External versus Endoscopic Dacryocystorhinostomy for Primary Acquired Nasolacrimal Duct Obstruction.

PURPOSE: The purpose of the study is to compare the surgical outcomes and success rates of external dacryocystorhinostomy (EX-DCR) versus endoscopic endonasal DCR (EN-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANDO). METHODS: This retrospective nonrandomized study was conducted at Farabi Eye Hospital and Noor Eye Hospital, Iran. A review of electronic medical records of all patients with PANDO who underwent EX-DCR or EN-DCR between January 2016 and 2018 was carried out. RESULTS: A total of 803 patients underwent surgery, of which 618 patients (77%) were managed by EX-DCR and 185 patients (23%) by EN-DCR. The majority of cases (62%) were female. The mean age of the patients in EX-DCR and EN-DCR groups was 40.8 ± 14.2 and 34.3 ± 9.2 years, respectively. EX-DCR resulted in significantly less amount of pain compared to EN-DCR (P < 0.05). The success rate of surgery among EX-DCR and EN-DCR groups was 92.4% and 91.1%, respectively, and did not show statistically significant difference. A higher incidence of intraoperative hemorrhage requiring intervention was noted in the EN-DCR group (16.7% vs. 4.5%). Postoperative patient's satisfaction with EN-DCR and EX-DCR was 73% and 82%, respectively. CONCLUSION: Both EX-DXR and endoscopic DCR surgeries have high success rates and low incidence of failure. The choice of DCR technique should be based on the experience of the surgeon and patient's lacrimal and nasal anatomy and preferences.

Evaluation of Corneal Biomechanical Properties in Patients With Thyroid Eye Disease Using Ocular Response Analyzer.

PURPOSE: To assess variations in the corneal biomechanical properties in thyroid eye disease (TED) patients using ocular response analyzer (ORA). PATIENTS AND METHODS: In this observational cross-sectional study, 75 patients with TED and 57 healthy subjects were enrolled. The mean age of the patients and healthy subjects were 47.50±1.55 and 43.6±1.23 years, respectively (P=0.06). All study participants underwent comprehensive ophthalmologic examination, Goldmann applanation tonometry (GAT), corneal pachymetry, and corneal biomechanical analysis using ORA. Corneal hysteresis (CH), corneal resistance factor (CRF), cornea-compensated IOP value (IOPcc), and Goldmann-corrected IOP value (IOPg) were measured with ORA. RESULTS: Central corneal thickness (CCT) in patients group (536.18±36.20 µm) and control group (539.22±28.83 µm) were not significantly different (P=0.1). In TED group, the IOPcc (20.23±0.54 mm Hg) was significantly higher than both IOP-GAT (17.54±0.49 mm Hg, P<0.001) and IOPg (18.35±0.52, P<0.001). CH in TED patients (9.01±0.20) was significantly lower compared with CH in healthy subjects (10.45±0.21) (P<0.001). Although CRF was lower in TED patients (10.06±0.16) in comparison with normal subjects (10.42±0.29), this difference was not statistically significant (P=0.25). Both CH and CRF were positively correlated with CCT (r=0.52, P<0.001 and r=0.62, P<0.001, respectively) in TED group. CONCLUSIONS: In TED patients, CH seems to be lower than in normal subjects. GAT might underestimate the IOP due to differences in corneal properties of cornea in TED patients.

Keratoconus Clinical Findings According to Different Classifications.

PURPOSE: To demonstrate the topographic and keratometric findings in patients with keratoconus (KC), according to age, sex, and KC severity groups. METHODS: A total of 2073 eyes of 1081 patients with KC were consecutively diagnosed and enrolled in this prospective cross-sectional study. All patients underwent ophthalmic examination and Pentacam (Oculus Optikgerate GmbH) measurements. The patients were divided into different groups according to their age, sex, Amsler-Krumeich classification, and keratoconus severity score classification. Keratometric (K) values (flattest, steepest, and mean), central and thinnest corneal thickness, and manifest refraction were recorded for each patient with KC and they were then compared according to the patient's age, sex, and KC severity groups. RESULTS: The age (mean ± SD) of the population was 24 ± 7 years. The average central corneal thickness and mean K of all patients were 462 ± 45 µm and 48.8 ± 4.8 diopters, respectively. Female patients with KC were significantly younger and had significantly higher K values and lower anterior chamber depth than those of men. All parameters except for the pupil diameter and astigmatism were significantly associated with KC severity grades. The thinnest corneal thickness was the most important and also the most sensitive and specific parameter for distinguishing all stages of KC severity in all KC severity classifications. The Amsler-Krumeich classification had the most correlation with other severity classifications. CONCLUSIONS: The results of this study enable clinicians and researchers to understand better the differences between clinical characteristics between sex, age groups, and the changes in clinical characteristics during disease progression, which may lead to further advancement in KC management.

Long-term outcomes of patients undergoing war-related amputations of the foot and ankle.

Long-term clinical and functional outcomes for patients undergoing foot and ankle amputations are not well documented. We attempted to document long-term outcomes for patients who required lower extremity amputations as a result of wounds suffered during wartime. For this study, 27 Iranian soldiers who had wounds requiring amputation of the foot and ankle were selected for follow-up. The participants' wartime medical records were reviewed, a clinical examination was performed, and each participant completed a questionnaire. Postamputation follow-up averaged 17.5 years. The most prevalent (66.6%) cause of injury was a land mine. The prevalences of different clinical symptoms reported by the amputees at the time of the last follow-up were as follows: 11 (40.7%) with phantom sensation, 6 (22.2%) with phantom pain, 12 (44.4%) with stump pain, 12 (44.4%) with back pain, 9 (33.3%) with contralateral knee pain, and 4 (14.8%) with ipsilateral knee pain; 20 (74%) reported treatment for psychological conditions. In regard to social conditions, 13 (48.1) were currently employed, or had been employed, for a number of years after the amputation; 26 (96%) had children, and all of the patients were married. The results of this observational study indicate that individuals have significant long-term pain and discomfort after war-related lower extremity amputation. Although all 27 (100%) of the amputees were able to maintain satisfactory family functioning, only 13 (48.1%) of the study participants were able to remain productively employed after undergoing amputation, and 20 (74%) reported long-term psychological problems in addition to their physical pain.