Endoscopic dacryocystorhinostomy among the old and oldest-old populations - A case control study.

OBJECTIVE: Despite increased risks of nasolacrimal duct obstruction (NLDO) with age, and the continuous growth of the old population proportion, data on endoscopic dacryocystorhinostomy (eDCR) among the old is lacking. This study aims to evaluate long-term eDCR efficacy and safety in the old and oldest-old population. METHODS: A retrospective case-control study of patients aged 80 ≤ (oldest-old) and 65-79 (old) compared with younger controls who underwent eDCR, between 2002 and 2017. Pre-, intra- and postoperative factors were collected using an integrated hospital-community system. Success rates were analyzed and measured at the first visit following surgery (immediate success), and after five years. Demographics, comorbidities, complications rates, and outcomes were compared between the groups. RESULTS: The study groups included 52 oldest-old patients (mean age 83.4 ± 3.6), 127 old patients (72.3 ± 4.14) and 142 control patients (57.8 ± 18.0). The immediate and success rates were 94.2%, 93.7% and 90.8% and five-year success rates were 80.0%, 76.6% and 80% among oldest-old, old and controls, respectively. No significant differences in success rates were found, even despite higher comorbidity rates among the study's group (96 and 92.8% vs. 63.2%, among oldest-old, old and controls respectively, p <0.001). Intra- and postoperative complications rates were low in all groups. CONCLUSIONS: Among older population, including oldest-old and old, eDCR safety and long-term outcomes are comparable with younger patients, suggesting that eDCR should be offered to NLDO patients, regardless of age.

Long-term Outcomes for Revision Endoscopic Dacryocystorhinostomy-The Effect of the Primary Approach.

OBJECTIVES/HYPOTHESIS: Revision endoscopic dacryocystorhinostomy (END-DCR) is the preferred approach for failed primary surgeries, yet quality data on long-term outcomes are lacking. This study aimed to evaluate three aspects of revision END-DCR: 5-year success rates, patient satisfaction, and the primary surgical approach's possible impact on revision. METHODS: This retrospective study included all revision END-DCRs conducted at Kaplan Medical Center between the years 2002 and 2015. For long-term follow-up analysis, two subgroups of first and second revision END-DCRs with a minimum of documented 5-year follow-up after surgery were defined. Data were analyzed according to the primary surgical approach. Surgical success was defined by either anatomical (observed patent lacrimal flow) or functional (symptoms cessation) success. Patient satisfaction was measured by a questionnaire. RESULTS: After exclusions, a total of 45 eyes from 38 patients who underwent revision END-DCR surgeries were included in the study. The yearly success rates from immediate to 5 years following the first revision were 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9% for the entire cohort, respectively. Immediate and 5-year success rates following the second revision were 88.8% and 77.8%, respectively. Primary END-DCR showed favorable 5-year success rates and patient satisfaction over primary external dacryocystorhinostomy (EXT-DCR) in both first and second revisions, but this did not reach significance. CONCLUSIONS: Revision END-DCR carries an excellent short-term success rate, which decreases mainly throughout the first 2 years following surgery. Postoperative follow-up should be maintained within this timeframe. Revision END-DCR following either primary endoscopic or EXT-DCR produces comparable surgical outcomes and patient-reported satisfaction. LEVEL OF EVIDENCE: 3b Laryngoscope, 131:E682-E688, 2021.

Five- and 10-Year Outcomes for Primary Endoscopic Dacryocystorhinostomy: Failure Rate and Risk Factors.

INTRODUCTION: Endoscopic dacryocystorhinostomy (eDCR) is the preferred approach for nasolacrimal duct obstruction, yet quality data on long-term outcomes is lacking. STUDY DESIGN: A retrospective study in a single, academic institution. OBJECTIVE: To assess the 5- and 10-year success rates of eDCR, and its associated risks. PATIENTS AND METHODS: All eDCRs conducted at Kaplan Medical Center between the years 2002-2017 were included. For long-term follow-up analysis, two subgroups with a minimum of documented 5- and 10-year follow-up after surgery were defined. Surgical success was defined by both anatomical (observed patent lacrimal flow) and functional (symptomatic relief) success. Data was collected from the hospital's electronic medical records and was completed by phone interviews. Pre-, intra-, and postoperative variables were collected and stratified by multivariate analysis. RESULTS: After exclusions, 321, 168, and 65 patients were included for immediate, 5- and 10-year outcome analysis, respectively. Overall success rates were 92.5%, 86.3%, and 80%, respectively. The anatomical success rates were 93.8%, 89.9%, and 86.1%, respectively. Multivariate analysis revealed that older age (P < .001, P = .001) previous smoking (P = .043, P = .037), and postoperative complains of epiphora (even when a successful irrigation was observed, P < .001, P = .01) were all associated with eDCR failure 5 and 10 years following surgery. Male gender was also associated with eDCR failure (5 years, P = .045; 10 years, P = .063). CONCLUSIONS: Despite decreased rates over time, eDCR is beneficial for the majority of patients also at 10 years following surgery. Older age, smoking, postoperative epiphora, and male gender are related to long-term failure and should be discussed with the patients before surgery. LEVEL OF EVIDENCE: 3b Laryngoscope, 131:10-16, 2021.

The Sutureless Mullerectomy.

PURPOSE: Müller's muscle-conjunctival resection (MMCR) is a well-known approach for ptosis repair. In its standard fashion, it involves resection of Müller's muscle and conjunctiva, followed by suturing of the conjunctiva and Müller's muscle to the tarsus with absorbable or nonabsorbable sutures. The authors herein present their experience in performing MMCR without sutures. METHODS: The study was conducted as a retrospective review of 19 patients (34 eyelids) undergoing sutureless MMCR. Thirty-three eyelids had acquired ptosis and 1 eyelid had congenital ptosis. Surgery consisted of a standard approach and placement of a Putterman clamp. Following excision of the clamped tissues, no internal sutures were placed. Preoperative and postoperative upper margin-to-reflex distances were measured and patients were evaluated for symmetry within 1 mm and the incidence of any complications. RESULTS: Nineteen patients underwent 34 sutureless MMCR procedures. Of these, 13 patients had bilateral ptosis repair. Thirty-three of 34 eyelids (97%) showed improvement in margin-to-reflex distances, with an average improvement of 1.4 mm (range, 0-3.5 mm, SD = 0.64) among all patients. Eighteen of the 19 patients (94.7%) showed postoperative symmetry of margin-to-reflex distances within 1 mm (p < 0.001, χ test). One patient who underwent unilateral surgery demonstrated a Herring's response postoperatively, leading to the single case of asymmetry. There was 1 case of corneal abrasion seen postoperatively. CONCLUSIONS: The sutureless technique is a rapid and effective method for performing MMCR. This technique is especially useful as an adjunct to blepharoplasty where mild ptosis exists for an added rejuvenating effect. It is low-risk and potentially corneoprotective when compared to the standard suture technique. Further studies could determine if a modified algorithm needs to be applied.

Protective effect of different ophthalmic viscosurgical devices on corneal endothelium during severe phacoemulsification model in rabbits.

BACKGROUND AND OBJECTIVE: To evaluate the protective effect of different ophthalmic viscosurgical devices (OVDs) on corneal endothelial cells against relatively severe phacoemulsification damage in a rabbit model. MATERIALS AND METHODS: Twenty-four rabbit eyes were randomly assigned to four similar groups: in three groups the aqueous humor was completely replaced by Visiol (TRB CHEMEDICA, München, Germany), Biolon (Bio-Technology General Ltd., Kiryat Malachi, Israel), and Viscoat (Alcon, Puurs, Belgium) and in the control group no OVD was applied. Endothelial cell counts were performed prior to initiating the study. All eyes were exposed to continuous 5 minutes of phacoemulsification. Endothelial cell counts were repeated 4 days postoperatively. RESULTS: Viscoat showed the highest endothelial cell loss (30%), followed by Biolon (25%), Visiol (22%), and the control group (19%). None of the differences between the groups were found to be statistically significant, although they were within each group (P = .028). CONCLUSION: None of the tested OVDs demonstrated protective effect on corneal endothelial cells in comparison to the control group. This model was found to be too aggressive for the demonstration of the protective effect of different OVDs even for hard cataract.

Protective effect of different ophthalmic viscosurgical devices on corneal endothelial cells during phacoemulsification: rabbit model.

PURPOSE: To evaluate the protective effect of different ophthalmic viscosurgical devices on corneal endothelial cells during phacoemulsification in a rabbit model. SETTING: Harlan Biotech Israel and Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel. DESIGN: Experimental study. METHODS: Rabbit eyes were randomly assigned to 3 equally sized groups. Endothelial cell counts were performed in all eyes before initiation of the study. The aqueous humor was completely replaced by Biolon (sodium hyaluronate 1.0%) in Group A, by a combination of Viscoat (sodium chondroitin sulfate 4.0%-sodium hyaluronate 3.0%) and Provisc (sodium chondroitin sulfate 1.0%) using the soft-shell technique in Group B, and by a combination of Visiol (sodium hyaluronate 2.0%-mannitol 0.5%) and Biolon using the soft-shell technique in Group C. The eyes were exposed to alternating 10 seconds of phacoemulsification and a 10-second pause until a total exposure time of 2.5 minutes elapsed. Endothelial cell counts were repeated 3 days after surgery. RESULTS: The study used 18 rabbit eyes, 6 in each group. Group A had the highest endothelial cell loss (13%) followed by Group B (7%), and Group C (4%). The difference in cell loss between Group C and Group A was statistically significant (P = .037). CONCLUSION: The study showed the efficiency and advantages of the soft-shell technique using the combination of Visiol and Biolon over Biolon alone.

Confusion/delirium following cataract surgery: an incidence study of 1-year duration.

BACKGROUND: Delirium is frequently observed in clinical practice, particularly in medical and surgical wards and more so among patients at risk, especially elderly with preexisting central nervous system impairments. OBJECTIVE: Despite the severe consequences of delirium, epidemiological data relating to incidence of delirium following "minor" surgery are lacking. The aim of the present study was to evaluate the incidence of delirium following cataract surgery in community-dwelling patients. OUTCOME: For purposes of the present study, the Confusion Rating Scale was used. RESULTS: Of 296 patients fulfilling the inclusion criteria, 13 (4.4%) had had immediate postoperative delirium. The two variables that significantly differentiated between delirious and nondelirious patients were older age (82.1 vs. 73.06 years; p < .001) and more frequent use of benzodiazepine premedication (69% vs. 39.9%; p < .002). CONCLUSION: These findings suggest that the incidence of delirium following cataract surgery requires greater awareness, possibly changes in premedication, and a longer observation period in the very old.