Comparison of external dacryocystorhinostomy and 5-fluorouracil augmented endonasal laser dacryocystorhinostomy. A retrospective review.

PURPOSE: To compare the success rates of external dacryocystorhinostomy (EXT-DCR) with 5-fluorouracil (5-FU) augmented endonasal laser dacryocystorhinostomy (ENL-DCR) and to record the complications associated with 5-FU augmented ENL-DCR MATERIALS AND METHODS: This was a retrospective non-randomised study. Forty-one patients with primary acquired nasolacrimal duct obstruction underwent an EXT-DCR (19 patients) or an ENL-DCR (22 patients) over a 3-year period. A Holmium YAG laser (Ho:YAG) was used in the latter group of patients. Silicone tubes intubated in all patients were removed at three months. 5-FU was applied intraoperatively at the site of the ostium in the ENL-DCR patients. The median follow-up was 12 months (range 3-24 months) for the ENL-DCR group and 22 months (range 6-28 months) for the EXT-DCR group. The patency of the lacrimal system and the severity of epiphora were assessed at a final-review. RESULTS: The median age of the EXT-DCR group was 77 years (range 53-87) and that of the ENL-DCR group was 71 years (range 23 to 84). There were 12 female patients in the former group and 19 in the latter. The percentage of success in the EXT-DCR group was 94.7% (95% confidence interval (CI) = 75.4-99.1) = ), and 63.6% in the ENL-DCR group (95% CI= 43.0-80.3). The confidence interval for the difference of 31.1% was 5.6-52.2. There was a statistically significant difference between the two groups, p=0.024 (Fisher exact test). CONCLUSIONS: These data suggest that EXT-DCR provides better results than 5-FU augmented ENL-DCR. However, ENL-DCR is the procedure of choice in certain circumstances such as in elderly, frail or medically unfit patients. Our results of 5-FU augmented ENL-DCR compare favourably with other published series.

Retained Viscoat and intraocular pressure after phaceomulsification.

PURPOSE: A single blind prospective randomised study to determine the effect of Viscoat retained in the eye on intraocular pressure (IOP) after phacoemulsification. METHODS: 82 patients were randomly selected to receive either Viscoat, a viscoelastic composed of 3% sodium hyaluronate (mol wt 500,000 daltons), and 4% chondroitin sulfate (mol wt 25,000 daltons) or Provisc, a viscoelastic compound composed of 1% sodium hyaluronate (mol wt 4,00,000 daltons) during phacoemulsification. In those patients receiving Viscoat the viscoelastic in the anterior chamber only was removed, whereas in those receiving Provisc attempts were made to remove the material entirely. The IOP was measured on the first postoperative day, 16-20 hours after surgery. RESULTS: The mean postoperative IOP in the Viscoat group was 22.37 +/- 9.0 mmHg and in the Provisc group was 19.67 +/- 6.95 mmHg. Five patients in the Viscoat group had pressure elevations above 30 mmHg as opposed to three in the Provisc group. CONCLUSIONS: The two viscoelastics cause equivalent pressure elevations postoperatively. In the Viscoat group there were five patients with IOPs above 30 mmHg. We recommend that Viscoat should be aspirated from both the anterior chamber and the capsular bag following routine phacoemulsification.