No abstract

SUMMARYThe early results of the first 50 primary endonasal laser dacryocystorhinostomies in 49 patients performed with the holmium:YAG laser are presented. Overall, 35 (70%) were successful in relieving symptoms of naso lacrimal obstruction after a mean follow-up period of 4 months. This improved to 79% in the subgroup of patients who underwent intubation of the naso-Iacrimal system. These results were similar to the results of a retrospective study of 67 patients undergoing conven tional dacryocystorhinostomy in our unit. Conventional surgery was performed under general anaesthesia in all but 1 case and all were treated as inpatients, with a mean hospital stay of 2.3 days, whereas all but 1 of the laser group had their surgery under local anaesthesia and 46 operations (94%) were performed as an outpatient procedure. Surgery was significantly quicker with the endonasal laser technique and 90% of patients questioned found this technique to be entirely accep METHODS Endoscopic Laser DCRConsecutive patients who required primary drainage surgery to relieve naso-Iacrimal obstruction (as evidenced by epiphora, mucocoele or a history of acute dacryocystitis) between July 1993 and March 1994 were recruited to this study. All patients gave written consent to the procedure. Pre-operatively, a history was taken and a routine ophthalmic exam ination was performed. Probing and syringing of the naso-Iacrimal system was performed and patients with common canalicular occlusion excluded.Age, sex and indications for surgery were noted. The light was directly visualised endonasally with a 0° nasal endoscope. The laser energy was delivered via a 15° probe, aimed at the light. For mucosal ablation, the laser was set at a pulse energy of 0.6 J with a frequency of 10 Hz. When bone was reached, the energy was increased to 1.0 J (at the same frequency) and was used to vaporise the bone. Once an ostium had been created, indicated by passage of the light probe into the nasal cavity, it was enlarged until easy Eye (1996) The average amount of local anaesthetic used was 5.9 ml. The mean operative time was 20.9 (14.8) minutes and the mean energy employed was 0.64 kJ. Per-operative complications occurred in 13 (26%) procedures; 10 of these were related to technical difficulties. Two patients suffered a transient medial rectus palsy as a result of the LA and 1 patient Twenty-eight procedures (56%) employed tubes and 22 (44 %) did not. There were no significant differences between these two subgroups for all analyses, apart from a higher volume of LA being used in the former (6.4 (1.6) versus 5.3 (1.0) ml respectively, p<0.05). However, more procedures with tubes were successful compared with those without (22 (79%) compared with 13 (59%) respectively), although the difference did not achieve statistical significance. Both subgroups had a similar duration of follow-up (4.0 (1.1) versus 4.1 (2.0) months, respectively). RESULTS Endoscopic Laser DCR Conventional DCROver the 2 year study period, 67 patients underwent conventional DCR. There w...

Dilating the pupil did not adversely affect the clinical accuracy of the IOLMaster.

We report three cases in which cosmetic injections of botulinum toxin A around the eye caused diplopia. Diplopia was due to inferior oblique paresis, which was bilateral in two cases. We suggest that consent for periocular botulinum toxin procedures should include a warning about diplopia.

SummaryA prospective, observer blinded study on 51 patients undergoing cataract surgery was conducted to assess Total Upper Eyelid Drop as a new end-point marker to single injection peribulbar block. At present, no such clinical marker exists to stop clinicians injecting more than necessary volumes of local anaesthetic and therefore to prevent dangerous increases in intra-ocular pressure. Using this technique, satisfactory ocular akinesia was achieved in 90% of eyes 10 min after injection. Operating conditions were satisfactory in 98% of cases. The mean (range) volume injected was 9.1 (4±15) ml. The mean increase in intra-ocular pressure immediately after injection was 6.9 mmHg, decreasing to 0.7 mmHg after 5 min without the application of ocular compression. We found a negative correlation between the increase in intra-ocular pressure and the volume of injection (p , 0.002), which has never previously been reported. We conclude that Total Upper Eyelid Drop is a reliable endpoint marker for producing satisfactory operating conditions for cataract surgery while minimising increases in intra-ocular pressure and its use may therefore avoid the risks associated with ocular compression.