Endoscopic endonasal dacryocystorhinostomy versus external dacryocystorhinostomy

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

Subclinical keratoconus among patients visiting laser unit - Hilla Teaching Hospital in Iraq

Subclinical Keratoconus is a term used to indicate a patient with inferior or central steepening of cornea on topography where the clinician suspects that it may progress to keratoconus. Diagnosis of sub-clinical keratoconus among myopic patients seeking for correction of their refractive errors by excimer laser, to avoid surgery for those patients and consider them at risk of developing post operative corneal ectasia which is the most severe post operative complication in photorefractive surgery. One thousand and two hundred myopic patients who attended laser unit/ Hilla Teaching Hospital, during a 1.5 year duration, seeking for correction of their refractive errors. Many investigations were done including visual acuity, slit lamp examination, corneal topography, keratometry and pachymetry. The present results indicating that 49 [4%] of patients diagnosed as having subclinical keratoconus. Out of these cases, 27 [55%] were males and 22 [45%] were females. Forty one of them [83.6%] were less than 25 years old. Sub-clinical keratoconus is one of the challenging problems facing refractive surgeons and is one of the most important and preventable causes of corneal ectasia following photorefractive surgeries