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Rikhtehgar MH, Rikhtehgar MJ, Hassanpour K, Aletaha M, Veisi A. Clinical outcomes of endoscopic dacryocystorhinostomy without preserving mucosal flaps in combination with silicone stent and steroid-soaked gelfoam. J Fr Ophtalmol 2024; 47:104013. [PMID: 37932172 DOI: 10.1016/j.jfo.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE To report clinical outcomes of endoscopic dacryocystorhinostomy (En-DCR) combined with stenting and without preserving the nasal and lacrimal mucosal flaps. METHODS In this prospective interventional case series, patients with primary acquired nasolacrimal duct obstruction who were candidates for En-DCR were enrolled. Patients with a known history of previous DCR, sinus surgery, rhinoplasty, nasal trauma, nasal anomaly, canalicular or punctal occlusion, or less than one year of follow-up were excluded. All patients underwent En-DCR and stenting followed by ostial packing using Gelfoam soaked with dexamethasone. The patients were assessed preoperatively, on the first postoperative day, after 2 weeks, 3 months, and 1 year. Postoperative outcomes were anatomical and functional success, defined as patent irrigation test and resolution of epiphora, respectively. The nasolacrimal drainage system was evaluated anatomically and functionally during the follow-up period. RESULTS Eighty-three patients with a mean age of 54.36±15.27 years were enrolled. Of these, 61 patients (73.5%) were women. The mean duration of follow-up was 20.7±6.9 months. Anatomical success was achieved in all patients and remained stable during the study duration and at 1 year. Functional failure leading to epiphora was observed in 1 patient 3 months after surgery and resolved after re-DCR at year 1. Preoperative tenderness and purulent reflux were observed in 12%, 33.7% of which completely resolved postoperatively. Moderate and severe hemorrhage was observed in 12 (14.5%) and 2 (2.4%) patients, respectively. CONCLUSION En-DCR without mucosal flap preservation in combination with silicone stent and steroid-soaked Gelfoam is a safe and highly successful procedure in patients with primary acquired nasolacrimal duct obstruction.
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Affiliation(s)
- M H Rikhtehgar
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of medical sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - M J Rikhtehgar
- Department of ophthalmology, Torfeh Eye Hospital, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - K Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of medical sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - M Aletaha
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of medical sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - A Veisi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of medical sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of medical sciences, Tehran, Iran.
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Chacko A, J.K. Y. Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy with or without Preservation of Nasal Mucosal Flap. Indian J Otolaryngol Head Neck Surg 2024; 76:894-898. [PMID: 38440443 PMCID: PMC10908912 DOI: 10.1007/s12070-023-04311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/20/2023] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To analyse the result of endoscopic endonasal dacryocystrhinostomy with or without preservation of nasal mucosal flap. STUDY DESIGN Randomised prospective cohort design. SETTING Tertiary academic centre. SUBJECTS AND METHODS 100 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups. Standard surgical procedure of endoscopic endonasal dacryocystorhinostomy was carried out except for the preservation of flap in group A and without preservation of flap in group B. Additional surgeries were done according to necessity. Postoperatively, patients were followed up on OPD-basis at the end of 1st week, 2nd week, 1st month, and 3rd month. Symptomatic improvement was assessed and patency checked by syringing by the ophthalmologist. RESULTS Nil intraoperative complications (p < 0.05) and nil postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96% at 3rd month in case group A and 98%, 92% and 82% respectively at the end of 2nd week, 1st month and 3rd month in group B. Nasal endoscopy of all surgical failures showed restenosis in both groups and synechiae in 2 patients in group B. CONCLUSIONS Preservation of nasal mucosal flap with modification around stoma can be used to cover the bared bone with avoidance of granulation tissue formation reducing the risk of closure of ostium with large rhinostomy and improve success of endoscopic endonasal DCR.
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Affiliation(s)
- Aneena Chacko
- Department of ENT, Amala Institute of Medical sciences, Kerala, 680555 India
| | - Yashveer J.K.
- Department of ENT, Gandhi Medical College and Associated Hospital, Bhopal, MP 462001 India
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Atkova EL, Krakhovetskiy NN, Fokina ND, Murakhovskaya YK, Kulish KK, Avagyan AS, Smirnova NS. [Pharmacological prevention of fibrosis in dacryosurgery]. Vestn Oftalmol 2024; 140:180-189. [PMID: 38739149 DOI: 10.17116/oftalma2024140022180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Chronic inflammatory process in the lacrimal drainage system is the main etiological factor leading to dacryostenosis and consequent obliteration - partial and total nasolacrimal duct obstruction. Prevention of this process is an urgent problem in dacryology. Currently, there is very little research on the development and use of conservative methods for treating dacryostenosis using anti-inflammatory, as well as anti-fibrotic drugs. In this regard, the main method of treating lacrimal drainage obstruction is dacryocystorhinostomy. However, the problem of recurrence after this operation has not been resolved. The causes of recurrence can be cicatricial healing of dacryocystorhinostomy ostium, canalicular obstruction, formation of granulations and synechiae in its area. Surgical methods of recurrence prevention are associated with possible complications, and there is conflicting data on the feasibility of their use. Based on this, the development of pharmacological methods for the prevention of fibrosis in dacryology is promising, among which the antitumor antibiotic Mitomycin C is the most studied. However, there are no specific scientifically substantiated recommendations for the use of this drug, and the data on its effectiveness vary. This has prompted researchers to look for and study alternative anti-fibrotic agents, such as antitumor drugs, glucocorticoids, hyaluronic acid, small molecule, biological, immunological and genetically engineered drugs, as well as nanoparticles. This review presents the current data on the efficacy and prospects of the use of these drugs in dacryology.
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Affiliation(s)
- E L Atkova
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | | | - N D Fokina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yu K Murakhovskaya
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - K K Kulish
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A S Avagyan
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - N S Smirnova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Mane BS, Naikwadi KB, Gavali RM. A Comparative Study Between Anterior-Posterior and Superior-Inferior Flap Suturing Technique in Endoscopic Dacryocystorhinostomy at our Tertiary Institution. Indian J Otolaryngol Head Neck Surg 2023; 75:2927-2935. [PMID: 37974788 PMCID: PMC10646028 DOI: 10.1007/s12070-023-03860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/04/2023] [Indexed: 11/19/2023] Open
Abstract
The Nasolacrimal sac inflammation, also known as dacryocystitis, is frequently accompanied by nasolacrimal duct blockage at the confluence of lacrimal sac and duct. Treatment of choice for dacryocystitis is dacryocystorhinostomy (DCR), which can be done through external approach and endoscopic approach. The endoscopic DCR has distinct advantage over the external DCR as there is no facial scar& also it maintains the pump action. We have used flap suturing technique of endoscopic DCR in our study where in lacrimal sac medial flap is sutured to nasal mucosal lateral flap wherein patients were selected into either of the two groups such as Anterior-Posterior type (group A) and Superior-Inferior type (group B) of Flap suturing technique. Aim and objectives of the study were to compare the subjective and objective success rate between group A & B of flap suturing used in endoscopic DCR & to compare the success rate of our techniques with other techniques in literature. Our study was Duration based prospective observational study with a Duration of one year from June 2021 till June 2022 with study population comprised of patients in age group of 20 to 70 years, with complaints of watering of eye (epiphora) attended ENT Department of our institute during this one year. Study population comprised of Total of 86 patients (100 eyes) of which 45 patients (51 EYES) underwent anterior- posterior flap suturing (Group A) and 41 patients (49 eyes) underwent superior- inferior flap suturing (Group B) technique of endoscopic DCR The mean age ± standard error of mean was 45.1765 ± 1.5 and 49.0816 ± 1.9 in group A & B respectively,which was not statistically significant (p value = 0.994). The male and female patients in group A & B was 27.45%,72.54% and 34.69%,65.30% respectively which was not statistically significant (p value = 0.434). At each follow‑up, subjective success rate was more in group A that indicated a better trend of success for that group. However, the difference in the success rate was not statistically significant.The objective success rate between the two groups were more or less similar & was not statistically significant. The subjective success rate in both Anterior-Posterior type (group A)and Superior-Inferior type (group B) of Flap suturing techniques of endoscopic dacryocystorhinostomy were more or less similar with regards to absence of epiphora but objective success rate with regards to the patency, were almost similar with a shift of trend from Group A to group B at 6 months follow up and we also found that complications in both the groups were very few, without statistically significant difference between them. In terms of success rate and complication,The endoscopic DCR with flap suturing technique found to be more or less similar with previous techniques of DCR described in the literature.
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Affiliation(s)
- Balaji Shankarrao Mane
- Department of Otorhinolaryngology, Ashwini Rural Medical College and Hospital, Solapur, India
| | - Kiran Bibhishan Naikwadi
- Department of Engineering Sciences & Allied Sciences, Bharati Vidyapeeths College of Engineering for Women, Pune, India
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Yang L, Li H, Yin Z, Zhang L, Yang Z. Reference role of middle turbinate axilla in lacrimal sac localization assisted by computed tomographic dacryocystography-reference value of middle turbinate in locating lacrimal sac. BMC Ophthalmol 2022; 22:500. [PMID: 36539768 PMCID: PMC9764462 DOI: 10.1186/s12886-022-02740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The middle turbinate axilla (MTA) has always been used as a stable anatomic landmark for endoscopic surgeons to locate the lacrimal sac on the lateral nasal wall. Yet, little is known about whether the lacrimal sac size will affect the positioning effect of MTA on lacrimal sac. The aim of this study was to investigate the regularity of lacrimal sac size and lacrimal sac localization through the reference position of the MTA on computed tomographic dacryocystography (CT-DCG) images. METHODS A series of 192 endoscopic dacryocystorhinostomy (DCR) surgeries were performed. All the patients had been diagnosed as unilateral nasolacrimal duct obstruction and received CT-DCG examinations. According to the maximum transverse diameter of the lacrimal sac on CT-DCG, the patients were classified into three groups. Measurements were taken on CT-DCG parasagittal images. RESULTS The average distance from the sac superior fundus (SSF) to the MTA was 7.52 mm ± 3.23 mm, and it increased with the increase of the maximum transverse diameter of the sac among groups (p < 0.01). The average distance from the common canaliculus (CC) to the MTA was 3.95 mm ± 2.49 mm. No significant difference was observed among the groups (p = 0.11). The average distance from the CC to the SSF was 3.41 mm ± 1.31 mm, and it increased with the increase of the sac transverse diameter among groups (p < 0.01). CONCLUSIONS The lacrimal sac can be accurately located on the lateral nasal wall by the reference position of the MTA on CT-DCG images. The distance of the SSF to the MTA and the SSF to the CC is related to the lacrimal sac size. The relative position of the CC to the MTA is relatively stable on CT-DCG images, which make it possible to locate the lacrimal sac of different sizes and the corresponding nasal mucosa incision design in endoscopic DCR.
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Affiliation(s)
- Lihong Yang
- grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science, Affiliated Eye Hospital of NanKai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin, 300020 China
| | - Hongxun Li
- grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science, Affiliated Eye Hospital of NanKai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin, 300020 China
| | - Zhi Yin
- grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science, Affiliated Eye Hospital of NanKai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin, 300020 China
| | - Lei Zhang
- grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science, Affiliated Eye Hospital of NanKai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin, 300020 China
| | - Zhenhai Yang
- grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science, Affiliated Eye Hospital of NanKai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin, 300020 China
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Navarro-Hernandez E, Galindo-Ferreiro A. Endocanalicular Laser Dacryocystorhinostomy and its modifications: A systematic review of techniques and success rates. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:692-704. [PMID: 35879174 DOI: 10.1016/j.oftale.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE the main objective of this work is to review the articles that refer to transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) in acquired nasolacrimal duct obstruction (NLDO), as well as its modifications. MATERIAL AND METHODS A systematic review of publications related to TCL-DCR of the lacrimal duct from 2000 to March 2021 was carried out in the MEDLINE, EMBASE and COCHRANE LIBRARY databases. The search terms in Spanish and English were: «Endocanalicular laser», dacryocystorhinostomy or «primary DCR-L» or «laser» and «tear ducts». RESULTS After subjecting the articles to the inclusion and exclusion criteria, we got 49 articles: 21 retrospective and 28 prospective studies. The bibliometric result obtained guaranteed, for this review, a level C recommendation according to the Scottish Intercollegiate Guidelines Network scale. CONCLUSIONS Currently, the classic TCL-DCR has lower success rates than its modifications, so we suggest using the latter. We prefer TCL-DCR with IS-MMC or TCDL associated with endoscopy techniques, without being able to opt for any option, since their success rates are very similar. We leave the choice to the discretion of the surgeon, depending on the management skills of endonasal techniques. More studies, with longer follow-up, and better defined criteria are necessary to clarify which is the best TCL-DCR technique.
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Affiliation(s)
| | - A Galindo-Ferreiro
- Servicio de Oftalmología, Hospital Universitario Río Hortega, Valladolid, Spain
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Endoscopic Dacryocystorhinostomy With Modified Mucosal Flap Technique. J Craniofac Surg 2022; 34:e216-e218. [PMID: 36195986 DOI: 10.1097/scs.0000000000009054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study is to evaluate the success of mucosa-sparing surgery with a modified inverted U flap in endoscopic dacryocystorhinostomy (E-DCR). Forty-two patients who underwent E-DCR without mucosal flap were included in group 1, and 41 patients who underwent E-DCR with modified inverted U mucosal flap technique were included in group 2. The patients were followed up for at least 12 months postoperatively, and the complications and functional success in both groups were analyzed comparatively. The functional success rate was 81% in group 1 and 95.1% in group 2. The difference between the 2 groups is statistically significant (P=0.04). Postoperative granulation tissue development was observed in 9 patients (20.4%) in group 1 and in 2 patients (4.88%) in group 2, and the difference was statistically significant (P=0.02). Mucosa-sparing E-DCR with modified inverted U flap achieves higher functional success than flapless surgery and causes less granulation formation.
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Pirola F, Spriano G, Ferreli F, Russo E, Di Bari M, Giannitto C, De Virgilio A, Mercante G, Vinciguerra P, Di Maria A, Malvezzi L. Clinical outcome and quality of life of lacrimal sac mucocele treated via endoscopic posterior approach. Am J Otolaryngol 2022; 43:103244. [PMID: 34563801 DOI: 10.1016/j.amjoto.2021.103244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Dacryocystorhinostomy (DCR) is the surgical treatment for lacrimal sac mucoceles (LSM), yet variants of the procedure are several. Since LSM causes bone remodeling and thinning, especially of the lacrimal bone, osteotomy at that site is reasonably the easiest. The aim of the study is to support treatment of LSM via a posterior DCR approach, in a large cohort of cases, and report patients' quality of life after the procedure with validated questionnaires. METHODS Single-center observational retrospective study on a specific methodology (endoscopic-DCR via posterior approach). Consecutive patients with LSM were enrolled in 2008-2020; CT scans were reviewed, bone thickness was measured bilaterally and compared. Resolution of mucocele, epiphora and infection were analyzed after 6-months. Patients were administered the Munk Score and Lacrimal Symptom Questionnaire (Lac-Q). Statistical analysis was done to compare bone thickness between the two sides; descriptive analysis of the questionnaires results was presented. RESULTS Forty-four patients with LSM were enrolled. The LSM side showed frontal process thickness of 4.00 ± 1.06 mm (vs 3.90 ± 1.03 on the unaffected side; p = 0.23) and a lacrimal bone of 0.32 ± 0.12 mm (vs 0.41 ± 0.12; p < 0.001). Resolution of infection was achieved in 97.4% cases, anatomical patency in 87.2%. After 5 years, 84.6% of patients reported no relevant epiphora (Munk score 0-1). Social impact (Lac-Q) due to lacrimal malfunctioning was still noted in 30.8% patients. CONCLUSIONS Adult LSM is a rare condition and DCR remains the mainstay of treatment. LSM physiopathology may support a preferred surgical choice via a posterior approach. Despite objective patency, some lacrimal way malfunctioning may be experienced in a minority of cases.
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Affiliation(s)
- Francesca Pirola
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy.
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Matteo Di Bari
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Caterina Giannitto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Alessandra Di Maria
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
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Mucosal Healing in Endonasal dacryocystorhinostomy; Comparison of Lacrimal and Double Nasal Mucosal Flap with Sacrifice of the Flap. A Randomized Controlled Study. The Journal of Laryngology & Otology 2021; 136:1189-1195. [PMID: 34895364 DOI: 10.1017/s0022215121004059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Atkova EL, Fedorov AA, Astrakhantsev AF, Rein DA, Krakhovetskiy NN. [Experimental investigation of the efficacy of pirfenidone in prevention of ostium cicatricial closure after dacryocystorhinostomy]. Vestn Oftalmol 2021; 137:31-39. [PMID: 34726855 DOI: 10.17116/oftalma202113705131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of the main reasons of failure of dacryocystorhinostomy (DCR) is cicatricial closure of the ostium. Finding a way to prevent this outcome remains one of the leading aims of research in dacryology. The effectiveness of the most widespread methods is often considered contradictory by various researchers. Pirfenidone is a small-molecule agent that demonstrated good antifibrotic effect and low toxicity in previous in vitro research. There haven't been any in vivo studies of its intraoperative use in DCR. Purpose - to determine the in vivo efficacy of pirfenidone in prevention of ostium cicatricial closure following dacryocystorhinostomy in an animal experiment. MATERIAL AND METHODS The study was conducted on 18 Chinchilla rabbits. They were divided into 3 groups and each animal underwent modified dacryocystorhinostomy. On the final stage of surgery rabbits of group 1 were injected 1 ml of 0.15 mg/ml pirfenidone solution, rabbits of group 2 - 0.3 mg/ml pirfenidone solution. No injections were performed in group 3. Animals were terminated on days 7 (6 rabbits), 14 (6 rabbits) and 28 (6 rabbits) following surgery. Lacrimal stoma patency was evaluated in vivo by irrigation, and morphologically postmortem. Tissue samples obtained from the stoma area were examined histologically for signs of fibrosis. RESULTS Failure of dacryocystorhinostomy was observed in 4 out of 18 cases: all rabbits of group 3 terminated on days 14 and 28. The most pronounced morphological signs of fibrosis were also noted in group 3. No topical or systemic adverse effects of the medication were observed in groups 1 and 2. CONCLUSION Pirfenidone demonstrated high antifibrotic efficacy and low toxicity in experimental dacrycystorhinostomy in rabbits. These results provide grounds for further research into the use of pirfenidone in dacrycystorhinostomy.
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Affiliation(s)
- E L Atkova
- Research Institute of Eye Diseases, Moscow, Russia
| | - A A Fedorov
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - D A Rein
- Research Institute of Eye Diseases, Moscow, Russia
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11
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Magomedov MM, Atkova EL, Krakhovetskiy NN, Maydanova AA, Magomedova NM. [Modern methods in treatment of lacrimal system vertical part obliteration]. Vestn Otorinolaringol 2021; 86:86-94. [PMID: 34499454 DOI: 10.17116/otorino20218604186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A review of the literature is devoted to the description of modern methods in treatment of lacrimal system vertical part obliteration. Particular attention is paid to various aspects of the most common surgical intervention - endonasal endoscopic dacryocystorhinostomy.
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Affiliation(s)
- M M Magomedov
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - E L Atkova
- The Research Institute of eye Diseases, Moscow, Russia
| | | | - A A Maydanova
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia.,The Research Institute of eye Diseases, Moscow, Russia
| | - N M Magomedova
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
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12
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Jeong I, Kim S. Outcome of Endonasal Dacryocystorhinostomy with Nasal and Lacrimal Sac Mucosal Flaps. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.7.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: In patients with nasolacrimal duct obstruction, the outcomes of surgery were evaluated according to the type or presence of flaps. Methods: In total, 509 eyes were compared retrospectively: 178 eyes in patients treated without flaps, 126 eyes in patients treated using nasal mucosa flaps, and 205 eyes in the patient group using nasal and lacrimal sac mucosal flap were compared retrospectively. We analyzed the factors of success according to the surgical method by comparing granulation and bony ostium obstruction at 1, 3, and 6 months after surgery in each group. Results: At 6 months after surgery, granulation was found in 6 eyes (2.93%) in the nasal and lacrimal sac mucosal flap group, 5 eyes (3.96%) in the nasal mucosal flap group, and 15 eyes (8.42%) in the group treated without flaps. Bony ostium obstruction was found in 3 eyes (1.46%) in the nasal and lacrimal sac mucosal flap group, 4 eyes (2.38%) in the nasal mucosal flap group, and 6 eyes (2.81%) in the group treated without flaps. The anatomical surgical success rate of patients treated with nasal and lacrimal sac mucosal flaps was 95.61%, which was higher than those of patients treated with nasal mucosal flaps (92.86%) and without flaps (88.20%). The functional and anatomical surgical success rate was 94.15% in the group treated with nasal and lacrimal sac mucosal flaps, 88.89% in the group treated with nasal mucosal flaps, and 84.83% in the group treated without flaps. Conclusions: Endonasal dacryocystorhinostomy using the nasal and lacrimal sac mucosal flap is an effective method that minimizes the risk of granulation and bony ostium obstruction.
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Yu B, Xia Y, Sun JY, Ye Q, Tu YH, Zhou GM, Wu WC. Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation. Int J Ophthalmol 2021; 14:844-848. [PMID: 34150538 DOI: 10.18240/ijo.2021.06.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To establish the necessity of silicone tube intubation in acute dacryocystitis (AD) patients undergoing endonasal endoscopic dacryocystorhinostomy (En-DCR). METHODS Patients presenting with unilateral AD were randomly assigned to two treatment groups. En-DCR procedures were performed following lacrimal abscess formation, with the operation being performed with silicone intubation for patients in group B but not group A. Functional success was defined by an absence of additional AD episodes, no epiphora, and ostium patency as established via endoscopic evaluation or fluorescein irrigation. Operative success rates and demographic variables were compared between treatment groups. RESULTS In total, 66 patients were analyzed in the present study (33 per group), with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B, respectively. All patients exhibited complete resolution of acute inflammation. Upon follow-up, granulation tissue was detected around the ostium at higher rates in group B (9/22, 40.9%) relative to group A (4/27, 14.8%). At the 12-month follow-up time point, patients in group A exhibited higher success rates (25/27, 92.6%) relative to patients in group B (20/22, 90.9%), but this difference was not significant. Cases of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ostium. CONCLUSION Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation, cost, and operative duration, these data do not support the routine silicone intubation of AD patients following En-DCR surgery.
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Affiliation(s)
- Bo Yu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yu Xia
- Department of Ophthalmology, Eye Hospital of Jinan, Jinan 250000, Shandong Province, China
| | - Jia-Ying Sun
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Qian Ye
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yun-Hai Tu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Guang-Ming Zhou
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Wen-Can Wu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Isaev EV, Egorov VI, Isaev VM, Svistushkin VM, Pustovit OM. [Method of endonasal endoscopic dacryocystorhinostomy with plastic stoma formation]. Vestn Otorinolaringol 2021; 86:58-62. [PMID: 33720653 DOI: 10.17116/otorino20218601158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article presents modern methods of surgical treatment of chronic dacryocystitis, a brief historical review of various options for endonasal endoscopic dacryocystorhinostomy is carried out. The method of plastic seamless formation of dacryocystostomy, which does not require intubation of the lacrimal passages and/or using of silicone stoma dilators, is described. Between 2010 and 2019 at The State Budgetary Healthcare Institution of Moscow Area Moscow regional research clinical institute n.a. M.F. Vladimirskiy, according to the developed technique, 32 patients (32 eyes) with chronic dacryocystitis were operated on. According to the results of observation 1 year after surgical treatment, all 100% of patients recorded a positive result (absence or significant decrease in lacrimation, good anatomical visualization of dacryocystostomy with a good tear passage, both passive and during washing the lacrimal passages).
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Affiliation(s)
- E V Isaev
- Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russia
| | - V I Egorov
- Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russia
| | - V M Isaev
- Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russia
| | - V M Svistushkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O M Pustovit
- Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russia
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Yim M, Wormald P, Doucet M, Gill A, Kingdom T, Orlandi R, Crum A, Marx D, Alt J. Adjunctive techniques to dacryocystorhinostomy: an evidence‐based review with recommendations. Int Forum Allergy Rhinol 2020; 11:885-893. [DOI: 10.1002/alr.22699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Michael Yim
- Department of Otolaryngology–Head and Neck Surgery Louisiana State University Shreveport Shreveport LA
| | - Peter‐John Wormald
- Department of Surgery‐Otolaryngology University of Adelaide Adelaide Australia
| | - Manon Doucet
- Department of Otolaryngology–Head and Neck Surgery Louisiana State University Shreveport Shreveport LA
| | - Amarbir Gill
- Division of Otolaryngology – Head and Neck Surgery University of Utah Health Salt Lake City UT
| | - Todd Kingdom
- Department of Otolaryngology–Head and Neck Surgery University of Colorado Denver CO
| | - Richard Orlandi
- Division of Otolaryngology – Head and Neck Surgery University of Utah Health Salt Lake City UT
| | - Alison Crum
- Department of Ophthalmology and Visual Sciences John A Moran Eye Center Salt Lake City UT
| | - Douglas Marx
- Department of Ophthalmology and Visual Sciences John A Moran Eye Center Salt Lake City UT
| | - Jeremiah Alt
- Division of Otolaryngology – Head and Neck Surgery University of Utah Health Salt Lake City UT
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Cohen O, Amos I, Halperin D, Bavnik Y, Milstein A, Shoshani Y, Leiba H, Warman M. Five- and 10-Year Outcomes for Primary Endoscopic Dacryocystorhinostomy: Failure Rate and Risk Factors. Laryngoscope 2020; 131:10-16. [PMID: 32011002 DOI: 10.1002/lary.28528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/30/2019] [Accepted: 01/06/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Endoscopic dacryocystorhinostomy (eDCR) is the preferred approach for nasolacrimal duct obstruction, yet quality data on long-term outcomes is lacking. STUDY DESIGN A retrospective study in a single, academic institution. OBJECTIVE To assess the 5- and 10-year success rates of eDCR, and its associated risks. PATIENTS AND METHODS All eDCRs conducted at Kaplan Medical Center between the years 2002-2017 were included. For long-term follow-up analysis, two subgroups with a minimum of documented 5- and 10-year follow-up after surgery were defined. Surgical success was defined by both anatomical (observed patent lacrimal flow) and functional (symptomatic relief) success. Data was collected from the hospital's electronic medical records and was completed by phone interviews. Pre-, intra-, and postoperative variables were collected and stratified by multivariate analysis. RESULTS After exclusions, 321, 168, and 65 patients were included for immediate, 5- and 10-year outcome analysis, respectively. Overall success rates were 92.5%, 86.3%, and 80%, respectively. The anatomical success rates were 93.8%, 89.9%, and 86.1%, respectively. Multivariate analysis revealed that older age (P < .001, P = .001) previous smoking (P = .043, P = .037), and postoperative complains of epiphora (even when a successful irrigation was observed, P < .001, P = .01) were all associated with eDCR failure 5 and 10 years following surgery. Male gender was also associated with eDCR failure (5 years, P = .045; 10 years, P = .063). CONCLUSIONS Despite decreased rates over time, eDCR is beneficial for the majority of patients also at 10 years following surgery. Older age, smoking, postoperative epiphora, and male gender are related to long-term failure and should be discussed with the patients before surgery. LEVEL OF EVIDENCE 3b Laryngoscope, 131:10-16, 2021.
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Affiliation(s)
- Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Itai Amos
- Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Yosef Bavnik
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Asher Milstein
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Yochai Shoshani
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Hana Leiba
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Meir Warman
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
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Endoscopic dacryocystorhinostomy with and without mucosal flap-is there any difference? Eye (Lond) 2019; 34:1449-1453. [PMID: 31767961 PMCID: PMC7468247 DOI: 10.1038/s41433-019-0716-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The nasal mucosa is sacrificed in conventional endoscopic dacryocystorhinostomies (EDCRs). Some surgeons, however, modify the technique by elevating a mucosal flap prior to creating the osteotomy with the aim of preserving the mucosa. To our knowledge, no clear-cut benefit of a mucosal flap has been established. The aim of this study is to examine the differences in surgical techniques and success rates of EDCRs with and without mucosal flap preservation. METHODS We carried out a medical record review of all patients who underwent primary EDCR at the Goldschleger Eye Institute from October 2009 to October 2017. The following data were retrieved from the medical database and analyzed: patient demographics (age at diagnosis and gender), medical history, examination findings, surgical details, postoperative success, complications, and follow-up. RESULTS A total of 107 patients who underwent 117 EDCRs participated in the study. Fifty-one patients comprised the group without a mucosal flap and 56 patients comprised the group with mucosal flap preservation. The medical history, presenting complaints, and preoperative examination findings were similar for both groups. The surgical success rate was not significantly different between the groups (82.1% without flap vs. 86.8% with flap, P = 0.478, Chi-square). CONCLUSION The findings of this comparison of EDCRs with and without mucosal flap preservation in a large patient population revealed no differences in surgical success or complications rates between the two procedures and, therefore, no benefit for adding flap preservation to conventional EDCRs.
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Ceylan SM, Erdoğan C, Sozen T, Kanmaz MA, Disikirik I, Jafarov S, Tahir E. The Fibrin Glue Application Enhances Surgical Success Rate in Endonasal Endoscopic Dacryocystorhinostomy With Lacrimal Sac Preservation. EAR, NOSE & THROAT JOURNAL 2019; 100:483S-488S. [PMID: 31625404 DOI: 10.1177/0145561319882123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study to compare lacrimal sac flap preserving techniques with or without fibrin glue in patients undergoing endoscopic endonasal dacryocystorhinostomy. A retrospective study included 132 patients who underwent unilateral endonasal dacryocystorhinostomy between February 2011 and March 2016. Patients were divided into 2 groups: the nonfibrin glue group (n = 66) and fibrin glue anastomosis group (n = 66). Surgical success was defined as the patients' subjective report of relief of epiphora and objective endoscopic confirmation of ostium patency confirmed by a positive functional dye test. These parameters were compared between the 2 groups. Both groups were similar, in terms of demographic and clinical characteristics. The surgical success rate was significantly higher in the fibrin glue anastomosis group (95.5%) than in the nonfibrin glue group (84.8%; P = .041). Complication rate was 6.1% in the nonfibrin glue group, whereas in the fibrin glue anastomosis group, it was 4.5%. The complication rate was similar in both groups (P = .99). Creation of an anastomosis between the lacrimal sac flaps and the nasal mucosa using fibrin glue improves the outcome of endonasal endoscopic dacryocystorhinostomy.
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Affiliation(s)
- Seyit Mehmet Ceylan
- Department of Otorhinolaryngology, School of Medicine, 390721SANKO University, Gaziantep, Turkey
| | - Ceren Erdoğan
- Department of Ophtalmology, Duztepe Yasam Hospital, Gaziantep, Turkey
| | - Tevfik Sozen
- Department of Otorhinolaryngology, School of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Mahmut Alper Kanmaz
- Department of Otorhinolaryngology, School of Medicine, 390721SANKO University, Gaziantep, Turkey
| | - Ilyas Disikirik
- Department of Ear Nose Throat Disease, Sani Konukoglu Hospital Practice and Research Center, Gaziantep, Turkey
| | - Shamkhal Jafarov
- Department of Ophtalmology, Duztepe Yasam Hospital, Gaziantep, Turkey
| | - Emel Tahir
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey
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At'kova EL, Zhukov OV, Krakhovetskiy NN, Yartsev VD, Reznikova LV. [Intraoperative prevention of dacryocystitis relapse]. Vestn Oftalmol 2018; 134:270-275. [PMID: 30499528 DOI: 10.17116/oftalma2018134051270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article reviews the literature devoted to modern intraoperative methods of preventing cicatricial process at the site of dacryostoma after endonasal endoscopic dacryocystorhinostomy. Despite the constant improvement of the surgery technique, complications in the postoperative period still occur. They include the formation of granulation tissue at the sites of dacryostoma, synechiae in the nasal cavity, or narrowing of the dacryostoma, which ultimately leads to a relapse of the disease. The main prevention methods are construction of flaps from the medial wall of the lacrimal sac, from mucosa of the nasal cavity, and intubation of the dacryostoma with the lacrimal implant. They are used separately and in various combinations.
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Affiliation(s)
- E L At'kova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - O V Zhukov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N N Krakhovetskiy
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - V D Yartsev
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - L V Reznikova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, Chair of Ophthalmology, 8-2 Malaya Trubetskaya St., Moscow, Russian Federation, 119991
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Kumar S, Mishra AK, Sethi A, Mallick A, Maggon N, Sharma H, Gupta A. Comparing Outcomes of the Standard Technique of Endoscopic DCR with Its Modifications: A Retrospective Analysis. Otolaryngol Head Neck Surg 2018; 160:347-354. [DOI: 10.1177/0194599818813123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To compare the outcomes of various techniques of endoscopic dacryocystorhinostomy (DCR). Study Design Retrospective case record analysis. Settings Tertiary care referral center. Subject and Methods Retrospective analysis of case records was carried out pertaining to the period from January 1996 to September 2017 with respect to patients who had undergone endoscopic DCR with either the standard technique or one of its modifications. Case notes showing well-documented preoperative evaluation, operative details, postoperative assessment, and minimum 6-month follow-up were considered. The outcomes were measured on the basis of patients’ postoperative symptoms, clinical examination, and sac-syringing results. Results A total of 423 patients were included in the study. Of these, 169 underwent standard endoscopic DCR; 87, endoscopic DCR with stent; 19, endoscopic DCR with mitomycin C; 62, powered DCR; 29, laser-assisted DCR; and 57, balloon DCR. There was no statistically significant difference in success rates, recurrences, or complications of various techniques at 3 or 6 months. Mean operating time was lowest for balloon DCR (mean ± SD, 27.1 ± 3.1 minutes), followed by standard endoscopic DCR (38.2 ± 3.6 minutes; P = .001). Conclusion Standard endoscopic DCR and its more sophisticated modifications were equally effective and safe in managing distal nasolacrimal drainage obstruction. Balloon DCR, followed by standard endoscopic DCR, was significantly faster than other techniques.
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Affiliation(s)
- Subodh Kumar
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Awadhesh Kumar Mishra
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Ashwani Sethi
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Ajay Mallick
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Nidhi Maggon
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Harikesh Sharma
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Anandita Gupta
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
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22
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Double Posterior Based Flap Technique in Primary Endoscopic Dacryocystorhinostomy With and Without Using Powered Instrument. Indian J Otolaryngol Head Neck Surg 2017; 69:474-479. [PMID: 29238676 DOI: 10.1007/s12070-017-1227-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/06/2017] [Indexed: 10/18/2022] Open
Abstract
To demonstrate the surgical technique and outcomes of double posterior based flap technique in primary endoscopic dacryocystorhinostomy (DCR) with and without use of powered instrument. 28 patients of nasolacrimal duct obstruction were included in the study from September 2012 to February 2015. All underwent endoscopic dacryocystorhinostomy with double posterior based nasal and lacrimal flap technique. In patients of group A (14 patients), bone removal was done with the help of Smith-Kerrison punch forceps and in patients of group B (14 patients), powered drill has been used for the same. Patients were visited the endoscopic clinic at 1, 3, 6 months and 1 year after the surgery for post operative evaluation. Of 28 patients, 26(92.85%) were found free of symptoms at the end of 1, 3 and at 6 months. One from each group had recurrence of symptoms. At the end of 12 months of 25 patients, 3(12%) patients were found to have recurrence of symptoms of which 1(8.33%) patients was from group A and 2(15.38%) were from group B and failures were because of granulation tissue and stomal stenosis. Patients assisted with powered drill had more postoperative complications compared to cold instrument. Double posterior based flap technique in primary endoscopic DCR without the assistance of powered drill could be an effective surgical option for the patients of chronic nasolacrimal duct obstruction enabling early epithelisation by preventing peristomal granulation tissue resulting in encouraging surgical outcome with least postoperative complication.
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Peng W, Tan B, Wang Y, Wang H, Wang Z, Liang X. A Modified Preserved Nasal and Lacrimal Flap Technique in Endoscopic Dacryocystorhinostomy. Sci Rep 2017; 7:6809. [PMID: 28754905 PMCID: PMC5533767 DOI: 10.1038/s41598-017-07364-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/26/2017] [Indexed: 12/04/2022] Open
Abstract
Here we describe a modified preserved nasal and lacrimal mucosal flap technique in endonasal endoscopic dacryocystorhinostomy (EES-DCR) for patients with epiphora secondary to primary acquired nasolacrimal duct obstruction (PANDO) and evaluate its outcomes. Twenty-five patients with PANDO were retrospectively reviewed. Modified preserved nasal and lacrimal mucosal flap technique in EES-DCR was applied in all 27 eyes of 25 patients. The patients were evaluated with objective (anatomical patency) and subjective (symptomatic cure) success rates within the duration of follow-up. In the present study, all of the patients’ surgical procedures were successful. There were 2 cases of flap dislocation from the rhinostomy site 1 week post-operation. After a mean follow-up of 4.9 ± 1.8 months, the success rate of anatomical patency was 100% (27/27) and the success rate of symptomatic cure was 92.6% (25/27). No significant complications occurred intraoperatively. We concluded that the modified preserved nasal and lacrimal mucosal flap technique in EES-DCR for treating PANDO is simple and safe, can effectively cover the bare bone around the opened sac, and provide a similar or even better clinical outcome compared with other routine treatment techniques used for this condition.
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Affiliation(s)
- Wenyan Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China
| | - Bowei Tan
- Brookdale University Hospital and Medical Center, Brooklyn, NY, 11212, USA
| | - Yandong Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China
| | - Haiying Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China
| | - Zhonghao Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China.
| | - Xuanwei Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China.
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Green R, Gohil R, Ross P. Mucosal and lacrimal flaps for endonasal dacryocystorhinostomy: a systematic review. Clin Otolaryngol 2016; 42:514-520. [PMID: 27662629 DOI: 10.1111/coa.12754] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Historically dacryocystorhinostomy (DCR) has been performed externally with very good outcomes. Current literature shows comparable success rates between endonasal and external approaches. A common reason for the failure of a DCR is the reclosure of the nasolacrimal stoma by granulation tissue and synechiae. OBJECTIVE OF REVIEW A systematic review and critical evaluation of the evidence relating to the preservation of nasal mucosal flaps in DCR surgery. TYPE OF REVIEW AND EVALUATION METHOD A systematic review using the consort guidance for review of randomised control trials. SEARCH STRATEGY A search of the following evidence-based medicine databases was performed: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, Ovid, Medline, EMBASE and PubMed. The search was limited to English language articles, and the following key words were used: Endonasal, Endoscopic, Dacryocystorhinostomy, DCR, Mucosal Flaps, between years 1970 and 2015. RESULTS The best available evidence was level 1B, comprising two randomised control trials and three comparative studies included in the review. The main outcome measures used were lacrimal irrigation and absence of epiphora. Two of the studies demonstrated a statistically significant benefit of mucosal sparing either with nasal mucosal flaps or with lacrimal flaps. More debridement was needed, and granulation tissue was also seen in the groups without mucosal preservation. There was no difference in surgical complications between a mucosal and non-mucosal-sparing technique. CONCLUSIONS The overall quality of current evidence is poor, and there does however appear to be a trend towards improved outcomes and reduced granulation in groups where nasal mucosal and lacrimal flaps were preserved, but this is not clear-cut. There was no evidence of increased complication rates with mucosal-sparing techniques. We recommend that until further good quality research is available we should be performing a mucosal-sparing technique when performing DCR routinely.
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Affiliation(s)
- R Green
- ENT Department Ninewells Hospital, Dundee, UK
| | - R Gohil
- ENT Department Ninewells Hospital, Dundee, UK
| | - P Ross
- ENT Department Ninewells Hospital, Dundee, UK
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Yarmohammadi ME, Ghasemi H, Jafari F, Izadi P, Nadoushan MJ, Chin NS. Teamwork Endoscopic Endonasal Surgery in Failed External Dacryocystorhinostomy. J Ophthalmic Vis Res 2016; 11:282-6. [PMID: 27621786 PMCID: PMC5000531 DOI: 10.4103/2008-322x.188396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the results of a teamwork revision endoscopic dacryocystorhinostomy (DCR) in eyes with previously failed external DCR. Methods: This retrospective study was performed on 50 failed external DCR subjects who underwent a teamwork revision endoscopic DCR by an ophthalmologist and an otolaryngologist. Paranasal sinus CT scanning was performed for each patient before the revision surgery. During surgery, any abnormal tissue noticed before silicone intubation was sent for pathological evaluation. Results: Endoscopic revision DCR was performed on 50 failed external DCR subjects with one-year follow-up. Of these, 31 were female (62%). The age range of the subjects was 18-88 years (mean: 59.98 years). Sinus CT showed at least one abnormality in 94% of cases. Revision endoscopy showed septal deviation (66%), scar formation (32%), ostium problems (28%), and sump syndrome (6%). Pathologic and clinical findings showed that chronic inflammation had a significant association with scar tissue and septal synechia (P = 0.001 and 0.008, respectively). At the final follow-up, anatomical and functional success was achieved in 45 out of 50 (90%) of subjects. Conclusion: Endoscopic revision DCR when performed as cooperation of otolaryngologists and ophthalmologists may help resolve the endonasal problems and increase the success rate.
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Affiliation(s)
| | - Hassan Ghasemi
- Department of Ophthalmology, Shahid Mostafa Khomeini Hospital, Shahed University, Tehran, Iran
| | - Farhad Jafari
- Department of Health and Social Medicine, Shahed University, Tehran, Iran
| | - Pupak Izadi
- Department of Otolaryngology, Shahid Mostafa Khomeini Hospital, Shahed University, Tehran, Iran
| | | | - Narges Saghari Chin
- Department of Ophthalmology, Shahid Mostafa Khomeini Hospital, Shahed University, Tehran, Iran
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Comparison of impact of four surgical methods on surgical outcomes in endoscopic dacryocystorhinostomy. J Craniomaxillofac Surg 2016; 44:749-52. [PMID: 27061784 DOI: 10.1016/j.jcms.2016.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/18/2016] [Accepted: 02/29/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate differences in the surgical outcomes of endoscopic dacryocystorhinostomy (DCR) according to four different surgical methods. MATERIAL AND METHODS This retrospective study included 222 patients who underwent endoscopic DCR from 2011 to 2013. All patients were assigned to one of four groups according to instruments for incision of nasal mucosa and the formation of mucosal flap: group 1, a sickle knife with mucosal flap; group 2, a sickle knife without mucosal flap; group 3, electrocautery with mucosal flap; and group 4, electrocautery without mucosal flap. The follow up period was at least 6 months. RESULTS There were 33 eyes in group 1, 44 eyes in group 2, 49 eyes in group 3, and 97 eyes in group 4. There were no significant differences in success rate between groups (P = 0.878). Wound healing time was significantly different between groups (P < 0.001). In post hoc analysis, wound healing time was significantly shorter in group 1 and group 2 than in group 3 and group 4. The vertical ostium size and postsurgical complication were not significantly different between groups. CONCLUSIONS The use of cold instruments such as sickle knife may be more helpful and effective for shortening wound healing time rather than making mucosal flaps in endoscopic DCR.
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Do JR, Lee H, Baek S, Lee TS, Chang M. Efficacy of postoperative mitomycin-C eye drops on the clinical outcome in endoscopic dacryocystorhinostomy. Graefes Arch Clin Exp Ophthalmol 2015; 254:785-90. [DOI: 10.1007/s00417-015-3229-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/15/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022] Open
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Britto FCCD, Rosier VV, Luz TV, Verde RCL, Lima CMFD, Lessa MM. Nasolacrimal duct mucocele: case report and literature review. Int Arch Otorhinolaryngol 2015; 19:96-8. [PMID: 25992160 PMCID: PMC4392515 DOI: 10.1055/s-0034-1366978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022] Open
Abstract
Introduction Mucoceles are benign expansive cystic formations, composed of a mucus-secreting epithelium (respiratory or pseudostratified epithelium). Nasolacrimal mucocele occurs in a small proportion of children with nasolacrimal duct obstruction and is characterized by a cystic mass in the medial canthus with dilation of the nasolacrimal duct; although dacryocystoceles are rare in adults, they have been reported in patients with trachoma. Objective Discuss clinical aspects, diagnosis, and therapeutic management of mucocele of nasolacrimal duct based on literature review. Resumed Report The authors report a case of bilateral congenital nasolacrimal duct cysts in a 30-year-old man, identified as a tumor in the topography of both lacrimal sacs since birth without associated symptoms. The patient underwent successive surgical treatments, leading to recurrence of the tumor at the right side and recurrent local infections. Conclusion Endoscopic dacryocystorhinostomy has been increasingly used with good results and success rates similar to the external access.
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Affiliation(s)
| | - Vitor Veloso Rosier
- Department of Otolaryngology, Hospital Universitário Professor Edgard Santos-Universidade Federal da Bahia (HUPES-UFBA), Salvador, BA, Brazil
| | - Tovar Vicente Luz
- Department of Otolaryngology, Endoscopic Sinus Surgery, HUPES-UFBA, Salvador, BA, Brazil
| | | | | | - Marcus Miranda Lessa
- Department of Otolaryngology, Universidade de São Paulo, São Paulo, SP, Brazil; HUPES-UFBA, Salvador, BA, Brazil
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Wang X, Bian Y, Yan W, Daniel P, Tu Y, Wu W. Endoscopic endonasal dacryocystorhinostomy with ostial stent intubation following nasolacrimal duct stent incarceration. Curr Eye Res 2014; 40:1185-94. [PMID: 25495271 DOI: 10.3109/02713683.2014.987873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To study the feasibility of endoscopic endonasal dacryocystorhinostomy (EE-DCR) with novel lacrimal ostial stent (LOS) intubation for patients with chronic dacryocystitis with incarceration of a previously implanted nasolacrimal duct stent (NDS). METHODS According to surgical procedure, 166 patients (167 eyes) were divided into two groups: EE-DCR with LOS intubation was performed on 126 patients (127 eyes) in the EE-DCR group; while external dacryocystorhinostomy (E-DCR) with silicone tube intubation was performed on 40 patients (40 eyes) in the E-DCR group. The LOS or silicone tube was retained for 3-6 months. All patients were followed up for 12-36 months. Success rate of tear drainage reconstruction (TDR) and complications were retrospectively compared. RESULTS Excluding patients with early detachment of the LOS or the silicone tube, or with incomplete follow-up period, 117 patients (117 eyes) in the EE-DCR group and 36 patients (36 eyes) in the E-DCR group were included. The mean surgical time was 45.8 ± 11.5 min in the EE-DCR group and 68.1 ± 23.8 min in the E-DCR group (p < 0.001). Intraoperatively, the lacrimal sac was observed to become very small and its walls were thin, hyperemic and fragile, firmly attaching to the NDS by fibrous bands in all eyes. Upon final review, success rate of TDR was 83.8% (98/117) in the EE-DCR group, while 58.3% (21/36) in the E-DCR group (p < 0.01). Failure of TDR due to ostial closure by excessive fibrosis occurred in 14 out of 19 patients in the EE-DCR group, significantly less than the 11 out of 15 patients with failed TDR in the E-DCR group (χ(2 )= 6.959, p < 0.01). No significant difference existed in failures due to granuloma occluding the ostium or common canaliculus obstruction. CONCLUSION EE-DCR with LOS intubation may be an effective procedure to manage the special subgroup of patients with chronic dacryocystitis with incarcerations of a previously implanted NDS.
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Affiliation(s)
- Xiaopeng Wang
- a Department of Ophthalmology , Jinhua Center Hospital , Jinhua , Zhejiang , People's Republic of China
| | - Yang Bian
- b Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , People's Republic of China and
| | - Wentao Yan
- b Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , People's Republic of China and
| | - Pelaez Daniel
- c Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Yunhai Tu
- b Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , People's Republic of China and
| | - Wencan Wu
- b Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , People's Republic of China and
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Abstract
PURPOSE To describe the technique of endocanalicular laser dacryocystorhinostomy with mucosal flap creation and to report the outcomes of this technique. METHODS Prospective noncomparative case series of 7 patients with primary acquired nasolacrimal duct obstruction undergoing endocanalicular laser dacryocystorhinostomy with mucosal flap. The mucosal flap was created using an endoscopic endonasal approach. An endocanalicular approach was used to fashion the lacrimal sac opening and the osteotomy of the lacrimal sac fossa. RESULTS Nine procedures were performed in 7 female patients. Average patient age was 68±15 years. Intraoperative complications included bleeding during the creation of the mucosal flap in 1 patient. The procedure was associated with no pain to moderate pain in all cases. Anatomical success was achieved in 89% of procedures and symptomatic relief was achieved in 89% of surgeries for an average follow up of 10 ± 5 months. Only 1 patient required an external dacryocystorhinostomy revision because of postoperative restenosis. CONCLUSIONS Endocanalicular laser dacryocystorhinostomy provides a minimally invasive approach to epiphora with a good success rate. The addition of a nasal mucosal flap to this technique may aid in proper fistulization and should be studied in larger prospective trials.
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Endoscopic dacryocystorhinostomy with canalicular marsupialization in common canalicular obstruction. Can J Ophthalmol 2013; 48:335-9. [DOI: 10.1016/j.jcjo.2013.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/21/2013] [Accepted: 03/15/2013] [Indexed: 11/18/2022]
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Ji QS, Zhong JX, Tu YH, Wu WC. New mucosal flap modification for endonasal endoscopic dacryocystorhinostomy in Asians. Int J Ophthalmol 2012; 5:704-7. [PMID: 23275904 DOI: 10.3980/j.issn.2222-3959.2012.06.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 11/09/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To describe a simple modification of fashioning the mucosal flap for endonasal endoscopic dacryocystorhinostomy (EES-DCR) in Asians and investigate its efficacy. METHODS A total of 120 patients with unilateral primary chronic dacryocystitis (PCD) were randomized into two groups: the new shaped nasal mucosal flap group (group A) and the removed nasal mucosal flap group (group B). All patients underwent standard EES-DCR. Patients in group A were performed a new shaped nasal mucosal flap covering the bared bone around the opened sac and those in group B was removed the nasal mucosal flap uncovering the bared bone. Patients were followed up for one year. The occurrence of granulation tissue, the proliferation of scar tissue and success rate of EES-DCR was compared. RESULTS In the present study, complete postoperative data were acquired from 54 patients in group A and from 57 patients in group B. During process of review, the occurrence of granulation tissue was at the ostium margins account for 15% (8/54) in group A and 39% (22/57) in group B (P<0.05). At the one-year review, scar tissue was present in 5 patients in group A compared with 18 in group B (P<0.05). The success rate of EES-DCR was 98% (53/54) in group A and 84% (48/57) in group B (P<0.05). CONCLUSION The simple modification of fashioning nasal mucosal flap can effectively cover the bared bone around the opened sac and reduce formation of granulation tissue, lessen the risk of scar tissue formation and closure of ostium, thus improve the success rate of EES-DCR in Asians.
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Affiliation(s)
- Qing-Shan Ji
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
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Paik JS, Cho WK, Yang SW. Comparison of endoscopic revision for failed primary external versus endoscopic dacryocystorhinostomy. Clin Exp Ophthalmol 2012; 41:116-21. [DOI: 10.1111/j.1442-9071.2012.02844.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khalifa MA, Ragab SM, Saafan ME, El-Guindy AS. Endoscopic Dacryocystorhinostomy with Double Posteriorly Based Nasal and Lacrimal Flaps. Otolaryngol Head Neck Surg 2012; 147:782-7. [DOI: 10.1177/0194599812447759] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To conduct the first prospective randomized controlled trial assessing and comparing the safety and efficacy of endoscopic dacryocystorhinostomy (DCR) with double posteriorly based nasal and lacrimal flaps to conventional endoscopic DCR in adult patients with acquired complete nasolacrimal obstruction. Study Design A prospective randomized controlled study. Setting General hospital. Subjects and Methods Seventy-four adult patients with a total of 80 procedures were recruited to undergo endoscopic DCR. They were prospectively equally randomized into 2 groups: endoscopic DCR with flaps (group I) and conventional endoscopic DCR (group II). Regular follow-up settings were done to document the patient’s subjective improvement, judge ostium patency on irrigation, and record any complications. Results Endoscopic DCR with flaps had a higher (92.1%) but nonsignificant difference in success rate when compared with conventional endoscopic DCR (87.4%). There was no significant difference between the 2 techniques in operative time, adverse events, and tolerability of the technique to be done under local anesthesia with minimal sedation. Group I demonstrated a significantly lower number of debridement sessions than did group II. Conclusion Endoscopic DCR with double posteriorly based nasal and lacrimal flaps provides a viable alternative to conventional endoscopic DCR in managing acquired nasolacrimal duct obstructions in adults. It has a comparable success rate, operative time, and safety profile, with a suggestion of a better healing profile in terms of mucosal recovery, wound healing, and less need for debridement sessions.
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Affiliation(s)
- Mohammed A. Khalifa
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Tanta, Egypt
| | - Sameh M. Ragab
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Tanta, Egypt
| | - Magdy E. Saafan
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Tanta, Egypt
| | - Ahmed S. El-Guindy
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Tanta, Egypt
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Kodama S, Hirano T, Suzuki M. Endoscopic Dacryocystorhinostomy with Mucosal Flap. ACTA ACUST UNITED AC 2011; 114:820-3. [DOI: 10.3950/jibiinkoka.114.820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jang HD, Kim SS. Results of Endonasal Dacryocystorhinostomy with Lacrimal Sac Flap and Silastic Sheet. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.12.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Duk Jang
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Sang Soo Kim
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
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