteration and obstruction of the endolymphatic duct is a well-accepted animal ...

Biología

An &#8220;All-laser&#8221; Endothelial Transplant

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an intended depth, and a near infrared diode laser to weld the corneal tissue. The proposed technique enables to reach the three main goals in endothelial keratoplasty: a precise control in the thickness of the donor tissue; its easy insertion in the recipient bed and a reduced risk of donor lenticule dislocation. The donor cornea thickness is measured in the surgery room with optical coherence tomography (OCT), in order to correctly design the donor tissue dimensions. A femtosecond laser is used to cut the donor cornea. The recipient eye is prepared by manual stripping of the descemetic membrane. The donor endothelium is inserted into a Busin-injector, the peripheral inner side is stained with a proper chromophore (a water solution of Indocyanine Green) and then it is pulled in the anterior chamber. The transplanted tissue is placed in the final and correct location and then diode laser welding is induced from outside the eyeball. The procedure has been performed on more than 15 patients evidencing an improvement in surgery performances, with a good recovery of visual acuity and a reduced donor lenticule dislocation event.

An all laser procedure is proposed in the endothelial transplant. The surgical technique is based on the use of a femtosecond laser to prepare the donor tissue. Laser welding technique is then used to secure the donor endothelium in the correct position.

Un &quot;All-láser&quot; Trasplante endotelial

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an ...

Medicina

Establishment of a Severe Dry Eye Model Using Complete Dacryoadenectomy in Rabbits

Dry eye disease (DED) is a complex disease with multiple etiologies and variable symptoms, having ocular surface inflammation as its key pathophysiologic step. Despite advances in our understanding of DED, significant knowledge gaps remain. Advances are limited in part due to the lack of informative animal models. The authors recently reported on a method of DED induced by injecting all orbital lacrimal gland (LG) tissues with the lectin concanavalin A. Here, we report a novel model of aqueous-deficient DED based on the surgical resection of all orbital LG (dacryoadenectomy) tissues. Both methods use rabbits because of their similarity to human eyes in terms of the size and structure of the ocular surface. One week after removal of the nictitating membrane, the orbital superior LG was surgically removed under anesthesia, followed by removal of the palpebral superior LG, and finally removal of the inferior LG. Dacryoadenectomy induced severe DED, evidenced by a marked reduction in the tear break up time test and the Schirmer&#39;s tear test, and significantly increased tear osmolarity and rose bengal staining. Dacryoadenectomy-induced DED lasted at least eight weeks. There were no complications and animals tolerated the procedure well. The technique can be mastered relatively easily by those with adequate surgical experience and appreciation of the relevant rabbit anatomy. Since this model recapitulates the features of human aqueous-deficient DED, it is suitable for studies of ocular surface homeostasis, DED, and candidate therapeutics.

A novel approach is presented to induce chronic dry eye disease in rabbits by surgically removing all orbital lacrimal glands. This method, distinct from those previously reported, produces a stable, reproducible model of aqueous deficient dry eye well suited to study tear physiology and pathophysiology and ocular therapeutics.

Establecimiento de un modelo de ojos secos severos mediante dacrioadenectomía completa en conejos

Dry eye disease (DED) is a complex disease with multiple etiologies and variable symptoms, having ocular surface inflammation as its key pathophysiologic ...

Endaural Endoscopic Atticoantrotomy (Retrograde Mastoidectomy) using a Constant Suction Bone-drilling Technique

Endoscopic middle ear surgery is a widely employed minimally invasive surgical technique to address middle ear and mastoid pathology. Bone drilling is the main technical challenge of endoscopic middle ear surgery. The accompanying video describes the detailed protocol of a constant-suction bone-drilling technique and the procedure of endaural exclusive endoscopic atticoantrotomy (retrograde mastoidectomy) using this technique. The main components of this bone-drilling technique include a soft and flexible suction tube, which is placed into the tympanic cavity to provide constant suction, and a soft sleeve, which is wrapped around the drill shaft to prevent the high-speed rotating shaft from damaging the lens of the endoscope. With these simple modifications, the traditional otological electrodrill can be used for drilling a tiny endaural incision in endoscopic middle ear surgery. Based on this bone-drilling technique, endaural endoscopic atticoantrotomy (retrograde mastoidectomy) can be successfully established for the removal of various amounts of bone, depending on the extent of the lesion. The short-term postoperative outcome seems promising.

Endaural Endoscopic Atticoantrotomy Retrograde Mastoidectomy using a Constant Suction Bone-drilling Technique

In this paper, we present the protocol and short-term outcomes of endaural exclusive endoscopic atticoantrotomy using a constant suction bone-drilling technique.

Atticoantrotomía endoscópica endaural (mastoidectomía retrógrada) utilizando una técnica de perforación ósea por succión constante

Endoscopic middle ear surgery is a widely employed minimally invasive surgical technique to address middle ear and mastoid pathology. Bone drilling is the ...

The Microscopic Transcanal Approach in Stapes Surgery Revisited

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the external auditory canal, the middle ear, and epitympanon. Such an approach avoids a retroauricular or endaural skin incision; however, working through a narrow space needs angled microsurgical instruments and specific training in otologic surgery. The transcanal approach restricts the working space; however, it offers a binocular microscopic vision into the middle ear without extended skin incisions and thus, reducing post-operative pain and bleeding. In addition, this minimally invasive approach avoids scar tissue complications, hypoesthesia of the auricle, and potential protrusion of the pinna. Despite its numerous advantages, this method is still not routinely performed by otologic surgeons. Since this minimally invasive technique is more challenging, there is a need for extensive training in order for it to be widely adopted by otologic surgeons. This article provides step-by-step surgical instructions for stapes surgery and reports possible indications, pitfalls, and limitations using this microscopic transcanal technique.

This article describes the microscopic transcanal technique for stapes surgery, providing step-by-step surgical instructions for familiarizing surgeons with this approach.

El enfoque microscópico transcanal en la cirugía de estribos revisado

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the ...

Endolymphatic Duct Blockage as a Surgical Treatment Option for M&#233;ni&#232;re's Disease

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing and equilibrium. After a regular mastoidectomy, the posterior semicircular canal is identified, and Donaldson's line is determined. This is a line through the horizontal semicircular canal, crossing the posterior semicircular canal. The endolymphatic sac is usually found at this site under the posterior semicircular canal. The bone of the endolymphatic sac and the dura are thinned until the sac is skeletonized, after which the endolymphatic duct is identified. The duct is then blocked with a titanium clip. Using a computerized tomography (CT) scan, the position is confirmed. Follow-up visits take place 1 week, 6 weeks and 1 year after surgery. To this day, only one prospective trial assessing this method has been conducted, comparing this new method to endolymphatic sac decompression. Results of the duct blockage are promising, with 96.5% of the patients free of vertigo after 2 years. However, further research is required.

Endolymphatic duct blockage is a relatively new surgical method for patients suffering from M&#233;ni&#232;re's disease. Following a regular mastoidectomy, the endolymphatic duct is identified and ligated using a regular titanium hemoclip. The effectiveness of this procedure is currently being assessed in a randomized trial.

Obstrucción del conducto endolinfático como opción de tratamiento quirúrgico para la enfermedad de Ménière

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing ...

Robot-Assisted Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma

Congenital cholesteatoma accounts for 25% of cholesteatoma cases in children. Transcanal Endoscopic Ear Surgery (TEES) is ideal for these patients because it offers a wide endoscopic view of the middle ear and a minimally invasive approach. The two main limitations are the loss of one operative hand and a narrow external auditory canal in younger children. Here, we present the case of a 3-year-old patient with a Potsic stage III congenital cholesteatoma adherent to the incus and branches of the stapes. A robotic-assisted TEES procedure was performed, during which a robotic arm with 6 degrees of freedom held a 0&#176;, 2.9 mm wide endoscope, enabling the surgeon to work in a narrow environment with both hands. The procedure's duration was 2 h and 9 min, including 16 min for the installation and draping of the robotic arm. After a trans-canal approach, the cholesteatoma was dissected from the ossicles using both a needle (or sickle knife) and suction to stabilize the ossicles and limit the risk of hearing trauma. The cholesteatoma was debulked to reduce its size, allowing it to be pushed under the malleus anteriorly and then separated from other adherences before removal. A tragal cartilage graft was used to reinforce the tympanic membrane.

This protocol describes the removal of congenital cholesteatoma using minimally invasive transcanal endoscopic ear surgery with a two-handed approach and a robotic endoscope holder.

Cirugía endoscópica de oreja transcanal asistida por robot para el colesteatoma congénito

Congenital cholesteatoma accounts for 25% of cholesteatoma cases in children. Transcanal Endoscopic Ear Surgery (TEES) is ideal for these patients because ...

Nasolacrimal Lavage as a Treatment for Ocular Surface Toxic Soup Syndrome

Ocular surface toxic soup syndrome (OSTSS) is characterized by inadequate tear drainage through the nasolacrimal duct system, leading to the accumulation of inflammatory mediators in the tear film. This condition can result in toxic keratoconjunctivitis, with symptoms such as conjunctival hyperemia, itchiness, discomfort, and epiphora. Dilation and irrigation are common diagnostic procedures in both optometry and ophthalmology, used to assess nasolacrimal duct obstruction in cases of epiphora. This technique involves the injection of saline into the nasolacrimal duct system through the puncta, followed by the evaluation of reflux, which indicates obstruction. Although intended to be diagnostic, many patients report significant improvements in epiphora and ocular comfort after the procedure. In this paper, we present a case study in which a patient achieved complete resolution of epiphora and itchiness following therapeutic nasolacrimal lavage performed every 2 months. Subjective improvements in symptoms in 3 additional patients are also reported. We propose nasolacrimal lavage not only as a diagnostic tool but also as an effective therapeutic intervention for managing OSTSS.

OSTSS leads to pooled inflammatory mediators in the tear film, causing symptoms like epiphora and discomfort. Here, we present a case where therapeutic nasolacrimal lavage every 2 months resolved epiphora and itchiness, suggesting its efficacy as a therapeutic intervention for OSTSS. Additionally, we report subjective improvements in symptoms in 3 additional patients.

Lavado nasolagrimal como tratamiento para el síndrome de sopa tóxica de la superficie ocular

Ocular surface toxic soup syndrome (OSTSS) is characterized by inadequate tear drainage through the nasolacrimal duct system, leading to the accumulation ...