Surgeon Experience as Predictors of Outcome of Dacryocystorhinostomy Surgery.

BACKGROUND: Dacryocystorhinostomy surgery aims to treat nasolacrimal duct obstruction and are often performed by general ophthalmologists in developing countries. The aim of this study is to estimate the clinical burden, surgeon's experience, and outcome of dacryocystorhinostomy surgery. METHODS: A cross-sectional survey of Nepalese Ophthalmologists registered with the Nepal Ophthalmic Society was conducted after ethical clearance from Nepal Health Research Council. The survey form consisted of a single mail-shot questionnaire information including the age and experience, average case per month, and participant-reported post-operative complications and failures. Data were entered onto Microsoft excel (Microsoft Corp) and analyzed using SPSS 22.0. The data were presented in graphical and tabular format and appropriate statistical tools were employed for the analysis. RESULTS: Out of 300 practicing ophthalmologist, 135 (45%) comprising male 60 (44.4%) and female 75(55.6%) responded to the survey. Majority of respondents were general ophthalmologists (37 ,41.6%) followed by oculoplastic surgeons (27,30.3%) and other subspecialties (25,28.1%). More than 70% respondents perform 1-10 surgeries /month and only 3% perform >50 surgeries /month. The success rate of 75-90% was reported by 45(50%) respondents whereas > 90% success rate by 41 (46.1%). More than 80% surgeons experienced an infection rate of <1% regardless of the intubation status. CONCLUSIONS: This survey revealed huge differences in surgery practice patterns among ophthalmologists in Nepal. The surgical success rate and post-operative infection rate depends upon surgeon experience. Moreover, uniform surgery protocols and training budding ophthalmologists/ young Oculoplastic surgeons in the best modern dacryocystorhinostomy surgery are required.

Transient Inverse Bell's Phenomenon Following Frontalis Sling-Suspension Ptosis Surgery: A Rare Ophthalmic Phenomenon.

INTRODUCTION: Inverse Bell's phenomenon is a rare ophthalmic phenomenon where downward instead of upward movement of the eyeball occurs during eyelid closure. It may be associated with peripheral facial nerve palsy, conjunctival scarring, and ptosis surgery. CASE REPORT: A 9-year-old male patient with right upper-lid congenital ptosis developed inverse Bell's phenomenon 2 days after frontalis sling-suspension ptosis surgery. At the 3-week postoperative visit, there had been spontaneous resolution of the inversion of Bell's phenomenon without any corneal complication. CONCLUSION: Inverse Bell's phenomenon, more often reported to be associated with levator-resection surgery, may develop following frontalis sling-suspension ptosis surgery. Close monitoring and frequent instillation of topical lubricants are necessary to prevent exposure keratopathy until the resolution of inverse Bell's phenomenon in patients with lagophthalmos after ptosis surgery.

A Case of Orbital Myiasis in Recurrent Eyelid Basal Cell Carcinoma Invasive into the Orbit.

Introduction. Orbital myiasis is the infestation of the orbital tissues by fly larvae or maggots. Compromise of periorbital tissues by malignant disease, surgery, ischemia, or infection may predispose the patient to orbital myiasis. Case Report. A 73-year-old male patient with neglected recurrent basal cell carcinoma of the eyelid invasive into the orbit presented with complaints of intense itching and crawling sensation with maggots wriggling and falling from the wound of left orbit. The patient improved following manual removal of the maggots along with oral Ivermectin treatment. Recurrence of the basal cell carcinoma was confirmed by punch biopsy from the wound and extended exenteration of the orbit followed by reconstructive surgery was done. Conclusion. Orbital myiasis is a rare and preventable ocular morbidity that can complicate the malignancies resulting in widespread tissue destruction. The broad spectrum antiparasitic agent, Ivermectin, can be used as noninvasive means to treat orbital myiasis. In massive orbital myiasis and those associated with malignancies, exenteration of the orbit must be seriously considered.