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Peter J Dolman

Publications and source records attributed to Peter J Dolman.

4 recordsLinked to original sources
PubMed2003

Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy.

OBJECTIVE: We compared outcomes after dacryocystorhinostomies (DCRs) performed by the traditional external approach (EX-DCR) or by a nonlaser, nonendoscopic endonasal approach (EN-DCR). DESIGN: Retrospective, nonrandomized, comparative interventional case series. PARTICIPANTS: A total of 354 consecutive cases of DCR were reviewed in 349 patients performed by one surgeon over a 4-year period with a minimum 1 year of follow-up using either EX-DCR or EN-DCR. Only patients with primary nasolacrimal duct obstruction and no eyelid, lacrimal sac, or canalicular pathology were included. INTERVENTION: A total of 153 EX-DCR and 201 EN-DCR patients were identified. EX-DCR was performed under sterile conditions, and EN-DCR was performed with a clean setup. Silicone stents were placed for 3 months. MAIN OUTCOME MEASURES: Patency of the lacrimal system as assessed by history and irrigation. Outcomes were graded as full success, partial success, or failure. Operative durations and postoperative complications were recorded from hospital charts. RESULTS: There was no significant difference in age or gender distribution between the two groups. The mean operative duration was 34.3 minutes for EX-DCR and 18.5 minutes for EN-DCR (P < 0.0001, t test). Full success was achieved in 90.2% of EX-DCRs and 89.1% of EN-DCRs. Partial success was recorded in 2.0% of EX-DCRs and 4.0% of EN-DCRs. The failure rate was 7.8% for EX-DCR and 7.0% for EN-DCR. There was no statistical significance between these outcomes with a two-sample test for equality of proportions with continuity correction (P = 0.914, power = 80% for alpha = 0.05 to detect a decreased success rate of 12%). Eleven of the failed cases in each group underwent revision EN-DCR surgery, with 90.9% success in each group. Epistaxis requiring perioperative nasal packing occurred in 7 (4.6%) EX-DCR patients and 11 (5.5%) EN-DCR patients. Wound complications in EX-DCR included bruising in four patients, localized infections in two patients, and punctal eversion in six patients. In EN-DCR, inadvertent incision of the periorbita occurred in five patients. One patient reported transient diplopia after the medial rectus was inadvertently pulled during an EN-DCR. Five patients had an EX-DCR on one side and an EN-DCR on the other side. All five reported retrospectively that they preferred the endonasal approach. CONCLUSIONS: The EN-DCR approach is more rapid than the traditional external approach, has an equivalent surgical success rate, and was preferred by patients who had alternative techniques performed on opposite sides.

Adolescent↗
PubMed2002

Comparison of retrobulbar analgesics for evisceration.

PURPOSE: To determine whether postoperative pain and nausea after evisceration surgery is better controlled with intraoperative retrobulbar ethanol or bupivacaine. METHODS: Prospective, randomized, clinical trial. Eleven patients undergoing evisceration surgery by two surgeons over a 6-month period for blind, chronically painful eyes were randomly allocated in two groups. One group (5 patients) received prophylactic retrobulbar 95% ethanol injections; the control group (6 patients) received retrobulbar 0.75% bupivacaine with 1:100,000 epinephrine. Postoperative pain and nausea were recorded by the patients with the use of a 10-point analog scale. Patients also documented the quantity of analgesics required. RESULTS: The mean and median postoperative pain and nausea scores were significantly lower for patients given intraoperative retrobulbar ethanol (paired t test, P<0.01). These patients also required significantly less analgesic medicine. Complications from the retrobulbar ethanol injections included forehead numbness and ptosis, both of which had resolved by the time of prosthesis fitting 6 weeks later. CONCLUSIONS: Surgeons should consider the use of intraoperative retrobulbar ethanol injections to help relieve postoperative pain and nausea.

Analgesics↗
PubMedDate not supplied

A modified posterior approach for upper eyelid retraction.

PURPOSE: To describe and review a graded technique for lowering the upper eyelid from a posterior approach, recessing or resecting Müller muscle and levator aponeurosis but leaving a central pillar of Müller muscle intact, occasionally including a temporal tarsorrhaphy or superior tarsal strip where needed, and performing tissue dissection with a hot-wire cautery instrument. METHODS: A 10-year retrospective chart review was performed. Where follow-up was less than 6 months, telephone interviews were conducted to assess patient satisfaction with the procedure. Statistical analysis was performed using an unpaired t test. RESULTS: Ninety-nine patients (161 eyelids, 62 bilateral and 37 unilateral) with a mean age of 47 years (range, 21-82 years) were studied. The mean follow-up period was 61 months. The mean preoperative and postoperative margin reflex distances (MRD1) were 7.3 mm (range, 4.5-10 mm) and 4.3 mm (range, 2-7 mm), respectively. Eighty-nine percent (144/161 eyelids) achieved the target result of an MRD1 of 4 +/- 1 mm after one procedure. Fifteen eyelids (9% of operated eyelids) required a second procedure, and in this group, 2 (13% of the reoperated eyelids) underwent a third procedure. Although bilateral cases were more likely to achieve symmetry (p = 0.0071), 90% of either unilateral or bilateral cases achieved a postoperative MRD1 of 4 +/- 1 mm. Both mild (MRD1 of 5-7 mm) and severe (MRD1 > 7 mm) cases of eyelid retraction achieved similar operative outcomes. In the first 6 months after surgery, complications included undercorrection (8 eyelids), overcorrection (2 eyelids), and pyogenic granuloma (2 eyelids). None had a flattened upper eyelid contour. Late recurrence of retraction was seen in 9 eyelids. Mean operative time was 16 minutes per eyelid. CONCLUSIONS: This technique of lowering the retracted upper eyelid is effective even in severe cases of eyelid retraction. Minimal complications were encountered, and upper eyelid contours were well preserved. The use of hot-wire cautery dissection proved useful in shortening operative time.

Adult↗