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Nash M.,Sydney Eye and Hand Hospital | Nash M.,Drummoyne Day Surgery Center | Skippen B.,Royal Prince Alfred Hospital | Gal A.,Laverty Pathology | And 3 more authors.
Orbit | Year: 2015

To assess the role of routine histopathological evaluation of the lacrimal sac wall when performing dacryocystorhinostomy (DCR) surgery.Methods: A retrospective review was conducted of the histology findings in lacrimal sac biopsies, taken routinely, in an external-approach DCR series. This is a single surgeon (RB), single pathologist (AG) consecutive series. The histopathology reports were reviewed and collated. Each patients medical history and risk factors for malignancy were recorded. The surgeon documented any abnormal lacrimal sac appearance at the time of surgery.Results: No patient in this series of 245, in whom 254 histology specimens were taken, recorded a significant pathological result that was not anticipated from pre-operative assessment, or from the appearance of the lacrimal sac intra-operatively.Conclusion: The reported recommendation for routine histopathological evaluation of the lacrimal sac wall when performing DCR surgery is not supported by this consecutive series. The authors recommend histopathological evaluation only in the setting of pre-existing clinical suspicion of malignancy, or an abnormal intra-operative appearance of the lacrimal sac. © 2015 Taylor and Francis. Source

Harish V.,Royal Prince Alfred Hospital | Harish V.,Drummoyne Day Surgery Center | Benger R.S.,Drummoyne Day Surgery Center
Clinical and Experimental Ophthalmology | Year: 2014

The creation of an alternative pathway from the lacrimal sac into the nose has been practised for over two millennia. Early historical figures who pioneered lacrimal surgery were Celsus and Galen, treating dacryocystitis by plunging a red-hot cautery iron through the lacrimal bone into the nose. Better understanding of lacrimal physiology and anatomy led to the introduction of more sophisticated techniques in the 18th century. However, despite these approaches, the technique of Celsus continued to be practised well into the eighteenth and nineteenth centuries. Modern lacrimal surgery began when the Italian otolaryngologist, Toti, described his external dacryocystorhinostomy procedure in 1904. Dupuy-Dutemps and Bourget refined Toti's procedure, and introduced the technique of anastomosing lacrimal and nasal mucosal flaps which remains the foundation of the external dacryocystorhinostomy performed today. The endonasal dacryocystorhinostomy was described before the external approach, but its popularity and success grew only in recent times. © 2014 Royal Australian and New Zealand College of Ophthalmologists 42 3 April 2014 10.1111/ceo.12161 History of Ophthalmology History of Ophthalmology © 2013 Royal Australian and New Zealand College of Ophthalmologists. Source

Skippen B.,University of Wales | Skippen B.,Drummoyne Day Surgery Center | Hamilton A.,Manchester Royal Eye Hospital | Evans S.,University of Wales | Benger R.,Drummoyne Day Surgery Center
Ophthalmic Plastic and Reconstructive Surgery | Year: 2016

Purpose: To present the results of 1-stage surgical advancement flaps for the repair of large full thickness lower eyelid defects. These avoid the disadvantages of the 2-stage Hughes procedure and provide favorable functional and aesthetic outcomes. Methods: A retrospective case series of 36 lower eyelid repairs performed on 31 patients by a single surgeon in Sydney, Australia is presented. The selection criterion was a horizontal defect size 10 mm or greater that could have "classically" been repaired with a 2-stage Hughes procedure. Three different 1-stage surgical repair techniques were utilized, all incorporating local advancement-type flaps: 1) a lateral-based full thickness advancement flap; 2) a vertical tarsal plate advancement flap combined with a full thickness skin graft; and 3) a vertical skin advancement flap combined with a mucosal graft. The postoperative outcomes evaluated included flap viability, lower eyelid margin position and contour, characteristics of the new eyelid margin and patient satisfaction. Results: Thirty-six lower eyelid repairs were performed in 31 patients. There were no cases of flap ischemia, necrosis, or failure. There was 1 case (3%) of postoperative eyelid retraction, 1 case (3%) of eyelid entropion requiring surgical repair, 1 case (3%) of pyogenic granuloma, 2 cases (6%) of eyelid margin cyst, and 7 cases (19%) of eyelid distichiasis. In 34 cases (94%), the patient was satisfied with the aesthetic result. Conclusion: The techniques described provide successful alternatives to the Hughes procedure. They are 1-stage and do not render the patient temporarily monocular, or alter the upper eyelid anatomy or function. All maintained favorable long-term functional and aesthetic outcomes for the reconstructed lower eyelid. © 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Source

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