Imaging plane angulation and partial volume.

OBJECTIVE: The rate of false passages during probing for congenital nasolacrimal system obstruction (CNLO) is a major limiting factor for a successful outcome. This shortcoming may be decreased with the use of a nasal endoscope during probing. This approach is particularly important in the probing training of ophthalmology residents. METHODS: An experienced pediatric ophthalmologist performed probings on 11 eyes, and a group of ophthalmology residents under his supervision performed probings on another 11 eyes for CNLO. Their claims of a successful or unsuccessful procedure were evaluated with nasal endoscopy by an ear--nose--throat (ENT) surgeon. The age range of the patients was 8-23 months. RESULTS: The ophthalmologist made two false passages, one of which he was aware, out of 11 eyes. The residents had five false passages, two of which were unclear to them, out of another 11 eyes. No false passages occurred in obstructions at the level of the Hasner valve. None of the successful probings required more than a 30 mm probe introduction into the nasolacrimal canal from the inferior punctum. CONCLUSION: It seems justified to have a nasal endoscopic evaluation, performed by an ENT surgeon, for probings during the training program of ophthalmology residents. Difficult cases with stenosis proximal to the inferior meatus, prior false passage experience on a particular case, and any indication for silicone tube implantation will benefit from the use of an endoscope during the procedure. In order to achieve the best results in CNLO, the collaborative teamwork of an ophthalmologist and an ENT specialist is necessary.

Endoscopy↗

PubMed2001

[Minimally invasive therapy in varicose veins].

In patients with varicose vein a duplex ultrasound is absolutely necessary prior to surgery in order to check the deep and the superficial vein systems. A standard classification is recommended to describe the type of venous insufficiency. Teleangiectasis and small varicose veins can be treated by sclerotherapy, but laser-therapy gets more and more popular. The inverting (partial)stripping of the greater and/or lesser saphenous vein avoiding nerve damage has gained popularity as did the miniphlebectomy. Newer methods using heat by radiofrequency order cryosurgery should generate less complications and have to show similar long term results than the classical procedures. Subfascial endoscopic perforator vein surgery (SEPS) is effective. Local or extended fascioctomy followed by skin transplantation in patients with recurrent ulcerations is considered as an option of therapy.

Endoscopy↗