No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Surgical management of Centurion syndrome
... 2,4,5 Various authors have advised adjunctive procedures like punctoplasty, medial conjunctivoplasty, and lower eyelid (medial) retractor plication to increase success. 2,4,6,7 Limited awareness about CS likely contributes to its underdiagnosis and compromised management. Frequent reporting of this enigmatic entity in the literature may increase its awareness and understanding. ...
... Over time, a few adjunctive procedures have been added to improve the success rate to minimize the epiphora. 6,7 CS causes significant clear-fluid epiphora, especially in teenagers, due to classic mid-facial growth spurt. 2,4,5 They often visit ophthalmologists seeking relief for epiphora but with a high probability of misdiagnosis. ...
... Authors have predicted enophthalmos to be a limiting factor in the successful outcome of the anterior MCT release procedures. 6,7 Hence, a lower eyelid retractor plication is suggested as a successful adjunct procedure to the MCT release. 7 which was corrected by additional dacryocystorhinostomy. 2 However, Ma'luf et al. (2003) described that none of their patients (n = 4) had adequate apposition of the lower puncta after bilateral anterior canthal tendon release surgery, and only one patient had partial relief of epiphora on one side. ...
Aim:
To describe the clinical features and long-term outcomes of the medial canthal tendon (MCT) release procedure in patients with Centurion Syndrome (CS).
Methods:
We performed a retrospective analysis of the diagnosed patients with CS from July 2013 to December 2019. CS was diagnosed clinically based on the anterior displacement of MCT, anterior dislocation of lacrimal punctum out of tear lake, prominent nasal bridge, beak sign, and synophyrs. All symptomatic patients were advised the anterior limb of MCT release with modified closure of the skin incision. The outcome measures were based on Munk's score (subjective) and the fluorescein dye disappearance test (objective). A minimum postoperative follow-up of 12 months was an inclusion criterion.
Results:
We studied 22 patients (44 eyes) having a median age of 14.5 years. Anteriorly displaced MCT and lacrimal punctum were noted in 44 eyes (100%), prominent nasal bridge in 20 patients (90.9%), beak sign in 36 eyes (81.8%), and synophyrs in 17 (77.3%) patients. All 44 eyes underwent MCT release with adjunctive punctoplasty (n = 6 eyes) or lower eyelid retractor plication (n = 4 eyes). At a mean follow-up of 12.6 months, 26 eyes (59.1%) showed complete response, i.e., negative FDDT and grade 0 Munk score. Partial response was noted in 14 (31.8%) eyes, i.e., delayed FDDT and reduction of ≥2 grades on Munk score.
Conclusion:
Along with the classic features of CS, beak sign and synophyrs are important diagnostic ophthalmic-facial features of CS. The transverse closure of surgical wounds may provide effective long-term benefits in the medial canthal tendon release procedure.
... Huerva ve ark.nın tek olguluk yazışmalarına göre, medial kantal tendon serbestleştirilmesi ve lateral kantal tendonunun tekrar tespiti ile kapak-glob teması düzeltilmiş, fakat alt punktumun gözyaşı gölcüğü ile temasaı ancak alt retraktör katlanması ile sağlanabilmiştir. 8 Bizim olgumuzda, olgunun her iki gözünde de medial kantal ligamanın ön bacağının diseke edilip ayrılması sağlanmış, ancak tekrar geriye sütürasyonu yapılmamıştır. Aynı seansta punktumların fizyolojik pozisyonlarını alabilmesi için ek olarak, punktal ektropion tamirinde kullanılan yöntemle, hem konjonktival doku çıkarılmış, hem de retraktörler sütürasyona dahil edilerek etkin punktum inversiyonu sağlanmıştır. ...
Centurion syndrome is a rare medial canthal tendon insertion anomaly that causes epiphora in young adults. The purpose of the current study
is to describe the clinical signs and outcome of surgery in a 18-year-old male patient with Centurion syndrome. Ophthalmic examination
revealed bilateral loss of lid globe apposition medially, with anterior displacement of the lacrimal puncta out of the tear lake and a prominent
nasal bridge. The patient, whose findings were consistent with Centurion syndrome, underwent bilateral medial canthal tendon release and
medial tarsoconjunctival resection. Tearing was completely resolved after surgery. Anterior medial canthal tendon release with medial
conjunctivoplasty is an effective surgical approach in patients with Centurion syndrome. (Turk J Ophthalmol 2012; 42: 243-5)
Centurion syndrome is a rare medial canthal insertion anomaly impeding the apposition of the punctum and the lacrimal lake. Medial canthal tendon release combined with its posterior refixation and different surgical interventions may be needed to improve the related functional epiphora.
Centurion syndrome is a rare medial canthal insertion anomaly impeding the apposition of the punctum and the lacrimal lake. Medial canthal tendon release combined with its posterior refixation and different surgical interventions may be needed to improve the related functional epiphora.
To describe the clinical signs and outcome of surgery in cases with Centurion syndrome and highlight the clinical presentation of this syndrome.
A retrospective review of records of patients with Centurion syndrome who underwent surgery between January 2002 and July 2007. The position of the punctum, nasal bridge prominence, Hertel exophthalmometry and the presence of inferiorly directed sharp angulation of the medial canthus was noted. The patients underwent anterior canthal tendon release, punctoplasty or medial conjunctivoplasty or a combination of these.
Of the 13 cases, 10 had been treated medically elsewhere. The mean age of onset was 20.7 years. Most of the patients were male 10 (76.9%). A prominent nasal bridge was demonstrable in 9 (69.2%) patients and sharp inferior angulation of the medial canthus, the 'beak' sign was present in 9 (69.2%) cases. Anterior canthal tendon release alone was performed in 4 patients, in combination with punctoplasty in 5 and with conjunctivoplasty in 4. Watering resolved in 10 patients. 3 patients who had a combination of anterior canthal tendon release and punctoplasty had persistent but asymptomatic epiphora.
Centurion syndrome is characterised by the abnormal anterior insertion of the medial canthal tendon with displacement of the punctum out of the lacrimal lake. Most cases present with unexplained watering. Surgical management by anterior canthal tendon release with or without conjunctivoplasty or lower lid retractor plication is usually successful.
Centurion syndrome is an uncommon, idiopathic medial canthal anomaly that causes epiphora due to the forward displacement of the lacrimal punctum out of the tear lake associated with the abnormal anterior insertion of the medial canthal tendon and enophthalmos. A case of Centurion syndrome is presented together with the description of a previously unreported surgical treatment: The combined surgical techniques of medial canthal tendon release and lower eyelid retractor plication. © 2006 Royal Australian and New Zealand College of Ophthalmologists.
To describe the clinical features and treatment outcomes in patients with the centurion syndrome.
Review of medical records.
Forty patients, 38 of whom were male, were examined. Epiphora commenced during the second decade of life in all patients. Fluorescein dye pooled near the medial canthus because of anterior displacement of the medial lower eyelid and inferior punctum. Probing of the canaliculi and irrigation of the lacrimal drainage system confirmed anatomic patency in all patients. Disinsertion of the anterior limb of the medial canthal tendon relieved epiphora by restoring normal apposition between the lower eyelid and the globe in all 22 patients who underwent surgery.
Centurion syndrome is a unique clinical entity that may manifest as epiphora during puberty. Outcomes of surgical correction are favorable.
Two separate pedigrees had typical Meesmann's dystrophy of the corneal epithelium. Histologic examination of one patient from each pedigree showed two characteristic findings in corneal epithelium; the previously designated "peculiar substance" in the cells, and the vacuolated homogeneous substance mostly within the cysts. The primary disturbance probably involves the cytoplasmic ground substance that ultimately may result in complete homogenization of cells and the formation of cysts. Thickening of the epithelial basement membrane is variable and is a nonspecific response by the epithelial basal cells.
Most corneal dystrophies are autosomal dominant, bilateral disorders that primarily affect one layer of an otherwise normal cornea, progress slowly after their appearance in the first or second decade, and are not associated with a systemic disease. Epithelial basement membrane dystrophy and Fuchs' endothelial dystrophy are seen commonly by the general ophthalmologist; fleck, posterior polymorphous, granular or lattice dystrophies are seen more rarely, and others may never be seen in general office practice. While the distinctive clinical appearance of most corneal dystrophies allows accurate diagnosis, the integration of slitlamp findings with histopathologic and biochemical findings aids in the understanding of the clinical observations and provides a more rational basis for therapy. Transmission electtron microscopy is the most accurate method of histopathologic diagnosis. Epithelial dystrophies usually manifest intraepithelial cysts and abnormal basement membrane. In stromal dystrophies, an abnormal substance accumulates within the keratocytes or among the collagen fibrils; it may be an excess normal metabolite (like glycosaminoglycans in macular dystrophy), a material not usually present (like amyloid in lattice dystrophy), or a substance of unknown composition (like hyaline in granular dystrophy). Each dystrophy is illustrated with a composite drawing. Endothelial dystrophies will be reviewed separately in a second article.
Ultrastructural studies were done on a cornea obtained at the time of lamellar keratoplasty from a patient with the clinical diagnosis of Meesmann's corneal dystrophy. Light microscopy showed in the corneal epithelium the typical tiny cysts containing cellular debris and a homogeneous substance that reacted with periodic acid and Schiff's reagent and stained with Hale's colloidal iron; as well, the basement membrane was markedly thickened. Electron microscopy revealed that the cysts had a corrugated or microvillous wall, consistent with acantholysis. The epithelial cells were rich in glycogen, and many contained the peculiar substance described by others in Meesmann's corneal dystrophy. This substance appeared to be derived from the tonofilaments and was in close relation to the desmosomes. The thick basement membrane showed secondary changes, with one thick zone that was rich in collagen fibrils mimicking abnormal anchoring fibrils and one thin zone that was poor in fibrils but had frequent intercalated fibroblasts and probably represented a repair phenomenon. There was no apparent modification of Bowman's layer or the superficial stroma.
To describe a series of patients with epiphora due to a medial canthal anomaly. This anomaly consists of an anterior displacement of the anterior limb of the medial canthal tendon and a prominent nasal bridge, with lid malposition away from the globe and displacement of the lacrimal puncta out of the tear lake. The authors use the term Centurion syndrome to describe this anomaly.
The history, results of examination, investigations, and surgical management and outcome of 13 patients with Centurion syndrome were reviewed. Seven patients were recalled for examination to complete patient details.
All patients had epiphora since childhood, which worsened at puberty, and all were patent to syringing. Lacrimal scintillography (ten cases) showed a functional block at the inner canthus, with hold up of activity before entry into the sac. Surgery to restore lid globe apposition medially by release of the anterior limb of the medial canthal tendon (eight patients), sometimes combined with dacryocystorhinostomy (four patients), relieved the epiphora.
There is a group of patients with unexplained epiphora due to a medial canthal anomaly, which the authors have termed Centurion syndrome. It is important to recognize this anomaly, as it can be corrected surgically by medial canthal tendon release or by medial canthal tendon release combined with dacryocystorhinostomy if there is concomitant lacrimal outflow obstruction.
To investigate the effectiveness of anterior canthal tendon release in the management of centurion syndrome.
Four patients diagnosed as having the centurion syndrome were treated over a period of 3 years. They all underwent bilateral anterior canthal tendon release under local anesthesia.
None of these patients had adequate apposition of the lower puncta after surgery. One patient had partial relief of epiphora on one side.
Our results indicate that anterior canthal tendon release is insufficient as a sole treatment for patients with centurion syndrome.
To delineate the microstructural features of Meesmann corneal dystrophy using in vivo confocal microscopy.
Three subjects with clinically diagnosed Meesmann corneal dystrophy were examined by slit-lamp biomicroscopy and slit-scanning in vivo confocal microscopy.
On slit-lamp biomicroscopy, all subjects demonstrated large bilateral multiple epithelial cystic lesions extending to the midperiphery. On in vivo confocal microscopy, these lesions appeared as hyporeflective areas in the basal epithelial layer. The majority were circular, oval or teardrop shaped and ranged between 48 mum and 145 mum in diameter. Large elongated intraepithelial clefts were also seen. Reflective spots were visible within most of the lesions and these may represent the fibrillogranular material (termed peculiar substance) and tonofilament bundles observed in electron microscopy studies. An additional finding was the fragmented appearance of the subbasal nerve plexus.
We present the first case series of Meesmann corneal dystrophy imaged by in vivo confocal microscopy and describe the associated microstructural features. Delineation of these features facilitates the use of the confocal microscope to aid diagnosis and management of corneal dystrophies.
To analyze mutations of the keratin 3 gene (KRT3) and keratin 12 gene (KRT12) in 2 Taiwanese families with Meesmann corneal dystrophy (MCD).
Diagnosis of MCD was confirmed by slit-lamp examination of the cornea in 4 members of family 1 and 6 members of family 2. All exons and flanking intron boundaries of KRT3 and KRT12 were amplified by polymerase chain reaction (PCR), and products were subjected to direct sequencing. Restriction fragment length polymorphism analysis (RFLP) with created mismatch primers, Bst XI and Nsp I, was used to confirm the presence of the mutations in affected individuals in family 1 and family 2, respectively.
A novel heterozygous missense mutation (1508G-->C), predicting the substitution of a proline for an arginine (R503P) was detected in the helix termination motif of the keratin 3 polypeptide in family 1. Another novel heterozygous missense mutation (1286A-->G), predicting the substitution of a cysteine for a tyrosine at codon 429 (Y429C) was detected in the helix termination motif of the keratin 12 polypeptide in family 2. These 2 mutations were excluded from 50 normal controls by RFLP analysis, indicating that they were not common polymorphisms.
A novel missense mutation (R503P) in KRT3 and another novel missense mutation (Y429C) in KRT12 lead to MCD in 2 unrelated Taiwanese families. The mutant codons in our study are all located in the highly conserved alpha-helix-termination motif, which is essential for keratin filament assembly. Mutation at this area may account for the disruption of keratin filament assembly, leading to MCD.
A bstract
Centurion syndrome is an uncommon, idiopathic medial canthal anomaly that causes epiphora due to the forward displacement of the lacrimal punctum out of the tear lake associated with the abnormal anterior insertion of the medial canthal tendon and enophthalmos. A case of Centurion syndrome is presented together with the description of a previously unreported surgical treatment: the combined surgical techniques of medial canthal tendon release and lower eyelid retractor plication.
University Hospital Arnau de Vilanova, Lleida, Spain; and † Department of Ophthalmology
- Valentín Huerva
- M Carmen
- Sánchez
- M Luisa
- † Canto
- Department
- Ophthalmology
Valentín Huerva,* M. Carmen Sánchez,* Luisa M. Canto † *Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain; and † Department of Ophthalmology, Santa María Hospital, Lleida, Spain Correspondence to: Valentín Huerva, MD, PhD; vhuerva@mixmail.com Can J Ophthalmol 2007;42:879–80 doi:10.3129/i07-166
University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario; and † Department of Pathology
- Patrick Gooi
- Seymour Brownstein
- W Bruce Jackson
- George
- Department
- Ophthalmology
Patrick Gooi,* † Seymour Brownstein,* † W. Bruce Jackson,* George Mintsioulis* *Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario; and † Department of Pathology, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario Correspondence to: Seymour Brownstein, MD; sbrownstein@ohri.ca Can J Ophthalmol 2007;42:878–9 doi:10.3129.i07-168