Outcome comparison between transcanalicular and external dacryocystorhinostomy.

AIM: To compare the outcomes achieved with external dacryocystorhinostomy (EX-DCR) and transcanalicular dacryocystorhinostomy (TC-DCR) using a multidiode laser in patients with bilateral nasolacrimal duct obstruction (NLDO). METHODS: This prospective study was conducted on 38 eyes of 19 patients with bilateral NLDO. Simultaneous bilateral surgery was performed on all patients. TC-DCR (Group 1) with a diode laser was used in the right eye, and EX-DCR (Group 2) was used in the left eye. All patients were placed under general anesthesia. Routine follow-ups were scheduled at 1wk; 1, 3, 6 and 12mo postoperative intervals. Objective (lacrimal system irrigation) and subjective [tearing, irritation, pain, discharge and visual analogue scale (VAS) score] outcomes were evaluated. RESULTS: The overall objective success rate at 12mo was 73.7% (14/19) in Group 1 and 89.5 % (17/19) in Group 2. This difference was statistically significant. There were no significant between-group differences in the subjective results, such as tearing, pain and irritation. Only the discharge scores were found to be significantly higher in Group 1 compared to Group 2 at the 1y follow-up. The average VAS score was 6.8 in Group 1 and 8.7 in Group 2, with no statistically significant differences. CONCLUSION: Although TC-DCR allows surgeons to perform a minimally invasive and safe procedure, EX-DCR offers better objective and subjective outcomes than TC-DCR.

Assessment of patient satisfaction following external versus transcanalicular dacryocystorhinostomy with a diode laser and evaluation if change in quality of life after simultaneous bilateral surgery in patients with bilateral nasolacrimal duct obstruction.

AIM: To compare patient satisfaction and experience after external dacryocystorhinostomy (EX-DCR) versus transcanalicular DCR (TC-DCR) with a diode laser and to evaluate the change in quality of life following simultaneous bilateral DCR. METHODS: Prospective evaluation of 38 eyes of 19 patients with bilateral nasolacrimal duct obstruction (NLDO) who underwent TC-DCR for the right eye (Group 1) and EX-DCR for the left eye (Group 2) simultaneously. The subjective outcomes (tearing, irritation, pain, discharge, swelling, and change in visual acuity) of the patients in the two groups at 1 week, 1 month, and 3 months were compared using a questionnaire. The patients answered the questions in the Glascow Benefit Inventory (GBI) to evaluate the change in quality of life after simultaneous bilateral DCR at 1 month and 3 months. The symptom scores were compared between Group 1 and Group 2 using a Mann-Whitney test. The Wilcoxon test was used for the comparison of intragroup differences. RESULTS: The overall symptom scores significantly improved in both groups. The overall symptom score and six ocular symptom scores did not show a significant difference between the two groups at 1 week, 1 month, and 3 months. Quality of life of the patients significantly improved after simultaneous bilateral surgery according to GBI scoring at 1 month and 3 months. CONCLUSION: The subjective outcomes significantly improved in similar ways after successful TC-DCR and EX-DCR during the early postoperative period. Our study shows that simultaneous bilateral DCR confers a significant quality of life improvement.

Effects of contact lenses on corneal thickness and corneal curvature during usage.

PURPOSE: To investigate the effects of contact lenses on corneal thickness and curvature. METHODS: Eighty-four eyes of 45 patients (26 female and 19 male) wearing contact lens for the first time with a median age of 23.04 +/- 7.2 years (range, 15-44 years) were included in the study. After all patients had undergone a routine ophthalmic examination, corneal thickness measurements in nine regions and corneal topography were performed before wearing contact lenses and after 1 month, 6 months, and 12 months. Patients were classified into three groups according to duration of wear. Groups were also classified into two subgroups according to the lens type (rigid gas-permeable and soft contact lenses). RESULTS: Mean visual acuity was 0.82 +/- 0.26 with spectacles and 0.92 +/- 0.26 with contact lenses. At the end of 1 month, statistically significant corneal thinning and thickening were noted in different regions in group 1. In group 2, statistically significant corneal thinning was noted in all regions with soft contact lenses and rigid gas-permeable contact lenses except in the inferior temporal region at the end of 6 months. In group 3, corneal thinning was noted in all regions with soft contact lenses and rigid gas-permeable contact lenses. This corneal thinning was statistically significant in all regions with the soft contact lenses except in the inferior nasal region and with rigid gas-permeable contact lenses except in the central region. When corneal curvatures were examined, corneal flattening was seen in groups 1 and 2. In group 3, corneal steepening was noted. CONCLUSIONS: Soft contact lenses and rigid gas-permeable contact lenses cause corneal thickening and corneal flattening in the first months, but they cause corneal thinning and corneal steepening with time. These alterations can be evaluated as evidence that contact lenses negatively influence corneal physiology.