Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Delivery of Health Care/organization & administration , Lacrimal Apparatus Diseases/therapy , Orbital Diseases/therapy , Pandemics , Pneumonia, Viral/epidemiology , Surgery, Plastic , COVID-19 , Humans , Ophthalmologists/organization & administration , Practice Patterns, Physicians'/organization & administration , SARS-CoV-2 , Victoria/epidemiologyABSTRACT
BACKGROUND: Definitive treatment of nasolacrimal duct obstruction is with external or endonasal dacryocystorhinostomy (DCR). Recent trials suggest surgical equivalency between techniques. We sought to compare alternative outcomes of DCR techniques in terms of quality of life and cost. METHODS: This study was a multicentre prospective nonrandomized case series comparing adult patients treated with external or endonasal DCR. Groups were allocated according to DCR technique. Participation did not affect treatment choice. The Glasgow Benefit Inventory (GBI) was utilized to compare postoperative quality of life, and an activity-based costing (ABC) method used to estimate costs of the two techniques. Surgical data were also collected. A minimum of 3 months follow-up was observed. RESULTS: Seventy-seven patients were included--37 external and 40 endonasal. Both techniques resulted in positive health status change, with mean GBI scores of +16.1 for external DCR and +24.1 for endonasal (p = 0.18). Using an ABC method, the operative costs of external DCR were less than endonasal at $715.79 AUD and $932.52 AUD respectively. CONCLUSIONS: This trial suggests that external and endonasal DCR produce comparable outcomes in terms of postoperative quality of life, with external DCR resulting in lower operative costs.
Subject(s)
Dacryocystorhinostomy/economics , Dacryocystorhinostomy/methods , Health Care Costs , Lacrimal Duct Obstruction/economics , Nasolacrimal Duct/surgery , Patient Satisfaction , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective Studies , Quality of Life , Sickness Impact Profile , Surveys and Questionnaires , Treatment OutcomeSubject(s)
Anesthetics, Local , Diagnostic Techniques, Ophthalmological , Entropion/diagnosis , Tetracaine , Anesthetics, Local/administration & dosage , Diagnosis, Differential , Entropion/physiopathology , Eyelids/drug effects , Eyelids/physiopathology , Follow-Up Studies , Humans , Ophthalmic Solutions , Tetracaine/administration & dosageABSTRACT
PURPOSE: To describe a technique for lengthening the levator palpebrae muscle at the level of the transverse orbital ligament (Whitnall ligament) by using hang-back sutures in cases of upper eyelid retraction in Graves orbitopathy, and to report its results. METHODS: A cohort of consecutive patients undergoing this procedure by a single surgeon was analyzed. The surgical technique involved division of the levator muscle high up, at the level of the transverse orbital ligament, with lengthening of the muscle by a graded amount with the use of nonabsorbable hang-back sutures. The length of the sutures was twice the amount of desired lowering of the eyelid. RESULTS: Surgery was performed on 38 eyelids of 21 patients. The mean preoperative eyelid retraction was 4.7 mm (range, 3 mm to 8 mm). Thirty-two eyelids (84%) were within 1 mm of the desired postoperative position. One patient required reoperation for significant undercorrection (2 eyelids), another 4 had ptosis repairs for overcorrection (5 eyelids, one of which was only 1-mm overcorrected). One eyelid required medial contour repair, but none needed lateral contour correction. CONCLUSIONS: This procedure gives a relatively predictable result in patients with moderate to severe upper eyelid retraction and avoids the postoperative complication of contour deformities, especially lateral flare.
