Anterior flaps anastomosis in external dacryocystorhinostomy.

PURPOSE: To evaluate the outcome of the modified technique of external dacrycystorhinostomy with anterior flaps anastomosis only. METHODS: This prospective study included 52 patients with lacrimal drainage system disorders who underwent the modified technique of external dacrycystorhinostomy with anterior flaps anastomosis only. In this modified procedure of external dacryocystorhinostomy, anastomosis of anterior flaps only was created by suturing anterior flaps of the lacrimal sac and nasal mucosa, whereas posterior flaps were excised. The success rate and potential complications were recorded during the follow-up period. RESULTS: The mean age of the patients was 44.6 +/- 9.9 SD years, including 37 females and 15 males. Mean of follow up was 17.1 +/- 1.8 SD months. Intraoperative complications, hemorrhage occurred in 3 cases (5.8%) and laceration of the nasal mucosa in 2 cases (3.8%). The surgery was uneventful in 47 cases (90.4%). The postoperative complication was closure of the anastomosis that occurred in 2 cases (3.8%). The success rate was evaluated by lacrimal patency to irrigation and relief of epiphora. Fifty patients (96.2%) showed a patent lacrimal system to irrigation and relief of epiphora, 2 patients (3.8%) had recurrence of epiphora and not patent lacrimal system to irrigation. CONCLUSION: This modified technique of external dacryocystorhinostomy with anterior flaps anastomosis only simplifies the surgical procedure and is effective in the management of obstruction of lacrimal drainage system beyond the common canalicular opening. Although it is simpler, quicker and easier to master the surgical technique, external dacryocystorhinostomy with anterior flaps anastomosis only shows a success rate comparable with those found in traditional external dacryocystorhinostomy. Further studies with larger series of cases are necessary.

The success rate of external dacryocystorhinostomy.

PURPOSE: To compare the success rate of external dacryocystorhinostomy with and without silicone intubation. METHODS: This study included 129 patients with lacrimal drainage system disorders who underwent the external dacryocystorhinostomy and divided in two groups depending on whether silicone intubation was used during the surgery or not. Forty one DCR's were performed with intubation and 88 without. The data was analysed using the average, standard deviation, variation coefficient, and the statistical significance was determined using t-test. RESULTS: The mean age of the patients was 38.0 +/- 14.6SD years, including 97 females and 32 males. The mean duration of tubes was 5.2 +/- 0.8SD months. The mean time of follow-up was 14.7 +/- 3.5SD months. Intraoperative complications were present more frequently in the group without intubation 19.3% compared to 12.2% in the group with intubation (p > 0.05). The postoperative complication was closure of the anastomosis, less frequent in the group with intubation 4.9% compared to 12.5% in the group without intubation (p > 0.05). The success rate was evaluated by lacrimal patency to irrigation and relief of epiphora. Patency was achieved in 89.9% of cases, whereas epiphora recurred in 10.1% of cases. By groups, patency in the group with intubation was higher 95.1% compared to 87.5% in the group without intubation (p > 0.05). CONCLUSION: Our findings suggest that success rate was higher in dacryocystorhinostomy with silicone intubation, although results were not statistically significant. Prospective studies involving larger patient numbers are required to confirm this beneficial effect of silicone intubation.

Choice of surgical procedure for ptosis correction.

PURPOSE: the ideal procedure for ptosis management is not available until now. In many ptosis cases there is a doubt which procedure will give the best results and patient satisfaction. The aim of this paper was to present our point of view in this topic. METHOD: retrospective review and analysis of 350 ptosis cases operated by a single surgeon was done. Primary outcome measure was cosmetic appearance, secondary outcome measures includes the need for reoperation and specific complications for each operation: central picking of operated eyelid for Fasanella-Servat operation, presence and degree of lid-lag phenomenon and lagophthalmos for levator muscle resection and frontalis muscle suspension. RESULTS: 350 cases of ptosis are operated by a single consultant surgeon. Among them, Fasanella-Servat procedure was done in 119 cases (reoperation rate was 8.4%), levator muscle resection in 112 (reoperation rate was 10.7%), frontalis muscle suspension in 116 (reoperation rate was 10.3%) and Mc. Cord procedure in 3 cases. CONCLUSION: levator muscle function is a key determining factor in choosing the appropriate operating procedure for ptosis correction regardless of the degree and etiology of ptosis.