Scarring in external dacryocystorhinostomy: fact or fiction?

PURPOSE: To determine patients' long-term satisfaction with external dacryocystorhinostomy (DCR) with respect to the visibility of the scar and the resolution of symptoms. METHOD: A single postal questionnaire with stamped addressed envelope for reply was sent to 204 sequential external primary DCR patients operated on by AAM from January 1999 to April 2002. RESULTS: Of the 79% who replied, 67% rated the scar as invisible with 97% happy with the scar. In 92% the epiphora was either improved or cured and 85% would recommend the operation. Younger patients were significantly more likely to rate the scar as visible but equally likely to rate the scar as good or better. Women were no more likely than men to rate the scar as visible, but if visible, were more likely to consider the scar poor. CONCLUSIONS: There was an excellent response rate for a single questionnaire. Patient satisfaction with the DCR scar is very high, with the majority considering the scar invisible. Only 3% remained unhappy with the scar. Overall patient satisfaction with external DCR is very high, for the majority of patients the procedure is effective, and 85% would recommend the operation.

A brief history of punctoplasty: the 3-snip revisited.

PURPOSE: To determine when and how to perform punctoplasty, review the history, and determine the efficacy of posterior ampullectomy. METHOD: Retrospective analysis of 53 cases of punctal stenosis, operated by a single surgeon by means of posterior ampullectomy via 3-snips. A review of the history of the procedure from papers found with a Medline search for 1-snip, 2-snip, 3-snip, and punctoplasty. RESULTS: In all, 102 sets of notes were reviewed. The age range was from 9 to 89 years with a mean age of 56 years. A total of 74% of patients were female. We excluded 22 patients who had additional surgery and 16 patients who elected not to have surgery. There was no comment as to success or failure in four sets of notes and seven notes could not be found; these cases were also excluded. Of the remaining 53 patients, success was documented in 49 cases, or 92%. CONCLUSIONS: The historical review helps explain the debate about the procedure. The retrospective review confirms that posterior ampullectomy via 3-snips is an effective procedure.

Upper lid loading with gold weights in paralytic lagophthalmos: a modified technique to maximize the long-term functional and cosmetic success.

PURPOSE: To describe a modified fixation technique to improve the long-term functional and cosmetic success of upper lid loading with gold weights. METHOD: A retrospective single surgeon study of combined upper pre-tarsal and direct levator fixation of the gold weight. The minimum follow-up period was 12 months. RESULTS: Gold weights were implanted with the modified technique into 29 patients. The gold weight was removed in two cases due to infection and in one case due to ptosis. There was no loss of function over the follow-up period and the cosmetic outcome was good or very good in all cases. The follow-up ranged from 12 to 84 months with a mean of 40 months. CONCLUSIONS: Combined upper pre-tarsal fixation and direct levator fixation is effective in maximizing both the long-term functional and cosmetic success of upper lid loading with gold weights in paralytic lagophthalmos.

Long-term results of combined cataract and glaucoma surgery versus trabeculectomy alone in low-risk patients.

PURPOSE: To compare the long-term results of combined extracapsular cataract extraction (ECCE), intraocular lens (IOL) implantation, and trabeculectomy with those of trabeculectomy alone in low-risk patients. SETTING: An ophthalmic department in a British general district hospital. METHODS: We did a retrospective analysis of the case records of all low-risk patients who had either combined ECCE, IOL implantation, and trabeculectomy (combined group) or trabeculectomy alone between August 1991 and February 1993 with a minimum of 12 months follow-up (mean 21 months). The combined group comprised 21 patients (14 women) and the trabeculectomy group, 24 patients (18 women). The mean ages were 79.8 years (range 66 to 90 years) and 76.0 years (range 61 to 87 years), respectively. We measured final intraocular pressure (IOP), number of medications used, best corrected visual acuity, visual field, and complication rates. RESULTS: Average IOPs at diagnosis, the preoperative visit, and last follow-up visit were 27.6, 23.1, and 15.6 mm Hg, respectively, in the combined group and 31.8, 26.7, and 15.3 mm Hg, respectively, in the trabeculectomy group. The differences between groups were not statistically significant at any stage. All patients had an IOP lower than 22 mm Hg at the last follow-up. In more than 75% of patients in the combined group, visual acuity improved by more than one Snellen line. CONCLUSIONS: The combined procedure compared favorably with trabeculectomy alone in low-risk patients.