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Juan Murube, MD, PhD (Spain). THE TWO EASIEST SURGERIES TO TREAT DRY EYE: 1. PUNCTUM PATCHING 2. CISTERNOPLASTY _____________________________. WHY SPEAK ABOUT THE SURGICAL TREATMENT OF DRY EYE?. DRY EYE IS THE MOST FREQUENT DISEASE IN OPHTHALMOLOGY. - PowerPoint PPT Presentation
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Juan Murube, MD, PhD (Spain)
THE TWO EASIEST SURGERIES TO TREAT
DRY EYE:
1. PUNCTUM PATCHING
2. CISTERNOPLASTY_____________________________
WHY SPEAK ABOUT THE SURGICAL TREATMENT OF DRY EYE?
• DRY EYE IS THE MOST FREQUENT DISEASE IN OPHTHALMOLOGY.
• DRY EYE AND GLAUCOMA ARE AT PRESENT THE MOST FREQUENT CHRONIC MEDICAL TREATMENTS IN OPHTHALMOLOGY.
• ALL PEOPLE WILL SUFFER DRY EYE IF THEY LIVE LONG ENOUGH.
• AT PRESENT DRY EYE HAS NO CURE, AND TREATMENT IS ONLY PALLIATIVE
• IN THE NEAR FUTURE, SURGICAL TREATMENT OF DRY EYE WILL GREATLY INCREASE IN FREQUENCY.
THE TRIPLE CLASSIFICATION OF DRY EYE
I. ETIOPATHOGENIC II. HISTOGLANDULAR III. SEVERITY
1. Age-related A queo-deficient 1. Mild. 2. Hormonal L ipo-deficient 2. Moderate 3. Pharmacologic M ucin-deficient 3. Severe 4. Immunopathic E pitheliopathic 5. Hyponutritional N on ocular dryness 6. Dysgenetic 7. Adenitic 8. Traumatic 9. Neurodeprivative 10. Tantalic
SURGICAL TREATMENT
1. SUPPLYING FLUID TO THE LACRIMAL POOLPAROTID DUCT TRANSPOSITIONSALIVARY GLAND TRANSPLANTATIONABDOMINAL RESERVOIR
2. RETAINING FLUID IN THE LACRIMAL POOL
PUNCTUM OCCLUSIONCISTERNOPLASTY
STENO’s DUCT TRANSPOSITION, 1951
TRANSPLANTATION OF MAJOR SALIVARY
GLANDS to the TEMPORAL FOSSA, 1986
TRANSPLANTATION OF MINOR GLANDS (f.i. labial) TO THE SURFOCULUS
SUBCUTANEOUS ABDOMINAL RESERVOIRS
SURGICAL TREATMENT
1. SUPPLYING FLUID TO THE SURFOCULAR POOLPAROTID DUCT TRANSPOSITIONSALIVARY GLAND TRANSPLANTATATIONABDOMINAL RESERVOIR
2. RETAINING FLUID IN THE SURFOCULAR POOLPUNCTUM OCCLUSIONCISTERNOPLASTY
3 METHODS FOR THERMAL OCCLUSION:
1. GALVANOCAUTEY2. DIATHERMY3. LASER
PUNCTUM PLUGSiniciated by Freeman in 1975
PUNCTUM OCCLUSION WITH SMART PLUGS
PATCHING OF THE LACRIMAL PUNCTUM with autologous conjunctiva
PUNCTUM PATCHING with AUTOLOGOUS SKIN
2, CISTERNOPLASTY-THE VOLUME OF A NORMAL LACRIMAL BASIN IS ≈ 7 μl. - A DROP OF ARTIFICIAL TEAR HAS ≈ 30 μl, AND
OVERCHARGES THE LACRIMAL POOL.- FIVE MINUTES AFTER INSTILLING THE DROP, THE
LACRIMAL POOL RETURNS TO ≈ 7 μl. - IT WAS MANDATORY TO LOOK FOR A SOLUTION TO
THIS WASTE !
CISTERNOPLASTY
A CISTERNOPLASTY QUADRUPLICATES THE CONTENT OF THE LACRIMAL BASIN, AND THE TIME OF RETENTION
THANKS FOR YOUR ATTENTION
• PUNCTUM PATCHING WITH 1. AUTOLOGOUS CONJUNCTIVA OR LID SKIN……2. AND CISTERNOPLASTY DO NOT CURE,
…BUT GREATLY IMPROVE THE LIFE OF PEOPLE DEFINED IN THE TRIPLE CLASSIFICATION OF DRY
EYE AS HAVING MEDIUM AND SEVERE DRY EYE
GARRET
ABDOMINAL RESERVOIR IS THE ONLY TECHNIQUE
THAT ALLOWS TO PERFORM A SUCCESSFUL
KERATOPLASTY IN TOTAL DRY EYES
PUNTUM PLUGSiniciated by Freeman in 1975
PUNCTUM PLUG
CAUTERIZATION OF THE LACRIMAL CANALICULI
TREATMENT OF DRY EYE
1. PSYCHOLOGIC2. ENVIRONMENTAL3. MEDICAL4. SURGICAL
PUNCTUM PATCHING with AUTOLOGOUS SKIN
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