Local anaesthetic endonasal endoscopic laser dacryocystorhinostomy: analysis of patients' acceptability and various factors affecting the success of this procedure.

BACKGROUND AND OBJECTIVES: Endonasal endoscopic laser dacryocystorhinostomy is now a well established, effective approach to relieve nasolacrimal duct obstruction. Whereas attempts have been made to comment on the efficacy of the procedure, no study has been conducted to evaluate the acceptability of this procedure by those at the receiving end, ie, the patients. An attempt has been made in the present study to critically evaluate the procedure from the point of view of patients' acceptability and also to evaluate certain factors which may influence the success rate of this procedure. PATIENTS AND METHODS: Forty-six eyes from 40 patients underwent endonasal endoscopic laser dacryocystorhinostomy, performed by the same surgeon, over a period of 15 months. Various aspects of the procedure were evaluated by patients by filling out a simple questionnaire (Figure 1). In addition to recording patients' views, success of the procedure was confirmed by performing a postoperative sac washout in the clinic. Patients were also subdivided according to their age, duration of symptoms and history of previous surgical intervention. The data were statistically analysed using chi-square tests with the Yates correction. RESULTS: The percentage of patients who declared themselves completely cured was 65.22%. A partial resolution was felt by 23.91% of patients and no improvement was reported by 10.87% of patients. Forty-two out of the 46 eyes (91.3%) achieved anatomical success by the procedure, as shown by a postoperative sac washout performed in the clinic. Some of them, however, did not have complete resolution of their symptoms perhaps due to an additional factor of lacrimal pump dysfunction in these patients. During the procedure 60.86% of eyes felt no discomfort at all whereas 39.14% of eyes felt some discomfort at some point of time during the procedure (Table 1). When directly asked 86.12% of patients recommended the procedure (implying that the procedure had some good effect on their quality of life), 8.33% of patients did not recommend it and 5.55% of patients made no comments. Various factors affecting the success of this procedure were analysed (Table 2) and it was found that eyes which had no previous surgical intervention showed a complete cure rate which was significantly higher than that seen in eyes which had some sort of previous intervention (P = 0.0003); eyes with a short (<6 mths) duration of symptoms showed significantly higher success rates (P = 0.0098) in comparison to that shown by eyes with longer (>6 mths) duration of symptoms; and younger patients (<50 yrs) had a complete resolution rate much higher than patients over 50 yrs of age (P = 0.0309). CONCLUSION: The present study clearly shows that endonasal endoscopic laser DCR is an effective procedure, well tolerated and recommended by the patients. Discomfort during the procedure is not a major problem. Younger patients, with no previous surgical intervention and with short duration of symptoms are likely to be benefited the most. Though success rates are higher with external DCR, endonasal endoscopic laser DCR offers certain advantages over the external approach while keeping the option of external DCR open, if needed at a later date.

Intraocular pressure -- all that is raised is not glaucoma.

Increased intraocular pressure invariably sets our mind in the direction of either establishing or ruling out the diagnosis of glaucoma and in the process, sometimes, certain hidden factors may escape our attention, leading to some delay in delivering the specific treatment to the patient. We present a case whose underlying pathology remained obscured for more than 10 years before we examined this patient and discovered the hidden secret.

Comprehensive method of analyzing the results of photoastigmatic refractive keratectomy for the treatment of post-cataract myopic anisometropia.

PURPOSE: To assess the efficacy, stability, and safety of photoastigmatic refractive keratectomy (PARK) in treating post-cataract myopic anisometropia to restore binocularity and to describe a comprehensive method for analyzing the results of refractive surgery. SETTING: St. Paul's Eye Center, Royal Liverpool Hospital, Liverpool, United Kingdom. METHODS: Nineteen patients (20 eyes) with post-cataract myopic anisometropia were treated with PARK using a VISX Twenty-Twenty laser and followed for 12 months. Cataract surgery had been performed between 10 and 144 months (mean 43.4 months) previously. A comprehensive method based on Long's matrix formalism and the vech operator of Harris, in addition to the nearest equivalent sphere and cylinder, was used to analyze the refractive data. RESULTS: The mean preoperative refraction in the post-cataract eyes was -4.79 +1.17 x 0.2 and in the fellow eyes, +0.02 +0.31 x 166. Twelve months after PARK, the postoperative refraction in the post-cataract eyes was -0.90 +0.65 x 2, a significant reduction (P = .15). This postoperative refraction was not significantly different from that in the fellow eye (P = .93). The pretreatment mean uncorrected visual acuity was 0.12. It improved to 0.41 at 12 months, at which time 52% of eyes achieved a visual acuity of 0.5 or better without correction. All patients regained binocularity. At 12 months, 2 eyes (11%) showed clinically unacceptable regression; 1 eye with grade 2 haze lost 1 line of corrected visual acuity. CONCLUSIONS: Photoastigmatic refractive keratectomy reduced post-cataract myopic anisometropia, allowing restoration of binocularity in all patients. Overall, the results in this elderly population with previous ocular surgery, posterior capsule thickening, and macular degeneration are not as satisfactory as those obtained from similar treatment of physiological myopia. Stability and postoperative complications are acceptable.

Echovirus keratoconjunctivitis.

PURPOSE: To investigate an outbreak of echovirus-related keratoconjunctivitis. METHODS: We undertook a retrospective study of recent cases of echovirus infection with recall and further evaluation of conjunctivitis patients. All patients from whom an echovirus was isolated in Liverpool during 1995 were included. The natural course of ocular echovirus disease was studied, including the likelihood of echovirus keratoconjunctivitis being linked with meningitis and the risk of long-term carriage of the virus in the conjunctiva. RESULTS: Of 10 unrelated patients with echovirus conjunctivitis, six also had a mild keratitis. None of these patients developed meningitis, and no cases of long-term carriage in the conjunctiva were encountered. There was no link between cases of echovirus meningitis and conjunctivitis. There was no corresponding increase in other ocular viral isolates. CONCLUSIONS: Echovirus is a relatively unrecognized cause of keratoconjunctivitis. Echoviral keratoconjunctivitis appears to be an independent ocular event unassociated with systemic sequelae. Long-term carriage in the conjunctiva does not appear to occur.

Paget's disease: ocular complications of disodium pamidronate treatment.

Three cases of uveitis associated with disodium pamidronate have been notified to the Committee for Safety of Medicines. Two new cases of bilateral anterior uveitis and episcleritis after administration of intravenous disodium pamidronate are described.

Determining progressive visual field loss in serial Humphrey visual fields.

PURPOSE: To evaluate the three commercially available computerized statistical algorithms for determining progression of glaucomatous field loss in serial Humphrey fields. METHODS: Serial Humphrey fields of 102 ocular hypertensive and glaucomatous eyes were analyzed by linear regression analysis of Statpac, glaucoma change probability and Progressor Programme, and the results compared with a retrospectively determined clinical outcome. RESULTS: Linear regression analysis of Statpac identified progression in 11 field series, glaucoma change probability identified progression in 23 field series, and Progressor Programme identified progression in 27 field series. Clinical outcome identified much less-progression than any of the three algorithms, determining that only seven eyes showed deterioration. There was a wide variation of results from analysis of the same group of field series by the three different algorithms. In contrast to the other two algorithms, which detected progression in similar percentages of both ocular hypertension and glaucoma field series. Progressor Programme detected progression predominantly in glaucoma field series. CONCLUSIONS: There was a high degree of variability among the three different algorithms for determining visual field progression, and none of them correlated well with clinical impression.

Endonasal laser dacryocystorhinostomy under direct vision.

We describe a method of endonasal laser dacryocystorhinostomy, using a neodynium-YAG laser, whose ease of performance should make it attractive to general ophthalmologists as an alternative to the routine external approach. A small series of 6 patients were investigated 6 months after surgery and a patent drainage system was revealed.