[Outcomes of inferior access external dacryocystorhinostomy performed by residents]. / Resultados de la dacriocistorrinostomía externa vía inferior realizada por médicos residentes.

PURPOSE: To assess the outcomes of external dacryocystorhinostomy (DCREx) performed by residents at the Hospital Universitari de Bellvitge, comparing the cases operated on by residents and the cases operated on by staff surgeons. METHODS: We performed a retrospective study between January 2006 and December 2007 of all DCREx performed at our hospital. The operations involved 65 cases from 54 patients: 16 operations were performed by residents and 49 by staff surgeons. The cases were divided into two groups: cases operated on by residents and cases operated on by staff surgeons, and the following variables were studied: epidemiologic characteristics of the patients (age, sex), side of intervention, antecedents of lacrimal sac inflammation, type of anesthesia, intrasurgical and postsurgical complications and results. <> was defined as the possibility to pass physiologic serum through the lacrimal pathway and <> if the patient in addition was without symptoms of epiphora. RESULTS: The procedure was successful in 88% of cases: 80% were classified as <> while only 8% were considered <>. The operations performed by residents were successful in 81% of cases (75% <> and 6% <>), whereas staff surgeons achieved success in 90% of cases (82% <> - 8% <>). CONCLUSION: The results show that residents with suitable training and supervision can achieve good success rates approaching those of staff surgeon outcomes, without additional complications (Arch Soc Esp Oftalmol 2009; 84: 501-506).

Resultados de la dacriocistorrinostomía externa vía inferior realizada por médicos residentes / Outcomes of inferior access external dacryocystorhinostomy performed by residents

Objetivo: Analizar los resultados de la dacriocistorrinostomíaexterna (DCREx) realizada por losmédicos residentes del Hospital Universitari deBellvitge, estudiando las diferencias de sus cirugíasrespecto a los médicos adjuntos.Métodos: Realizamos un estudio retrospectivoestudiando todas las DCREx realizadas entre enerode 2006 y diciembre de 2007 en nuestro centro quecorrespondieron a 65 cirugías de 54 pacientes, delas cuales 16 fueron realizadas por médicos residentesy 49 por los médicos adjuntos.Se constituyen dos grupos: casos intervenidos porlos médicos residentes y casos intervenidos por losmédicos adjuntos, y se estudian las siguientes variables:características epidemiológicas de los pacientesintervenidos (edad, sexo), lado de intervención,antecedente de inflamación del saco lagrimal, tipode anestesia empleada, complicaciones intraquirúrgicas,postquirúrgicas y resultados de la cirugía. Sedefine como «éxito anatómico» cuando se compruebala permeabilidad de la vía lagrimal al irrigarsuero, y «éxito funcional» cuando además elpaciente no refiere síntomas de epífora.Resultados: En el 88% de los casos se obtuvieronbuenos resultados: en un 80% de los casos se alcanzó éxito funcional y en un 8% sólo anatómico. En lascirugías realizadas por los médicos residentes se consiguióun éxito global del 81% (75% funcional-6%anatómico), frente al 90% de éxito global alcanzadopor los adjuntos (82% funcional-8% anatómico).Conclusión: Los resultados indican que con el adecuadoentrenamiento y supervisión, en la DCRExlos residentes pueden obtener tasas de éxito satisfactorias,muy próximas a las alcanzadas por losadjuntos, sin que exista un incremento en las complicaciones(AU)

Purpose: To assess the outcomes of external dacryocystorhinostomy(DCREx) performed by residentsat the Hospital Universitari de Bellvitge, comparingthe cases operated on by residents and thecases operated on by staff surgeons.Methods:We performed a retrospective study betweenJanuary 2006 and December 2007 of all DCRExperformed at our hospital. The operations involved 65cases from 54 patients: 16 operations were performedby residents and 49 by staff surgeons.The cases were divided into two groups: cases operatedon by residents and cases operated on by staffsurgeons, and the following variables were studied:epidemiologic characteristics of the patients (age,sex), side of intervention, antecedents of lacrimalsac inflammation, type of anesthesia, intrasurgicaland postsurgical complications and results. «Anatomicsuccess» was defined as the possibility to passphysiologic serum through the lacrimal pathwayand «functional success» if the patient in additionwas without symptoms of epiphora.Results: The procedure was successful in 88% ofcases: 80% were classified as «functional success»while only 8% were considered «anatomic success». The operations performed by residents were successful in 81% of cases (75% «functional success» and 6% «anatomic success»), whereas staffsurgeons achieved success in 90% of cases (82%«functional success» – 8% «anatomic success»).Conclusion: The results show that residents withsuitable training and supervision can achieve goodsuccess rates approaching those of staff surgeonoutcomes, without additional complications(AU)

Blefaroptosis miogénica congénita: indicaciones de tratamiento y resultados en 50 casos / Congenital myogenic blepharoptosis: indications of treatment and results of 50 cases

Objetivo. Presentar los resultados de 50 casos de ptosis congénitasmiopáticas y revisar indicaciones de tratamiento. Material y método. Estudio retrospectivo, no comparativo, intervencional de 50 pacientes con ptosis palpebral miogénica. Se evalúan resultados según una escala subjetiva. Resultados. Consideramos como resultados muy buenos o excelentes con valoración 4/5 o 5/5: 35% de pacientes con buena función del elevador; 70% en los pacientes con ptosis moderada o leve con mala o nula función del elevador, 42% en los pacientes con moderada ptosis y buena función del elevador y 100% en pacientes con ptosis severa con mala o nula función del elevador. Conclusiones. La ptosis palpebral congénita es una malformación relativamente frecuente con implicaciones estéticas y funcionales, que puede llevar a la disminución de la agudeza visual. Salvo en estos últimos casos que precisan un tratamiento precoz es conveniente esperar al momento más adecuado para su tratamiento, normalmente entre los4 y 6 años. Una evaluación correcta de cada caso nos permitirá elegirla técnica quirúrgica más adecuada (AU)

Ojective. To present results of 50 cases of congentital blepharoptosis and to revise indications for surgical treatment. Methods. Retrospective, non-comparative interventional case series of 50 patients with congenital myogenic blepharoptosis. Results were evaluated on a subjective scale. Results. Good or excellent results in a subjective scale (4/5 or 5/5)were found in 35% of patients with good levator function; 70% in patients with moderate to slight blepharoptosis and bad or no levator function;42% in patients with moderate blephatoptosis and good levator function and 100% in patients with severe blepharoptosis and bad or no levator function. Conclusions. Congenital blepharoptosis is a relativelly frequent malformation with sthetic involvement and with a lack of proper development of visual function in most severe cases. Except in these cases, it is advisable to wait for treatment, normally between 4-6 years of age. A correct assessment of every case will help us indicate the most adequate surgical technique (AU)

[Upper eyelid surgery for treatment of congenital blepharoptosis]. / Cirugía del párpado superior para el tratamiento de las ptosis congénitas.

OBJECTIVE: [corrected] To revise techniques and indications for surgical treatment of childhood blepharoptosis. METHODS: Review of the medical literature and case reports. RESULTS: The treatment of blepharoptosis is not easy. There are different techniques for its correction, depending on invasivity and aetiological approach. Most used techniques are resection of the levator muscle through a skin incision in moderate ptosis and frontal suspension for severe cases. The indication of each technique depends on the type of ptosis, severity, features of levator muscle and age. CONCLUSIONS: Simple congenital ptosis is the most frequent type of ptosis in children although is necessary to consider types associated to rectus superior palsy, blepharofimosis syndrome and Marcus-Gunn phenomenon. It is important to evaluate ptosis severity and its repercussions on visual acuity and compensating torticolli. The timing for surgical treatment varies depending on age, severity and laterality.

Cirugía del párpado superior para el tratamiento de las ptosis congénitas / Upper eyelid surgery for treatment of congenital blepharoptosis

Objetivo. Revisión de las técnicas quirúrgicas e indicaciones de tratamiento en las ptosis palpebrales en edad pediátrica. Material y método. Revisión de la literatura médica y de series de casos clínicos. Resultados. El tratamiento de la caída del párpado superior no es fácil. Existen diferentes técnicas para su corrección, que varían en grado de invasividad y en su abordaje etiopatogénico. Las técnicas más usadas son la resección del elevador por vía anterior en ptosis moderadas y la suspensión frontal con material sintético para formas severas. La indicación de cada técnica depende del tipo de ptosis congénita, y fundamentalmente de su gravedad, de las características del músculo elevador del párpado superior y de la edad. Conclusiones. La ptosis congénita simple es la causa más frecuente de caída del párpado superior en el niño si bien hay que considerar también los casos con parálisis de recto superior, el síndrome de blefarofimosis o el fenómeno de Marcun Gunn. Es importante evaluar la gravedad de la ptosis y la repercusión visual que ésta pueda tener en la agudeza visual y tortícolis compensadora. El momento de la intervención quirúrgica varía según la edad, gravedad y lateralidad de la ptosis (AU)

OJECTIVE: To revise techniques and indications for surgical treatment of childhood blepharoptosis. METHODS: Review of the medical literature and case reports. RESULTS: The treatment of blepharoptosis is not easy. There are different techniques for its correction, depending on invasivity and aetiological approach. Most used techniques are resection of the levator muscle through a skin incision in moderate ptosis and frontal suspension for severe cases. The indication of each technique depends on the type of ptosis, severity, features of levator muscle and age. CONCLUSIONS: Simple congenital ptosis is the most frequent type of ptosis in children although is necessary to consider types associated to rectus superior palsy, blepharofimosis syndrome and Marcus-Gunn phenomenon. It is important to evaluate ptosis severity and its repercussions on visual acuity and compensating torticolli. The timing for surgical treatment varies depending on age, severity and laterality (AU)