The Effect of Dacryocystorhinostomy and Septoplasty Combination Surgery for Lacrimal Obstruction with Septal Deviation

PURPOSE: To evaluate the clinical effect of endonasal dacryocystorhinostomy (DCR) and septoplasty combination surgery for lacrimal obstruction in patients with nasal septal deviation. METHODS: The study group consisted of 24 eyes of 24 lacrimal obstruction patients with nasal septal deviation who had undergone endonasal DCR combined with septoplasty from 2006 to 2012. The types of lacrimal obstruction included nasolacrimal duct obstruction (18 cases), common canaliculus obstruction (5 cases) and lower lacrimal duct obstruction (1 case). The operations' procedure was as follows: first, an otorhinolaryngologist performed septoplasty and then, an ophthalmologist performed endonasal DCR. For catamnesis observation after the surgery, the operations' results and nasal complications were retrospectively analyzed. RESULTS: A total of 24 eyes of 24 patients were included in the present study. Eight patients were males, 16 patients were females and the mean patient age was 52.1 years. During 15.5 months of catamnesis, loss of epiphora was observed in 20 cases, improvement in epiphora was found in 3 cases, and the functional and anatomical success rate was 95.8% (23/24). Eight cases of postoperative complication were observed, 7 cases of granuloma were found in the bony ostium and surrounding area, and 1 case of synechia was found in the nasal cavity. CONCLUSIONS: The combination surgery of endonasal DCR and septoplasty provides a wider surgical view, allowing for an easier nasal cavity treatment, rendering the operation and after-care less difficult, as well as reducing the risk of surrounding tissue damage. This method is adequate for preventing complications after surgery and offers a better prognosis.

Effect of the Simultaneous Operation of Levator Resection and Frontalis Suspension for Congenital Ptosis

PURPOSE: To determine retrospectively if a simultaneous frontalis suspension could change the result of undercorrection observed during levator resection in congenital ptosis patients with poor levator functions. METHODS: Eight eyes in the present study were from 5 infants, 4 infants had congenital ptosis and 1 infant had blepharophimosis. The average age was 3.3 years (range: 1.5 to 6.9 years). If the upper lid margin was not positioned on the superior limbus after performing levator resection under general anesthesia, the height of the upper lid margin was controlled by simultaneous frontalis suspension. RESULTS: The average follow-up period was 29.8 months. After surgery on both eyes, all 8 cases showed good results and sudden relapse did not occur. Exposed corneal erosion was observed in 6 eyes, but with artificial tears, eye drops, and ointment there were significant improvements within 1 month in all cases. At final examinations, 6 out of 8 eyes showed excellent or good results; undercorrection in 2 eyes was observed and the lateral portion of ptosis in 1 eye was observed as an eye complication. CONCLUSIONS: If undercorrection caused by levator resection occurs in patients with congenital ptosis, the combination of frontalis suspension surgery may reduce undercorrection and any recurrence that might appear after surgery.