Effects of Merogel coverage on wound healing and ostial patency in endonasal endoscopic dacryocystorhinostomy for primary chronic dacryocystitis.

PURPOSE: To investigate the effects of Merogel coverage on ostial patency in endonasal endoscopic dacryocystorhinostomy (EES-DCR) for primary chronic dacryocystitis (PCD). METHODS: In all, 260 patients with unilateral PCD were randomized into two groups: the Merogel group and the control group. All patients underwent EES-DCR. The Merogel group received Merogel covering the wound 1-2 mm around the ostium and the control group received no treatment. Patients were followed up for 9 months. The mucosal epithelialization of the wound, the proliferation of fibrosis tissue, and the success rate of ostial patency were compared. RESULTS: Our study included 112 patients in the Merogel group and 115 patients in the control group. At the 2-week review, intact mucosal epithelium lined the ostia in 96 Merogel patients compared with 80 control patients (ITT analysis: χ(2)=4.502, P=0.034). At the 9-month review, scars were present in 18 patients in the Merogel group compared with 39 patients in the control group (ITT analysis: χ(2)=9.909, P=0.002, ITT analysis). No differences were observed in the granulation formation between the two groups. The success rate of ostial patency reached 94.6% (106/112) in the Merogel group compared with 80% (92/115) in the control group (ITT analysis: χ(2)=4.151, P=0.042). CONCLUSION: Merogel coverage may enhance the success rate of EES-DCR for PCD by promoting mucosal epithelial healing and preventing excessive scarring.

Efficacy of trichloroacetic acid (95%) in the management of xanthelasma palpebrarum.

BACKGROUND: Xanthelasma palpebrarum (XP) is a commonly occurring benign eyelid disorder. AIM: To determine the efficacy of topical trichloroacetic acid (TCA) 95% in the management of XP. METHODS: This was a retrospective review of patients treated with TCA between June 2000 and July 2007. We recorded the outcomes of patients who attended the clinic at least 3 months after their treatment. We also contacted all patients with a minimum interval of 12 months between treatment and a telephone interview to assess for recurrence/persistence of the lesion(s). RESULTS: In total, 102 patients were enrolled in the study. Of these, 44 were reviewed in the clinic. There were nine persistent lesions and four recurrences recorded at a mean follow-up of 14.3 months. Telephone interviews were conducted with 51 patients (146 lesions). Of these 51 patients, 43 had been given bilateral TCA treatment. The mean number of TCA treatments was 1.68. Mean time from the past TCA treatment to the telephone interview was 31.8 months. Of the 51 patients, 17 patients reported no recurrence, 22 patients had experienced a recurrence, 9 patients had persistence of the lesion and 3 patients undergone surgical excision of the lesion since the last TCA treatment. Overall, the success rate for TCA was 61% at a mean follow-up of 31.8 months. CONCLUSIONS: XP has a strong history of recurrence. TCA treatment may be effective in XP and is a short, simple and cheap procedure that can be repeated. Although the requirement for retreatment is high, patient satisfaction with the procedure is also high.

Our experience using primary oral antibiotics in the management of orbital cellulitis in a tertiary referral centre.

AIMS/PURPOSE: Orbital cellulitis is conventionally managed by intravenous (i.v.) antibiotic therapy, followed by oral antibiotics once the infection shows signs of significant improvement. We report 4 years of experience using primary oral ciprofloxacin and clindamycin in cases of orbital cellulitis. Oral ciprofloxacin and clindamycin have a similar bioavailability to the i.v. preparations and provide an appropriate spectrum of antibiotic cover for the pathogens responsible for orbital cellulitis. METHODS: A retrospective review was performed that identified all patients with orbital cellulitis and treated with primary oral antibiotic therapy admitted to the Manchester Royal Eye Hospital between March 2003 and March 2007. Age, stage of disease, surgical intervention, hospital duration, and complications were obtained. A comparison was made with patients admitted to our unit with orbital cellulitis and treated with primary i.v. antibiotics between March 2000 and March 2003. RESULTS: Nineteen patients were included in the review for the period March 2003 to March 2007, which comprised of 7 children and 12 adults. Five patients required surgical intervention. All patients responded to the oral regimen, 18 patients had no change to their oral antibiotic therapy. Mean hospital stay was 4.4 days. There were no complications. DISCUSSION: Empirical oral ciprofloxacin and clindamycin combination may be as safe and effective as i.v. therapy in the management of orbital cellulitis. Oral treatment can offer the advantages of rapid delivery of the first antibiotic dose, fewer interruptions in treatment, and simplified delivery of medication particularly in children.