BACKGROUND The surgical management of epiphora due to Primary Acquired Nasolacrimal Duct Obstruction (PANDO) is Dacryocystorhinostomy (DCR). Endonasal DCR is becoming more popular than external DCR because of many advantages like avoidance of facial scar, reduced morbidity, lesser time consumption and ease of revision surgery. The aim of the study is to find out the success rate, complications, advantages and disadvantages of endoscopic DCR with and without silastic tube insertion. MATERIALS AND METHODS We performed a clinical prospective comparative study of 70 patients with diagnosis of epiphora due to PANDO in the ENT and Ophthalmology Department of Government Medical College Hospital, Thrissur, from July 2008 to July 2014. Selection of type of operation was left to the patient's choice. A total of 50 patients were enrolled in the Endo DCR group and 20 patients were enrolled in the silastic tube insertion group. RESULTS All the 20 patients who were subjected to Endo DCR with silastic tube achieved anatomical and functional success (100%). In the Endo DCR without silastic tube group, 42 out of 50 patients (84%) achieved anatomical and functional success. CONCLUSION With the introduction of silastic tube, the success rate has increased. It is more useful in patients with less compliance and previous failures.
IntroductionTrypan Blue is an acid azo dye commonly used as a stain to distinguish viable from non-viable cells. It is a vital stain used intra operatively during cataract surgery to stain the external surface of the anterior lens capsule for better visualization.AimTo analyze the histomorphological effects of trypan blue on Lens Epithelial cells and the Basement Membrane on direct exposure by staining the internal surface of the anterior lens capsule during Small Incision Cataract Surgery.MethodsAnalytical cross sectional case control study. Anterior capsule specimens of 14 Patients undergoing small incision cataract surgery at Department of Ophthalmology, Govt Medical College Hospital, Thrissur were studied. Two specimens of anterior capsule taken from the same eye form the case and control. Control specimen (sample A) was removed first, after the routine external staining with trypan blue 0.06% (w/v) for 10 seconds. The stain was washed off by balanced salt solution in every case. Then trypan blue was injected under the remaining anterior capsule and case (Test) specimen (sample B) was obtained after direct contact of trypan blue to the internal surface (lens epithelial cells) for 1 minute. Histomorphological (qualitative and quantitative) examination of both specimens done.ResultsQualitative data analysis was done by EPI INFO software.v.7. Intactness of LECs throughout the length was statistically significant in Sample A (p = 0.000027). Partial and complete detachment of Lens Epithelial Cells, degeneration, and nuclear smudging were significantly higher in Sample B. Qualitative analysis of the basement membrane showed significant edema of the basement membrane in sample B. Basement membrane splitting observed in sample B was not statistically significant. Quantitative data analyzed using independent t test. There was a statistically significant decrease in cell density in sample B with p value less than 0.05.DiscussionOur study demonstrated that direct staining of the internal surface of anterior capsule with trypan blue affected LECs and the basement membrane. There were reduction in cell density, irreversible degeneration of Lens Epithelial Cells and basement membrane edema. Hence treating the internal surface of capsular bag with trypan blue may reduce incidence of Posterior capsular opacification.
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