Late failure of dacryocystorhinostomy.

PURPOSE: The authors describe a group of patients with initially successful dacryocystorhinostomy surgery with late recurrence of epiphora. The causes of late failure and its management are documented. METHODS: A retrospective chart review of primary dacryocystorhinostomy cases was undertaken. Inclusion criteria were an initially successful primary dacryocystorhinostomy and recurrence of symptoms at least 12 months after surgery, together with clinical evidence of impaired lacrimal drainage. Patients' subsequent procedures were detailed and outcomes determined. RESULTS: Thirteen cases of late failure of dacryocystorhinostomy were identified (8 of 1,158 surgeries by A.A.M., 4 of 378 by D.S., 1 patient whose initial dacryocystorhinostomy was done by another surgeon). Most patients were female (85%), and average age at initial surgery was 57.9 years. Most cases had nasolacrimal duct obstruction as the initial cause of epiphora (10 of 13 or 76.9%). The mean time to recurrence of symptoms after initial surgery was 46.9 months (range, 15-97 months). Pre- and intraoperative findings at second lacrimal surgery identified the cause of epiphora in late failure to be common canalicular obstruction in 11 of 13 patients (84.6%). Eleven of the 13 patients avoided repeat dacryocystorhinostomy, instead undergoing probing (with or without common canalicular membranotomy/membranectomy) and silicone intubation. Twelve of the 13 patients (92.3%) remained asymptomatic at final follow-up (range, 4-131 months). CONCLUSIONS: Although late failure after primary dacryocystorhinostomy is rare, this newly described group appears to be a distinct clinical entity, with lacrimal system obstruction often occurring at the common canaliculus. In the large majority of cases, a less invasive surgical solution than repeat dacryocystorhinostomy is effective in resolving symptoms.

Transcutaneous blepharoptosis surgery - advancement of levator aponeurosis.

Ptosis surgery has seen many advances in the last few decades, the most important of which have emerged as a result of better understanding of the anatomy and physiology of the eyelid and orbit. Anterior approaches such as a levator aponeurosis advancement, tarsoaponeurectomy and posterior repair involving resection of Muller's muscle have proven to be effective in most cases. The focus of this article is a discussion of the indications, operative techniques, success rates and complications of transcutaneous levator advancement in detail.

Seropositivity rates for Bartonella henselae, Toxocara canis and Toxoplasma gondii in New Zealand blood donors.

BACKGROUND: Bartonella henselae, Toxocara canis and Toxoplasma gondii organisms can all cause vision-threatening posterior segment disease. Diagnosis relies heavily on clinical findings, but detection of antibodies in the patient's serum may be helpful in some cases. The significance of a positive serology result depends on the seroprevalence in the general population. Seroprevalence rates for these organisms vary widely around the world and this study aimed to determine the rates for a New Zealand population. METHODS: One hundred and forty healthy blood donors from the Waikato region in the North Island of New Zealand had their serum tested using an indirect latex agglutination test for detection of T. gondii antibodies, an indirect immunofluorescent assay for B. henselae antibodies and an enzyme-linked immunosorbent assay test for T. canis antibodies. RESULTS: Seropositivity rates for T. canis, T. gondii and B. henselae in this New Zealand population were 0.7 +/- 1.65%, 42.9 +/- 8.12% and 5 +/- 3.61%, respectively. CONCLUSION: Seropositivity rates for T. gondii and B. henselae in New Zealand are similar to rates reported in some other countries; however, T. canis seroprevalence may be lower than reported elsewhere in the world.

Clear lens extraction for the treatment of persistent accommodative spasm after head trauma.

We report the case of a 28-year-old man with decreased visual acuity after closed head trauma sustained in a motor vehicle accident 16 weeks earlier. Several structures thought to be associated with the control of accommodation were injured. The patient had a persistent accommodative spasm causing up to 7.0 diopters of pseudomyopia. We present the patient's progress through the clinic, including manifest and cycloplegic refractions and results of a trial with atropine drops, and successful transition to bilateral pseudophakia 2 years and 9 months after the accident.