Success Rate of Endonasal Dacryocystorhinostomy Based on the Location of the Lacrimal Sac

PURPOSE: We studied whether the illumination had an influence on the identification of the location of the lacrimal sac and the success rate of endoscopic endonasal dacryocystorhinostomy (DCR). METHODS: Endoscopic endonasal DCR was performed on 85 eyes of 80 patients who had obstruction of nasolacrimal system without illumination. RESULTS: In all patients, identification of the location of the lacrimal sac by detecting the probe tip or the lacrimo-maxillary suture line was accomplished, without illumination. Final success rate was 87.1% in illuminator non-using group. CONCLUSIONS: We considered that endoscopic endonasal DCR without illumination, in the knowledge of lacrimal sac, ethmoid anatomy, and anatomical variations, was a non-invasive, efficient, and satisfactory method.

Comparison in Pain between Photorefractive Keratectomy and Laser In Situ Epithelial Keratomileusis during Intraoperative and Postoperative Period

PURPOSE: To compare the degree of pain between photorefractive keratectomy(PRK) and laser in situ epithelial keratomileusis(LASEK) during intraoperative and postoperative period, we used the visual pain analogue scale. METHODS: Forty patients requiring refractive surgery of both eyes were randomized into 2 groups and were studied by double-blind clinical trial prospectively. Each patient had PRK performed on one eye and LASEK on the other on the same day. On half of the patients PRK was performed before LASEK. The other half had LASEK first and then PRK. All surgeries were performed by one surgeon and subjective pain was assessed using analog scale of no pain(0) to worst pain imaginable(10) during the operation, post operatively, and on the first, second, sixth postoperative day. RESULTS: There were no significant carry-over effects in all 5 comparisons(p>0.30) between the two groups of different operation order. There was less discomfort in the PRK group compared with the LASEK group on all days of measurement. The pain felt by the patients was significantly less in the PRK group on the first(mean 3.29 versus 5.46, p<0.0001) and the second(mean 1.39 versus 3.61, p<0.0001) postoperative day. The sum of pain in all measuring days were also significantly less(mean 10.39 versus 16.29, p<0.0001) in the PRK group. CONCLUSION: We concluded that PRK is a more comfortable refractive surgery than LASEK in the aspect of pain.

Effect of Combined Therapy of Mitomycin C with Beta Irradiation for Prevention of Recurrence of Primary and Recurrent Pterygium

PURPOSE: The most common problem in pterygium operation is recurrence ; recurrence rate is higher in recurrent pterygium than primary one. Effects on recurrence rate of combination therapy of intraoperative mitomycin C soaking method with postoperative beta-irradiation (strontium 90) along with its complications were investigated in primary and recurrent pterygium. Recurrence rate of the combination therapy was compared with that of the pterygium excision, postoperative beta-irradiation, and intraoperative mitomycin C soaking, respectively. METHODS: Fifty-three patients (fifty-nine eyes) with primary pterygium and twenty-three patients (twenty-four eyes) with recurrent pterygium received surgery. Mitomycin C in a concentration of 0.2 mg/ml soaked in a 2 x 2 mm Weckcel sponge was applied on the bare sclera intraoperatively after pterygium excision. Forty-five seconds of beta irradiation was done on the first and sixth postoperative days. RESULTS: During the mean follow-up period of 15 months, recurrence rate was 3.4% (2 eyes) in primary pterygium and 4.2% (1 eye) in recurrent one, respectively. Compared to the recurrence rate of 22.5% in primary and 35.0% in recurrent pterygium, respectively when removal of pterygium alone was performed and 14.3% in primary and 20.0% in recurrent, respectively with postoperative beta-irradiation and 12.8% in primary and 15.0% in recurrent, respectively with intraoperative mitomycin C soaking. These differences were statistically significant (P<0.05). One eye showed symblepharon in recurrent pterygium with combination therapy. CONCLUSION: Combination therapy of intraoperative administration of mitomycin C and postoperative beta irradiation (strontium 90) is considered an effective and safe adjunct for prevention of the recurrence of recurrent pterygium as well as primary.