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New mucosal flap modification for endonasal endoscopic dacryocystorhinostomy in Asians

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International Journal of Ophthalmology(English edition) 2012年第6期5卷 704-707页

作者： Qing-Shan Ji Jing-Xiang Zhong yun-hai tu Wen-Can Wu Department of Ophthalmology the First Affiliated Hospital of Jinan University Department of Orbital and Oculoplastic Surgery Eye Hospital of Wenzhou Medical College Wenzhou 325027

AIM: To describe a simple modification of fashioning the mucosal flap for endonasal endoscopic dacryocystorhinostomy (EES-DCR) in Asians and investigate its efficacy. METHODS: A total of 120 patients with unilateral primary chronic dacryocystitis (PCD) were randomized into two groups: the new shaped nasal mucosal flap group (group A) and the removed nasal mucosal flap group (group B). All patients underwent standard EES-DCR. Patients in group A were performed a new shaped nasal mucosal flap covering the bared bone around the opened sac and those in group B was removed the nasal mucosal flap uncovering the bared bone. Patients were followed up for one year. The occurrence of granulation tissue, the proliferation of scar tissue and success rate of EES-DCR was compared. RESULTS: In the present study, complete postoperative data were acquired from 54 patients in group A and from 57 patients in group B. During process of review, the occurrence of granulation tissue was at the ostium margins account for 15% (8/54) in group A and 39% (22/57) in group B (P<0.05). At the one-year review, scar tissue was present in 5 patients in group A compared with 18 in group B (P<0.05). The success rate of EES-DCR was 98% (53/54) in group A and 84% (48/57) in group B (P<0.05). CONCLUSION: The simple modification of fashioning nasal mucosal flap can effectively cover the bared bone around the opened sac and reduce formation of granulation tissue, lessen the risk of scar tissue formation and closure of ostium, thus improve the success rate of EES-DCR in Asians.

关键词： mucosal flap endonasal endoscopic dacryocystorhinostomy chronic dacryocystitis

Predictive parameters on CT scan for dysthyroid optic neuropathy

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International Journal of Ophthalmology(English edition) 2020年第8期13卷 1266-1271页

作者： Bo Yu Can Gong Yuan-Fei Ji Yu Xia yun-hai tu Wen-Can Wu Department of Orbital and Oculoplastic Surgery Eye Hospital of Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina Department of Ophthalmology Loudi Central HospitalLoudi 417000Hunan ProvinceChina Eye Hospital of Wenzhou Medical University Wenzhou 325000ZhejiangProvinceChina

AIM:To evaluate the value of parameters on CT scan in predicting dysthyroid optic neuropathy(DON)and to provide guidance for early diagnosis of DON ***:A total of 67 eyes of 35 patients with thyroid-associated ophthalmopathy(TAO)were included in this *** were divided into 2 groups(DON group and non-DON group).Parameters were measured on high resolution CT,including muscle index(MI),superior ophthalmic vein(SOV)dilatation,extraocular muscle volume/orbit volume(MV/OV),and intracranial fat prolapsed,and be compared between these 2 *** relation between those parameters and visual function[visual acuity(VA)and visual field defect(VF defect)]were also ***:MI and MV/OV were significantly higher in DON group(P=0.00035 and P=0.00026).No significant difference was detected regarding intracranial fat prolapse existence and SOV dilatation(P=0.37 and P=0.15).MV/OV was found to have significant negative correlation with both VF defect(R=-0.332,P=0.0273)and VA(R=-0.635,P=0.00)while MI was found to have negative linear correlation with VA only(R=-0.456,P=0.00017).The area under receiver operating characteristic curves was 0.82 for MV/OV and 0.75 for *** best performance in detecting DON was achieved when MV/OV is set at 0.20 with 72%sensitivity and 87%specificity and MI is set at 0.52 with 64%sensitivity and 80%***:MI and MV/OV are predictive parameters for *** with clinical manifestations,MV/OV≥0.2 can be used as a good indicator for DON in TAO patients.

关键词： dysthyroid optic neuropathy muscle index superior ophthalmic vein dilatation intracranial fat prolapse muscle volume/orbital volume

Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses

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International Journal of Ophthalmology(English edition) 2022年第11期15卷 1765-1771页

作者： Yao-Hua Wang Wen-Hao Jiang yun-hai tu Guang-Ming Zhou Wen-Can Wu Bo Yu Department of Orbital Diseases and Ophthalmic tumor Affiliated Eye Hospital of Nanchang UniversityNanchang 330000Jiangxi ProvinceChina Eye Hospital of Wenzhou Medical University Wenzhou 325000Zhejiang ProvinceChina Department of Orbital and Oculoplastic Surgery Eye Hospital of Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina

AIM: To evaluate the outcome of endoscopic dacryocystorhinostomy(En-DCR) with mucosal anastomosis in chronic dacryocystitis patients, with various categories of ethmoid ***: Between July 2015 and September 2019, 1439 adult patients, representing 1623 affected eyes, presented with chronic dacryocystitis and were scheduled for En-DCR. The categories of ethmoid sinuses were preoperatively determined, using computed tomographydacr yocystography(CT-DCG), and were classified as category 1(C1), category 2(C2), and category 3(C3). No sinuses anterior to the posterior lacrimal crest defined as C1. Sinuses found between the anterior edge of the lacrimal bone and the posterior lacrimal crest defined as C2. Sinuses found anterior to the lacrimal bone suture defined as C3. At the end of surgery, the dacryocyst and nasal mucosa were anastomosed in C1, and the dacryocyst mucosa and anterior ethmoid sinus were anastomosed in C2 and C3 ethmoid sinus patients. The surgical success rate and related complications, in patients with 3 categories of ethmoid cells, were monitored and ***: Postoperative data was obtained for 179 C1 affected eyes, 878 C2 affected eyes, and 432 C3 affected eyes. The overall success rate of En-DCR was 93.0%(1385/1489). Additionally, the success rates were comparable among the different ethmoid categories at 12mo post operation. We demonstrated that the major reason for surgical failure was intranasal ostial closure, due to granulation or scar ***: En-DCR is a feasible and highly effective primary treatment for chronic dacryocystitis. To ensure surgical success, the surgery protocol must be designed in accordance with the category of ethmoid sinuses present in individual patient.

关键词： endoscopic dacryocystorhinostomy ethmoid sinuses mucosal anastomosis

Management of chronic dacryocystitis cases after failed external dacryocystorhinostomy using endoscopic technique with a novel lacrimal ostium stent

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International Journal of Ophthalmology(English edition) 2022年第3期15卷 413-419页

作者： Bo Yu yun-hai tu Guang-Ming Zhou Jie-Liang Shi En-De Wu Wen-Can Wu Department of Orbital and Oculoplastic Surgery Eye Hospital of Wenzhou Medical UniversityWenzhou 325027Zhejiang ProvinceChina

AIM: To demonstrate the outcomes of endoscopic endonasal dacryocystorhinostomy(En-DCR) with an novel lacrimal ostium stent(LOS) which was performed in patients with recurrent epiphora after failed external dacryocystorhinostomy(Ex-DCR) and analyze the causes of failed ***: From September 2015 and December 2017, the clinic data of 29 cases suffered from recurrent epiphora after failed Ex-DCR was *** LOS were implanted into the ostium at the end of the revisional *** causes of failed Ex-DCR were analyzed before revisional *** of revisional surgeries with the new device were evaluated as ***: The major causes of failure of the external approach were synechiae formation in the nasal ostium(29/29), followed by inadequate removal of the bony wall(21/29), nasal synechiae formation between lateral wall of nose and middle turbinate(11/29), and the bone opening was not in good location(7/29).The rate of success after revisional surgery was 82.76%.Re-obstruction of the ostiums were found in 5 failed ***: Endoscopic approach with a novel LOS may be an effective procedure to manage recurrent epiphora after previous failed Ex-DCR *** formation in the nasal ostium and inadequate removal of the bony wall were the major causes of failure of Ex-DCR.

关键词： external dacryocystorhinostomy failed endoscopic technique lacrimal ostium stent

Therapeutic difference between orbital decompression and glucocorticoids administration as the first-line treatment for dysthyroid optic neuropathy:a systematic review

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International Journal of Ophthalmology(English edition) 2021年第7期14卷 1107-1113页

作者： Ming-Na Xu Zhao-Qi Pan yun-hai tu He-Qing Tao Ke-Si Shi Wen-Can Wu The Eye Hospital of Wenzhou Medical University Wenzhou 325027Zhejiang ProvinceChina Peking University Third Hospital Beijing 100000China The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou 310000Zhejiang ProvinceChina

To assess all available data to compare the efficacy of glucocorticoids treatment and orbital decompression for dysthyroid optic neuropathy(DON).PubMed,EMBASE,the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant *** primary outcomes were the improvement in visual acuity and responder *** outcomes were the proptosis reduction,change in diplopia,and clinical activity score(CAS).One randomized controlled trial,three retrospective case series and one prospective case series met the inclusion *** were divided into intravenous high-dose glucocorticoids(ivGC)group and orbital decompression(OD)*** groups demonstrated improvement in visual *** addition,the proportion of patients with improved vision in OD group was higher than that in ivGC group(Ptudy also presented results regarding pre-existing and new-onset *** from diplopia,a wide variety of minor and major complications were noted in 5 included *** most common complication in ivGC group and OD group was Cushing's syndrome and epistaxis *** present systematic review shows that both glucocorticoids treatment and OD are effective in treating DON and OD may work better in improving visual acuity and reducing ***,high-quality,large-sample,controlled studies need to be performed in the future.

关键词： dysthyroid optic neuropathy glucocorticoid orbital decompression

Prognostic factors of trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy

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International Journal of Ophthalmology(English edition) 2018年第7期11卷 1222-1226页

作者： Ying-Jie Ma Bo Yu yun-hai tu Bang-Xun Mao Xin-Yi Yu Wen-Can Wu Eye Hospital of Wenzhou Medical University Wenzhou 325000 Zhejiang Province China Department of Orbital and Oculoplastic Surgery Eye Hospital of Wenzhou Medical University Wenzhou 325000 Zhejiang Province China

AIM： To investigate a possible correlation between visual acuity（VA） prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy（ITON）. METHODS： From July 1 st, 2012 to July 1 st, 2015, 224 adults diagnosed with ITON who underwent endoscopic transethmosphenoid optic canal decompression（ETOCD） were reviewed. Visual outcome before and after treatment were taken into comparison. RESULTS： Accompanied older in age, longer time to medical treatment and existence of optic canal fracture（OCF） were the independent predictors for poor postoperative VA and lower improvement degree of visual acuity（IDVA）, while worse preoperative VA was predictive factor for poor postoperative VA only. Mean value of IDVA in patients with OCF was 0.19±0.30. Mean value of IDVA in patients without OCF was 0.29±0.35. IDVA in cases without OCF was significant higher than those with OCF（t=2.272, P〈0.05）. CONCLUSION： Patients suffered from ITON without OCF before ETOCD have better surgical outcome than those with OCF. Older in age, longer time to medical treatment and existence of OCF are independent factors for poor VA prognosis and lower IDVA. Preoperative VA is independent factor for VA prognosis only.

关键词： trans-ethmosphenoid optic canal decompression indirect traumatic optic neuropathy adults visual acuity improvement degree of visual acuity

Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation

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International Journal of Ophthalmology(English edition) 2021年第6期14卷 844-848页

作者： Bo Yu Yu Xia Jia-Ying Sun Qian Ye yun-hai tu Guang-Ming Zhou Wen-Can Wu Department of Orbital and Oculoplastic Surgery Eye Hospital of Wenzhou Medical UniversityWenzhou 325027Zhejiang ProvinceChina Department of Ophthalmology Eye Hospital of JinanJinan 250000Shandong ProvinceChina Eye Hospital of Wenzhou Medical University Wenzhou 325027Zhejiang ProvinceChina

AIM:To establish the necessity of silicone tube intubation in acute dacryocystitis(AD)patients undergoing endonasal endoscopic dacryocystorhinostomy(En-DCR).METHODS:Patients presenting with unilateral AD were randomly assigned to two treatment ***-DCR procedures were performed following lacrimal abscess formation,with the operation being performed with silicone intubation for patients in group B but not group *** success was defined by an absence of additional AD episodes,no epiphora,and ostium patency as established via endoscopic evaluation or fluorescein *** success rates and demographic variables were compared between treatment ***:In total,66 patients were analyzed in the present study(33 per group),with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B,*** patients exhibited complete resolution of acute *** follow-up,granulation tissue was detected around the ostium at higher rates in group B(9/22,40.9%)relative to group A(4/27,14.8%).At the 12-month follow-up time point,patients in group A exhibited higher success rates(25/27,92.6%)relative to patients in group B(20/22,90.9%),but this difference was not *** of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ***:Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation,cost,and operative duration,these data do not support the routine silicone intubation of AD patients following En-DCR surgery.

关键词： En-DCR silicone tube acute dacryocystitis granulation

Endoscopic transnasal canaliculorhinostomy for refractory common canalicular obstruction with an unidentifiable lacrimal sac

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International Journal of Ophthalmology(English edition) 2020年第8期13卷 1238-1243页

作者： Zhao-Qi Pan Jian-Ju Liu Xian-Ke Jia Jason Kian Seng Lee yun-hai tu Jie-Liang Shi Bo Yu En-De Wu Wen-Can Wu The Mini-invasive Orbital&Oculoplastic Surgery Center Eye Hospital of Wenzhou Medical UniversityWenzhou 325027Zhejiang ProvinceChina Department of Ophthalmology the First Affiliated Hospital of Harbin Medical UniversityHarbin150000Heilongjiang ProvinceChina Department of Ophthalmology the People’s Hospital of PingyangWenzhou 325400Zhejiang ProvinceChina Ophthalmology and Visual Sciences Department Khoo Teck Puat Hospital999002Singapore

AIM:To describe the role of endoscopic transnasal canaliculorhinostomy(ETC)in refractory common canalicular obstruction(CCO)associated with an absent or unidentifiable lacrimal ***:The records of patients with refractory CCO who underwent ETC at the Eye Hospital of Wenzhou Medical University from October 2007 to December 2016 were retrospectively ***:Fifty-six patients(56 eyes)with refractory CCO were recruited into the *** patients were excluded due to the presence of a residual lacrimal sac or failure to complete the follow-up *** anatomic and functional success rates were both 85.4%(41/48)at a mean follow-up of 18.6 *** cases failed as a result of ostial synechia and two failed because of ostial obstruction by *** complications included mild nasal bleeding in 5 cases,dried nasal feeling in 8 cases,and olfactory dysfunction in 4 ***:Although being surgically challenging,ETC has comparable findings to its external approach counterpart or conjunctivodacryocystorhinostomy(CDCR)with Jones *** it may prove to be a novel alternate surgical technique for patients with refractory CCO without identifiable lacrimal sac.

关键词： refractory common canalicular obstruction endoscopic transnasal canaliculorhinostomy lacrimal reconstructive surgery

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中国内镜杂志 2016年第12期22卷 39-44页

作者：余波龚灿涂云海陈犇施节亮吴文灿温州医科大学附属眼视光医院眼眶眼整形专科浙江温州325027

目的初步观察甲状腺相关性眼病(TAO)行内镜下内侧壁眶减压联合脂肪减压术后眼眶各容积参数的变化。方法回顾分析2014年9月-2015年8月于温州医科大学附属眼视光医院由于眼球突出影响外观而行内镜下内侧壁眶减压联合脂肪减压术的TAO患者1 ... 详细信息

目的初步观察甲状腺相关性眼病(TAO)行内镜下内侧壁眶减压联合脂肪减压术后眼眶各容积参数的变化。方法回顾分析2014年9月-2015年8月于温州医科大学附属眼视光医院由于眼球突出影响外观而行内镜下内侧壁眶减压联合脂肪减压术的TAO患者1 1例(20眼),所有患者确诊为非组织活动期至少6个月,均因眼球突出影响外观而行手术治疗。所有患者术前和术后第3个月行高分辨率CT(HRCT)。运用眼眶CT结合计算机辅助测量软件测量眼球突出度,分析TAO手术前后眼眶各容积参数变化情况,并分析与眼球回退值之间的关系。结果术后眼球突出度较术前有明显降低;手术后内直肌容积(MMV)、球后脂肪容积(FV)、眼眶容积(OV)较术前有增加;手术前后眼外肌容积的变化值(?MV)与眼球回退值呈负性相关,眼眶容积变化值(?OV)与眼球回退值也呈负性相关。结论术后3个月内直肌的增粗,可能与手术干扰、术中去除内侧壁有关。眼外肌体积变化和眼眶容积变化与眼球突出度回退之间存在显著的负相关性。

关键词：甲状腺相关性眼病内镜眶减压脂肪减压眼眶容积