Endoscopic endonasal laser versus endonasal surgical dacryocystorhinostomy for epiphora due to nasolacrimal duct obstruction: prospective, randomised, controlled trial.

BACKGROUND: Rhinostomy patency is a problem in all forms of dacryocystorhinostomy. Laser-assisted procedures are potentially fast and result in excellent haemostasis. However, they may induce more fibroblastic activity, resulting in excessive scarring and stenosis of the rhinostomy, compared with non-laser dissection. OBJECTIVES: The objective of this study was to compare subjective outcomes following dacryocystorhinostomy conducted with endoscopic endonasal laser and with endonasal surgical techniques. STUDY DESIGN: Prospective, randomised, controlled trial comparing potassium titanyl phosphate endonasal laser dissection with endonasal surgical techniques, for dacryocystorhinostomy to treat epiphora due to primary, acquired nasolacrimal duct obstruction. PARTICIPANTS: One hundred and twenty-six adult patients with chronic epiphora due to primary, acquired nasolacrimal sac or duct obstruction. INTERVENTIONS: INTERVENTIONS comprised endonasal dacryocystorhinostomy, performed using potassium titanyl phosphate laser or surgical dissection, in order to open the lacrimal sac into the nasal cavity. OUTCOME MEASURES: These were: symptom score and symptom relief of epiphora (at three and 12 months post-procedure); duration and ease of procedure; and duration of hospital stay. RESULTS: Sixty patients underwent endonasal laser dacryocystorhinostomy and 66 underwent endonasal surgical dacryocystorhinostomy. Symptomatic success was 82 per cent at three months and 68 per cent at 12 months in the laser group, and 76 per cent at three months and 74 per cent at 12 months in the surgical group. A two-point reduction in the symptom score was associated with symptomatic success at three and 12 months. Eight patients randomised to the laser group required additional instrumentation in order to remove thick bone over the lacrimal sac. CONCLUSIONS: At three months, endonasal laser dacryocystorhinostomy had better results than endonasal surgical dacryocystorhinostomy. However, at 12 months, the surgical procedure had better results than the laser procedure. There was no statistically significant difference between the two groups at three or 12 months with regard to symptomatic outcome. The ease of procedure (on a scale of zero to 10) was 4.5 for the laser procedure and 4.1 for the surgical procedure. The average times for the procedures were 25 minutes in the laser group and 20 minutes in the surgical group. No statistical difference was found when comparing: symptom score improvement for local anaesthetic vs general anaesthetic; ages over and under 70 years; laterality; or operating surgeon. Change in the symptom score was a useful indicator of symptomatic success.

Double blind, randomised, placebo controlled, crossover, multicentre study to determine the efficacy of a 0.1% (w/v) sodium hyaluronate solution (Fermavisc) in the treatment of dry eye syndrome.

BACKGROUND/AIMS: Hyaluronan (sodium hyaluronate) has been shown to confer objective and subjective improvement in patients with dry eye syndrome. This study compared the efficacy and safety of a 0.1% solution of hyaluronan with 0.9% saline, when administered topically to the eye, in the treatment of symptoms of severe dry eye syndrome. METHODS: A randomised, double blind, crossover clinical trial in which subjects were randomised to receive either hyaluronan or saline, applied as one or two drops to the eye, three or four times a day or as required. After 28 days' treatment, subjects crossed over to the other study medication for a further 28 days' treatment. RESULTS: 70 subjects were included in the analyses of efficacy and significant improvements in Schirmer's score (p=0.0006) and rose bengal staining score (p=0.0001) were observed during treatment with hyaluronan. In a subjective assessment of the effectiveness of two treatments, a majority of subjects felt that hyaluronan was more effective than saline in alleviating the symptoms of burning and grittiness (p<0.001). No adverse events attributable to hyaluronan treatment were reported. CONCLUSION: The study demonstrates a clear benefit of hyaluronan over saline, in both subjective and objective assessments of dry eye syndrome. Hyaluronan was shown to be well tolerated.

Development and implementation of drinking water quality management procedures for rural communities: South African case studies

El impacto de las enfermedades de origen hidrico en Sudafrica es significativo, ya que la diarrea es la principal causa del 20

de las muertes entre 1 y 5 años y la calidad del agua en las comunidades rurales es pobre. Se brinda un panorama de la situacion en Sudafrica, se propone la puesta en marcha de procedimientos de evaluacion y monitoreo para revertir la situacion hacia niveles de calida de agua mas aceptables, y se describe el exito obtenido en seis comunidades rurales

Development and implementation of drinking water quality management procedures for rural communities: South African case studies

El impacto de las enfermedades de origen hidrico en Sudafrica es significativo, ya que la diarrea es la principal causa del 20 de las muertes entre 1 y 5 años y la calidad del agua en las comunidades rurales es pobre. Se brinda un panorama de la situacion en Sudafrica, se propone la puesta en marcha de procedimientos de evaluacion y monitoreo para revertir la situacion hacia niveles de calida de agua mas aceptables, y se describe el exito obtenido en seis comunidades rurales

Three year results of radial keratotomy surgery at the National University Hospital, Singapore.

This paper presents the three year results of radial keratotomy (RK) surgery on 51 of the first 59 consecutive eyes at the National University Hospital in Singapore. Before surgery, uncorrected visual acuity was worse than 6/24 in all eyes with 33.3% worse than 6/60. The average pre-operative spherical equivalent (SE) was -4.56 Dioptres(D). Three years after surgery the mean SE was -0.66D, a change of 3.9D; and 72.5% of eyes were within 1D of emmetropia. 70.6% had uncorrected visual acuity of at least 6/12 with no eyes having worse than 6/60 visual acuity. Analysis based on levels of pre-operative myopia showed that the best visual and refractive results were obtained in patients with SE of -6D or less. None of the patients were troubled by complications such as glare, fluctuating vision, irritation and discomfort three years after surgery. Our results indicate that RK surgery is safe and effective through the three years and more following surgery.

Primary posterior chamber IOL implantation in penetrating ocular trauma.

This paper describes the experience of primary cataract extraction and posterior chamber IOL implantation in 11 eyes with penetrating ocular trauma. The primary surgical procedure consisted of repair of corneoscleral laceration, cataract extraction, posterior chamber IOL implantation and in certain cases, removal of intraocular foreign body and vitrectomy. 10 out of 11 cases had a post operative visual acuity of 6/18 or better, with 9 out of 11 having a post operative visual acuity of 6/12 or better. One case initially had a visual acuity of 6/24 but later developed retinal detachment with a visual acuity of 'hand movements'. Another patient developed a small localised retinal detachment during the tenth postoperative month but with successful surgery, attained a visual acuity of 6/6. The encouraging results suggest that this procedure may be recommended in carefully selected cases, under the management of an experienced surgeon.

Autosomal recessive 'optic atrophy' with late onset and evidence of ganglion cell dysfunction: a sibship of two females.

Two sisters aged about 40 years presented with a recent moderate reduction in visual acuity and pale optic discs. The nonconsanguineous parents, 7 other siblings and all other family members have normal vision. This strongly indicates a hereditary, autosomal recessive origin. A primary ganglion cell pathology is strongly suspected because of the significant attenuation of the early component of the onset/offset visual-evoked potential in the presence of little change in the potential to a pattern reversal stimulus.

Atraumatic iris cilia.

We report two cases of ectopic cilia originating from the iris without any convincing history of injury to the eye. One required surgical removal to prevent further endothelial and lens damage developing over a five-year observation period.

Topical dexamethasone lowers rabbit ocular tension, as does topical mifepristone (RU 486), a peripheral blocker of dexamethasone and progesterone.

The variability of the response of the rabbit eye to topical 1% dexamethasone has been shown in two groups of 20 young albino rabbits each (total 40) tested in succession. The pressure anomalously fell significantly (but by only 1 mm Hg) in both groups in the first 4 weeks of administration, but not in subsequent weeks. Mifepristone (RU 486), a peripheral antagonist of dexamethasone and progesterone, reduced the pressure significantly, again by only 1 mm Hg, in the first group of 20 rabbits, not the second. Accordingly, no conclusion was possible on the originating question: does pre-treatment with mifepristone prevent the dexamethasone-induced rise in rabbit intra-ocular pressure?

Can passive touch be better than active touch? A comparison of active and passive tactile maze learning.

In a comparison of the performance of active (n=15) and passive (n=15) mechanically yoked subjects who learned their way through a tactile maze, it was shown that active subjects mad more errors and took a greater number of trials to reach criterion than did passive subjects. In addition, the difference between active and passive performance was largely accounted for by the greater number of repeated errors made by active subjects. In a second experiment it was found that the poorer performance of active subjects could be attributed to the interfering effects of decisions about which way to move. However, the responsibility for the production of movement had no effect on performance. it was argued that the results reflected limits to the cognitive system, not the haptic system.