Pneumomediastinum after external dacryocystorhinostomy

A 73-year-old man had right chronic epiphora for many years. After uneventful external dacryocystorhinostomy, he developed dyspnea and neck swelling after forcefully blowing his nose. CT showed diffuse cervicofacial subcutaneous emphysema and pneumomediastinum. He was admitted to prevent further cardiovascular complications. Pneumomediastinum is a rare complication of routine dacryocystorhinostomy. Supportive treatment to prevent additional air trapping is mandatory.     

Selective non-intubation of a silicone tube in external dacryocystorhinostomy

PURPOSE: To evaluate whether silicone tube insertion is always necessary in external dacryocystorhinostomy (DCR). METHODS: During external DCR for primary nasolacrimal duct obstruction carried out between January 2001 and October 2004, silicone intubation was not performed selectively if the lacrimal sac was large and the nasal cavity was not severely narrowed. RESULTS: Of a total of 166 DCR cases in 153 patients, no silicone tube was placed in 74 eyes of 69 patients (44.6%). Anatomic patency of rhinostomy was achieved in all non-intubation group eyes. However, four (6.7%) of these 69 eyes showed persistent epiphora even with anatomic patency. CONCLUSIONS: Silicone tubing can be avoided in about 50% of cases of external DCR without detrimentally affecting the success rate. Cases in which intubation was avoided had a large lacrimal sac and a wide nasal cavity.     

可充气球囊防止泪囊鼻腔吻合术后阻塞的临床研究

目的探讨可充气的球囊作为支撑物防止泪囊鼻腔吻合术后阻塞,提高手术成功率的临床效果。方法选取慢性泪囊炎患者120名120眼,随机分为A、B两组,每组60名（60眼）,行泪囊鼻腔吻合术;A组支撑物采用我院自行研制的可充气球囊,B组支撑物选用直径4mm硅胶管,结果A组治愈率100％,B组治愈率93．3％;两组结果比较,差异有统计学意义（P〈0．05）。结论本研究结果表明应用可充气球囊作为支撑物,防止泪囊鼻腔吻合术后阻塞效果良好,可提高手术成功率。     

Cosmetic evaluation of surgical scars after external dacryocystorhinostomy

AIM: To evaluate the surgical scars of external dacryocystorhinostomy (DCR) cosmetically. METHODS: Totally 50 consecutive cases of primary acquired nasolacrimal duct obstruction (PANDO) were included in the study. Surgical scars were assessed by the patients and two independent observers at 2, 6 and 12wk postoperatively on the basis of visibility of the scars and still photographs respectively and were graded from 0-3. Kappa test was utilised to check the agreement of scar grading between the two observers. Wilcoxan signed ranks test was used to analyse the improvement of scar grading. RESULTS: Thirty-four (68%) patients graded their incision site as very visible (grade 3) at 2wk. At 6 and 12wk, incision site was observed as grade 3 by 7 (14%) and 1 (2%) patients respectively. Photographic evaluation of patients by 2 observers showed an average score of 2.75, 1.94 and 0.94 at 2, 6 and 12wk respectively. Change in scar grading from grade 3 to grade 0 in consecutive follow-up (2, 6 and 12wk) was found to be highly significant both for the patient as well for the observers (P<0.0001). CONCLUSION: The external DCR is a highly effective and safe procedure and in view of low percentage of cases who complained of marked scarring in the present study, thus scarring should not be the main ground for deciding the approach to DCR surgery, even in young cosmetically conscious patients.     

Local prophylactic measures to prevent postoperative infection after cataract operations (author's transl)]

The Allen procedure to prevent postoperative endophthalmitis has been applied in cataract operations since 1973. Postoperative endophthalmitis has been observed through the years 1965--1973 in 0.49% of registered cases, while the infection rate has now been lowered to 0.067%.     

Long-term results of adjunctive use of mitomycin C in external dacryocystorhinostomy

Objective To assess the long-term results of intraoperative mitomycin C (MMC) in external dacryocystorhinostomy (EXT-DCR). Methods In this prospective randomized controlled study, 35 patients (40 eyes) with primary acquired nasolacrimal duct obstruction were assigned randomly into two groups. In the control group, a standard EXT-DCR procedure was performed. In the MMC group 0.2 mg/ml MMC was applied to the osteotomy site for 30 min. The results of EXT-DCR in both groups were evaluated by both asking patients about the tearing condition and examining the patency of irrigation at one-year follow up. Results Eighteen (90%) of the 20 eyes in the MMC group remained totally symptom-free and one eye (5%) improved; while 12 (60%) of 20 eyes in the control group were reported to be symptom-free and five (25%) of the eyes to have an improvement in the tearing symptoms (P = 0.087). The success rate in the MMC group was 95% compared with 85% in the control group (P = 0.605). No surgical complications occurred. Conclusions The satisfaction and success rates of the MMC group were higher than those of the control group and no deleterious effect was noted with MMC application, however the differences did not reach statistical significance. Intraoperative MMC application seems to be a safe adjuvant that could help in increasing the success rates of EXT-DCR surgery in primary acquired nasolacrimal duct obstruction ,however further studies with larger series are needed to make definite statements.     

Fluorescein transit test time and symptomatic outcomes after external dacryocystorhinostomy

PURPOSE: To determine the relation between the fluorescein transit test time and postoperative relief of epiphora in patent dacryocystorhinostomies. METHODS: A retrospective study of 40 patients who underwent 42 external dacryocystorhinostomies between January 1994 and January 2000 was performed. Postoperative symptomatic success was assessed by a questionnaire. Intranasal rigid endoscopy was performed to measure the fluorescein transit test time, defined as the time from instillation of fluorescein to its free flow from the osteotomy site. The main outcome measures were symptomatic success, fluorescein transit test time, and anatomic patency to irrigation. Statistical analysis was performed with the use of the Fisher exact test. RESULTS: Of the 42 dacryocystorhinostomies studied, 92.8% were patent to irrigation. There was a statistically significant association between a fluorescein transit test time of < or = 45 seconds and subjective success (P<0.001), with 96% of patients reporting a successful postoperative outcome. A slow fluorescein transit test, with an average time of 138.9 seconds, was associated with symptomatic failure (P<0.001), with 56.2% of this group reporting significant postoperative epiphora. CONCLUSIONS: The fluorescein transit test provides a quantitative measure of lacrimal drainage function after dacryocystorhinostomy, with a fluorescein transit test time of < or = 45 seconds being the relevant parameter to characterize symptomatic success. Postoperative failure in external dacryocystorhinostomy, as evidenced by slow transit times, may result from surgical interference with the lacrimal pump.     

Use of antimicrobials to prevent postoperative infection in patients with cataracts

Despite the high frequency of cataract surgery, there are still no definitive studies on antibiotic prophylaxis against endophthalmitis after cataract surgery. Most surgeons follow an empiric approach. The results of several recent studies shed additional light on this complex topic. There is better knowledge of the usual source of the infection and the specific organisms incriminated. This review presents some principles of prophylactic treatment and selected literature that addresses the effectiveness of antisepsis, topical preoperative antibiotics, intracameral antibiotics, subconjunctival antibiotics, systemic antibiotics, and postoperative antibiotics. The worldwide problem of antibiotic resistance should temper our approach. Some organizational statements are reviewed, and personal recommendations are offered. Controversy still abounds.     

Techniques to minimize skin incision scar for external dacryocystorhinostomy

Although there has been a narrowing in the gap in successful functional outcomes between external and endonasal DCR, external DCR is still being frequently performed when cost, availability of additional surgical instruments and visual systems, surgeon’s experience and preference are concerned. Nonetheless, skin incisions at the lateral nasal sidewall of the lower eyelid inevitably leave cutaneous scars. The purpose of this review is to evaluate the outcomes of current modified surgical practices that prevent a conspicuous scar in external DCR.     

预防白内障手术后感染的术中应对策略探讨

目的 探讨老年性白内障临床路径预防术后感染性眼内炎的术中措施及效果.方法 选择120例120眼白内障手术患者,随机分为对照组(A组)60例60眼术前、术毕应用复方氯化钠注射液冲洗结膜囊.研究组(B组)60例60眼术前、术毕应用0.1％聚维酮碘溶液(0.1％PVP-I,深圳市安多福消毒高科技股份有限公司生产,批号:粤卫消证字{2016}第9087号)结膜囊进行消毒,同时术中灌洗液中加入妥布霉素.分别取术前、术前冲洗结膜囊后、术毕冲洗结膜囊前后及术后第1天的结膜囊标本做细菌培养及药敏.取术毕前房房水的细菌培养及药敏.结果 1结膜囊细菌培养:a、术前A组阳性16例,B组阳性17例,两组的差异无明显统计学意义(x2 =0.04,P＞0.05).b、术前冲洗结膜囊后,A组阳性14例,B组阳性2例,两组的差异有明显统计学意义(x2=10.29,P＜0.05).c、术毕A组阳性17例,B组阳性5例,两组的差异明显统计学意义(x2=8.02,P＜0.05).d、术毕冲洗结膜囊后,A组阳性15例,B组阳性1例,两组的差异具有明显统计学意义(x2=14.14,P＜0.05).e、术后第1天A组阳性19例,B组阳性7例,两组的差异具有明显统计学意义(x2=8.51,P＜0.05).2.A组术毕前房水细菌培养阳性率3.33％,而B组房水细菌培养为阴性明显低于A组.所有患者观察术后3个月无眼内炎等并发症.结论 白内障术中应用0.1％PVP-I溶液结膜囊进行两次消毒,灌洗液中加入妥布霉素,能够进一步减少结膜囊细菌,保持房水无菌化,在预防感染上实用安全,效果更可靠.