Comparison of failed and successful dacryocystorhinostomy by using computed tomographic dacryocystography findings.

PURPOSE: To compare the spiral computed tomographic dacryocystography (CT-DCG) findings of failed and successful dacryocystorhinostomies (DCR) and to detect the possible causes of failure before reoperation. METHODS: Eighteen patients with failed and 15 patients with functional DCR were examined by spiral CT-DCG, a combination of contrast dacryocystography and spiral computed tomography. Radiologists, who were blinded to the clinical status of the patients, measured the diameter of the osteotomy window, evaluated its position relative to the lacrimal sac, and documented any abnormal findings around the osteotomy, which may contribute to the failure of DCR. RESULTS: Location of the osteotomy window was inappropriate in 83% (15/18) of unsuccessful cases and in 7% (1/15) of successful cases and the difference was statistically significant (p < 0.01). Presence of the ethmoid air cells medial to the ostium was detected to have a significantly higher frequency in the unsuccessful DCR group (78%, 14/18) than in the successful group (20%, 3/15) (p < 0.01). The antero-posterior diameter of bony ostium was less than 15 mm in 94% (17/18) of failed DCR cases, but in only 60% (9/15) of successful DCR cases, and the difference was statistically significant (p < 0.05). Some additional findings that may contribute to the failure were noted in failed cases. There were ethmoid sinusitis in three, concha bullosa in two, nasal polyposis in two, mass in medial canthus in one, and extensive granulation tissue around the rhinostomy in one of the failed cases. CONCLUSIONS: CT-DCG is a valuable imaging tool to evaluate DCR failures before reoperation. In this series, CT-DCG showed that small size and inappropriate position of osteotomy, and also extension of ethmoid air cells medial to the lacrimal sac, were frequently seen causative factors of DCR failure.

Comparison of failed and successful dacryocystorhinostomy by using computed tomographic dacryocystography findings.

PURPOSE: To compare the spiral computed tomographic dacryocystography (CT-DCG) findings of failed and successful dacryocystorhinostomies (DCR) and to detect the possible causes of failure before reoperation. METHODS: Eighteen patients with failed and 15 patients with functional DCR were examined by spiral CT-DCG, a combination of contrast dacryocystography and spiral computed tomography. Radiologists, who were blinded to the clinical status of the patients, measured the diameter of the osteotomy window, evaluated its position relative to the lacrimal sac, and documented any abnormal findings around the osteotomy, which may contribute to the failure of DCR. RESULTS: Location of the osteotomy window was inappropriate in 83% (15/18) of unsuccessful cases and in 7% (1/15) of successful cases and the difference was statistically significant (p<0.01). Presence of the ethmoid air cells medial to the ostium was detected to have a significantly higher frequency in the unsuccessful DCR group (78%, 14/18) than in the successful group (20%, 3/15) (p<0.01). The antero-posterior diameter of bony ostium was less than 15 mm in 94% (17/18) of failed DCR cases, but in only 60% (9/15) of successful DCR cases, and the difference was statistically significant (p<0.05). Some additional findings that may contribute to the failure were noted in failed cases. There were ethmoid sinusitis in three, concha bullosa in two, nasal polyposis in two, mass in medial canthus in one, and extensive granulation tissue around the rhinostomy in one of the failed cases. CONSLUSIONS. CT-DCG is a valuable imaging tool to evaluate DCR failures before reoperation. In this series, CT-DCG showed that small size and inappropriate position of osteotomy, and also extension of ethmoid air cells medial to the lacrimal sac, were frequently seen causative factors of DCR failure. (Eur J Ophthalmol 2005; 15: 523-9).

Results of classical and augmented bimedial rectus recession in infantile esotropia.

PURPOSE: To compare the success rates of augmented bimedial rectus recession and the standard recession. MATERIALS AND METHODS: Ninety patients were included in the study. The patients were evaluated in two groups according to the amount of recession. Group 1, the standard surgery group, received 5 mm or less of recession; Group 2, the augmented surgery group, received 6 mm of recession or more. The mean postoperative follow-up was 29 months (6-60 months) in Group 1, and 20 months (6-58 months) in Group 2. RESULTS: The mean age at the time of surgery was 4.61 years in Group 1 and 4.58 years in Group 2. The 56 patients in Group 1 underwent bilateral rectus recession varying from a minimum of 3 mm to a maximum of 5 mm; the 34 patients in Group 2 had recessions varying from a minimum of 6 mm to a maximum of 8 mm. The mean preoperative angle size was 39.64 +/- 8.93 SD (range 20-50 PD) in the standard surgery group, and 59.70 +/- 10. 04 SD (range 51-85 PD) in the augmented surgery group. The average postoperative deviation was 13.37 +/- 11.87 SD (range 0-45) in Group 1 and 9.02 +/- 10.02 (range 0-45) in Group 2. A good surgical result was achieved with one operation in 29 of 56 patients (51.8%) in Group 1 and 24 of 34 patients (70.58%) in Group 2. DISCUSSION: The optimal surgical technique for the correction of large-angle esotropia is still controversial; it appears that the augmented bilateral medial rectus recession is an effective and reasonable alternative to three- or four-muscle procedures as the initial surgical treatment.

Fuchs' heterochromic uveitis associated with retinitis pigmentosa.

We report a case of bilateral retinitis pigmentosa simplex (RP) with a combination of unilateral Fuchs' heterochromic uveitis (FHU). Both of these entities are quite rare syndromes and coexistence of these entities in one patient is rarer than can be expected. Even though this rare coexistence came together in one patient, we found no hereditary factors to presume that both traits segregate independently.

Autosomal recessive nanophthalmos.

Nanophthalmos is a rare congenital ocular malformation which is generally recognized at middle age when serious complications have already developed. In this report 7 early diagnosed nanophthalmic cases are presented and diagnostic criteria, complications, inheritance and various modalities of treatment are discussed.