British Journal of Ophthalmology

Asano, Mizuki; Takeuchi, Masaki; Ohno, Tomoko; Nakamura, Jutaro; Mizuki, Nobuhisa; Matsumura, Nozomi

doi: 10.1136/bjo-2023-324595pmid: 38242699

AimCongenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora and mucous discharge in the newborn. We conducted a multicentre randomised controlled trial to determine whether Crigler massage promotes the resolution of CNLDO in infants under 1 year of age.MethodsA total of 102 infants aged 3–11 months with unilateral CNLDO were enrolled in the study. Patients were randomly assigned to the massage and non-massage groups (n=51/group). As an allocation adjustment factor, the patients were divided into age groups of 3–5, 6–8 and 9–11 months. In the massage group, the guardian performed 10 strokes two times per day for each day until resolution or 1 month. The primary endpoint was a comparison of the 1-month resolution rate in the massage and non-massage groups.ResultsThis study included 49 male and 53 female patients with a mean age of 6.4±2.4 months. Overall, in this study, the resolution rate was not significantly different between the massage and non-massage groups (31.4% and 33.3%, respectively). However, the resolution rate was higher in the massage group in the 3–5 months age group among the protocol-compliant patients after excluding those with insufficient massage frequency (the massage group, 68.8% and the non-massage group, 28.6%, p=0.022).ConclusionsThere was no increase in the resolution rate after 1 month of lacrimal sac massage in patients 3–11 months old with unilateral CNLDO. However, in protocol-compliant younger age groups, Crigler massage may be effective.Trial registration numberUMIN Clinical Trial Registry (UMIN000032840; www.umin.ac.jp/).

McKay, Bryon R; Bansal, Aditya; Kryshtalskyj, Michael; Wong, David T; Berger, Alan R; Muni, Rajeev H

doi: 10.1136/bjo-2023-323879pmid: 38290803

BackgroundThe purpose of the study is to compare visual acuity, complications and outer retinal integrity following subretinal fluid (SRF) drainage from the peripheral retinal breaks (PRBs) versus posterior retinotomy (PR) versus perfluorocarbon liquid (PFCL) for macula-off rhegmatogenous retinal detachments (RRDs) at 2 years post-surgery.MethodsRetrospective analysis of 300 consecutive patients with primary RRD undergoing 23-gauge pars plana vitrectomy with SRF drainage through (1) PRB (n=100), (2) PR (n=100) or (3) with PFCL (n=100). Primary outcomes were visual acuity (best-corrected visual acuity (BCVA)) and complications (cystoid macular oedema (CMO) and epiretinal membrane (ERM)). Secondary outcomes were discontinuity of the external limiting membrane (ELM), ellipsoid zone (EZ) and interdigitation zone (IDZ) at 2 years post-surgery.ResultsMean (±SD) logMAR BCVA at 24 months was better in the PRB compared with PR and PFCL, with PFCL having the worst BCVA (PRB 0.5±0.6; PR 0.7±0.5; PFCL 0.9±0.7, p=0.001). CMO was higher with PFCL (PRB 29.7%; PR 30.2%; PFCL 45.9%, p=0.0015) and ERM formation was higher in PR (PRB 62.6%; PR 93.0%; PFCL 68.9%, p=0.002). There were no differences in ELM or EZ discontinuity. However, IDZ discontinuity was higher in PFCL (PRB 34%; PR 27%; PFCL 46%, p=0.002) at 2 years.ConclusionsVisual acuity was worse and discontinuity of the IDZ and CMO was greater in eyes with PFCL-assisted drainage compared with PRB or PR. Drainage technique may impact long-term visual acuity and photoreceptor integrity.

Ueno, Yuta; Oda, Masahiro; Yamaguchi, Takefumi; Fukuoka, Hideki; Nejima, Ryohei; Kitaguchi, Yoshiyuki; Miyake, Masahiro; Akiyama, Masato; Miyata, Kazunori; Kashiwagi, Kenji; Maeda, Naoyuki; Shimazaki, Jun; Noma, Hisashi; Mori, Kensaku; Oshika, Tetsuro

doi: 10.1136/bjo-2023-324488pmid: