ABSTRACT
Epiphora and recurrent dacryocystitis are common problems between adult patients consulting ophthalmic and ENT departments. They are occur mostly duo to obstruction of nasolacrimal duct for different causes. Surgical treatment is the only available way to treat them. To study the clinical outcomes of a new endoscopic endonasal dacryocystorhinostomy [EENDCR] technique compared to the conventional external Dacryocystorhinostomy technique [Ext-DCR]. A retrospective, comparative cross sectional study on 105 cases with epiphora operated upon in 5 years [2004-2009], 60 consecutive EENDCRs and 45 Ext-DCRs. Patients with anatomic nasolacrimal duct obstruction were included in the study; previous lacrimal surgery, functional nasolacrimal, canalicular obstruction and nasal problems were excluded. Two surgeons performed the EENDCRs, using a standardized operative technique, which involved creation of a large bony ostium and mucosal flaps between the lacrimal sac mucosa and nasal mucosa. One surgeon performed all Ext-DCRs. 53 patients [15 men, 38 women] underwent 60 EENDCRs. The average age of the patients was 40 years [range, 5 to 70 years]. In the Ext-DCR group, 45 patients [14 men, 31 women] underwent 45 OCRs. The average age was 30.5 years [range, 6 to 49 years]. The average follow-up time was 10 months for the EENDCR group and 12.2 months for the Ext-DCR group. Success was defined as relief of symptoms and by anatomic patency, which was assessed by history, fluorescein dye and syringing of lacrimal drainage system. The success rate was significantly higher in cases underwent Ext-DCRs [95.55% [43/45]] as compared to cases underwent EEDCRs [81.66% [49/60]]. [P < 0.05]. Ext-DCR offers better symptom free outcomes [95.55%] than endoscopic DCR [81.66%]. Patients who are more interested than others in cosmetic subject, their operations must be conducted with EENDR. A larger, randomized prospective trial is needed to fully assess the efficacy of this new technique
Subject(s)
Humans , Male , Female , Retrospective Studies , Cross-Sectional Studies , Lacrimal Apparatus Diseases/surgeryABSTRACT
Diabetic maculopathy means involvement of the macula by edema and exudates or ischemia which is the most common cause of visual impairment in diabetic patients, particularly those with type 2 diabetes. The literatures are rich in publications in these regards, nevertheless the works in general were not systematic, not enough details regarding procedures and dose parameters in using laser for treatment are mentioned. [In the present work, there is an attempt to build a systematic procedure regarding dose parameters, application parameters and laser safety]. A frequency doubled Nd: YAG laser was used to treat all eyes included in this study with diabetic maculopathy. Forty eyes of twenty five non insulin dependent diabetic Iraqi patients were evaluated, sixteen males and nine females. Their ages were 42- 76 years, all of them from patients attending ophthalmic out-patient department in the medical city. Maculopathy regressed in 38/40 of the treated eyes, unchanged in 2/40 eyes and no one deteriorated. Visual acuity improved in 6/40 of the treated eyes by at least two lines of Snellen's chart while it stabilized in other 34/40. Exudative diabetic maculopathy is responsible for reduction in vision and even legal blindness in many patients. Close regular follow up and early laser treatment of eyes with maculopathy is significant in stabilization of vision and reducing the rate of visual loss