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Singh S, Ali MJ. The Evolving Story of CNLDO: Serial Photographic Documentation and Parental Perspectives. Ophthalmic Plast Reconstr Surg 2023; 39:88-91. [PMID: 35829659 DOI: 10.1097/iop.0000000000002242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study is to report the temporal sequence of symptomatology of bilateral congenital nasolacrimal duct obstruction and parental perspectives of 2 established lacrimal surgeons studying the natural history of their newborn child. METHODS Prospective observational report. Once epiphora was noted, a daily assessment and documentation of several symptoms and signs were initiated using iPhone 11 pro camera. These include epiphora, associated discharge, tear meniscus level, matting of lashes, day-night variation in symptomatology, difficulty in eye-opening upon waking up, conjunctival congestion, periocular changes, especially in the tear trough area and lateral canthus, changes in symptom severity with time, regurgitation on pressure over lacrimal sac area, the fullness of the lacrimal sac area or palpable lacrimal sac swelling, and other associated clinical findings. RESULTS The weekly course of congenital nasolacrimal duct obstruction showed similar patterns in OU, although the phase of severe symptoms was spaced by a 6-week interval between the eyes. The epiphora appeared first, followed by rapidly increasing discharge, the severity of which was alarming to the parents. Periocular skin developed excoriation due to persistent epiphora and cleaning attempts. Focused and regular lacrimal sac compressions resulted in abrupt resolution of epiphora at different time points in each eye. The baby was comfortable when compressions were performed during breastfeeding. Cleaning the discharge regularly can be a daunting task for the new parents. The use of wet 'eye wipes' was more effective and comfortable than a cotton bud or cloth piece. Both the parents were lacrimal surgeons, and they did not overtly feel socially embarrassed due to the congenital nasolacrimal duct obstruction, but questions from family and friends were discomforting. CONCLUSION Parental perspectives of the temporal sequence of congenital nasolacrimal duct obstruction provide better insights into disease management and counseling.
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Affiliation(s)
- Swati Singh
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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Dani K, Yadalla D, Joy A, Wu AM, Jayagayathri R. Subjective outcome and quality of life following external dacryocystorhinostomy. Indian J Ophthalmol 2021; 69:1882-1886. [PMID: 34146050 PMCID: PMC8374794 DOI: 10.4103/ijo.ijo_3043_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: To assess the patient reported outcome and quality of life in post external dacryocystorhinostomy operated patients. Methods: A prospective questionnaire based study was carried out on 112 patients diagnosed with chronic dacryocystitis who underwent external dacryocystorhinostomy in the department of Orbit and Oculoplasty at a tertiary eye hospital in South India. Results: We included 112 cases in our study. Mean (SD) of the age of patients was 48.03 (12.79) years and ranged from 7 to 72 years of age. 44 (39.3%) patients were males and 68 (60.7%) were females. All cases had subjective symptoms of tearing, pain and swelling at baseline which were relieved by post-operative 3 in all cases. The mean (SD) best corrected visual acuity was 0.28 (0.39) at baseline and 0.25 (0.37) at postoperative 3 (p < 0.001). All four parameters studied in the GBI questionnaire - total mean GBI (32.22 vs 48.86, P < 0.001), general subscale (31.21 vs 44.08, P < 0.001), social health (46.28 vs 61.01, P < 0.001), physical outcome (22.17 vs 55.80, P = 0.0001) scores showed significant improvement from 1 vs 3 months post DCR. Conclusion: The GBI questionnaire is an effective tool for assessing patients’ quality of life following DCR. External DCR can not only produce a successful anatomical outcome but also bring about a measurable improvement in subjective symptoms and quality of life among patients with symptomatic NLDO.
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Affiliation(s)
- Koshal Dani
- Senior Resident, Aravind Eye Hospital, Pondicherry, India
| | - Dayakar Yadalla
- Orbit and Oculoplasty, Aravind Eye Hospital, Pondicherry, India
| | - Anupama Joy
- Orbit and Oculoplasty, Aravind Eye Hospital, Pondicherry, India
| | - Annie M Wu
- General Ophthalmology, University of Michigan Kellogg Eye Center, Ann Arbor, USA
| | - R Jayagayathri
- Orbit and Oculoplasty, Aravind Eye Hospital, Pondicherry, India
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Hatt SR, Leske DA, Castañeda YS, Wernimont SM, Liebermann L, Cheng-Patel CS, Birch EE, Holmes JM. Development of Pediatric Eye Questionnaires for Children With Eye Conditions. Am J Ophthalmol 2019; 200:201-217. [PMID: 30653960 DOI: 10.1016/j.ajo.2019.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To develop patient-derived Pediatric Eye Questionnaires (PedEyeQ) to separately assess eye-related quality of life (ER-QOL) and functional vision in children with eye conditions. DESIGN Questionnaire development study. METHODS A total of 444 children (0 to <18 years old), across 10 diagnostic categories, were enrolled at 2 sites. All parents (n = 444) and 277 children (5 to <18 years old) completed master questionnaires, developed from patient-derived concerns. Factor analysis was performed to identify unidimensional domains (eigenvalue >1.0) and Rasch analyses (differential item functioning, targeting, fit) to reduce items (separate analyses for subjects aged 0-4, 5-11, and 12-17 years and for each factor). RESULTS The Child 5- to 11-year-old PedEyeQ consisted of 4 unidimensional domains/questionnaires: functional vision, bothered by eyes/vision, social, frustration/worry (10 items each). The Child 12- to 17-year-old PedEyeQ consisted of the same 4 domains (total 39 items). The Proxy 0- to 4-year-old PedEyeQ consisted of 3 questionnaires/domains: functional vision, bothered by eyes/vision, social (total 29 items). The Proxy 5- to 11-year-old PedEyeQ consisted of 5 questionnaires/domains: functional vision, bothered by eyes/vision, social, frustration/worry, eye care (total 39 items), as did the Proxy 12- to 17-year-old PedEyeQ (total 42 items). The Parent PedEyeQ consisted of 4 questionnaires/domains: impact on parent/family, worry regarding child's eye condition, worry regarding child's self-perception and interactions, worry regarding child's visual function (total 35 items). Rasch look-up tables were created for scoring. CONCLUSIONS By following a rigorous approach, we have developed Pediatric Eye Questionnaires for separately assessing functional vision and ER-QOL domains in children of any age and with any eye condition.
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Affiliation(s)
- Sarah R Hatt
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David A Leske
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Laura Liebermann
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas, USA; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jonathan M Holmes
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
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Assessing the Outcomes of Powered Endoscopic Dacryocystorhinostomy in Adults Using the Lacrimal Symptom (Lac-Q) Questionnaire. Ophthalmic Plast Reconstr Surg 2017; 33:65-68. [PMID: 26882060 DOI: 10.1097/iop.0000000000000660] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to assess the quality of outcomes of powered endoscopic dacryocystorhinostomy using the lacrimal symptom (Lac-Q) questionnaire. METHODS Prospective interventional case series of 50 consecutive patients who underwent primary powered endoscopic dacryocystorhinostomy were included in the study. All the patients had stent placement which were removed at 4 weeks. The Lac-Q questionnaire was administered preoperatively and at 4 weeks and 16 weeks following the surgery. Outcomes assessed were anatomical success, functional success, and changes in the social impact and lacrimal symptoms scores. Statistical analysis was performed using Dunnette's procedure with bonferroni correction. RESULTS Fifty-five powered endoscopic dacryocysto rhinostomies were performed on 50 patients. A total of 150 questionnaire responses were analyzed. At the 16 week follow up, the anatomical and functional success rates were 98% and 94%, respectively. The mean social impact scores showed significant improvement postoperatively from 3.88 to 0.3 (p ≤ 0.001). The changes in the total scores (12.5 preoperatively to 1.0 at 16 weeks follow up) were statistically significant (p ≤ 0.001). Postoperative scoring correlated well with the anatomical and functional success rates. The symptom scores reflected changes with change in the clinical condition. CONCLUSION The Lac-Q questionnaire is a simple and useful tool to evaluate the quality of outcomes of powered endoscopic dacryocystorhinostomy.
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Hatt SR, Leske DA, Wernimont SM, Birch EE, Holmes JM. Comparison of Rating Scales in the Development of Patient-Reported Outcome Measures for Children with Eye Disorders. Strabismus 2017; 25:33-38. [PMID: 28166429 DOI: 10.1080/09273972.2016.1276941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A rating scale is a critical component of patient-reported outcome instrument design, but the optimal rating scale format for pediatric use has not been investigated. We compared rating scale performance when administering potential questionnaire items to children with eye disorders and their parents. METHODS Three commonly used rating scales were evaluated: frequency (never, sometimes, often, always), severity (not at all, a little, some, a lot), and difficulty (not difficult, a little difficult, difficult, very difficult). Ten patient-derived items were formatted for each rating scale, and rating scale testing order was randomized. Both child and parent were asked to comment on any problems with, or a preference for, a particular scale. Any confusion about options or inability to answer was recorded. RESULTS Twenty-one children, aged 5-17 years, with strabismus, amblyopia, or refractive error were recruited, each with one of their parents. Of the first 10 children, 4 (40%) had problems using the difficulty scale, compared with 1 (10%) using frequency, and none using severity. The difficulty scale was modified, replacing the word "difficult" with "hard." Eleven additional children (plus parents) then completed all 3 questionnaires. No children had problems using any scale. Four (36%) parents had problems using the difficulty ("hard") scale and 1 (9%) with frequency. Regarding preference, 6 (55%) of 11 children and 5 (50%) of 10 parents preferred using the frequency scale. CONCLUSIONS Children and parents found the frequency scale and question format to be the most easily understood. Children and parents also expressed preference for the frequency scale, compared with the difficulty and severity scales. We recommend frequency rating scales for patient-reported outcome measures in pediatric populations.
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Affiliation(s)
- Sarah R Hatt
- a Department of Ophthalmology , Mayo Clinic, Rochester , MN , USA
| | - David A Leske
- a Department of Ophthalmology , Mayo Clinic, Rochester , MN , USA
| | | | - Eileen E Birch
- b Retina Foundation of the Southwest , Dallas , TX , USA.,c Department of Ophthalmology, UT Southwestern Medical Center , Dallas , TX , USA
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Penttilä E, Smirnov G, Tuomilehto H, Kaarniranta K, Seppä J. Endoscopic dacryocystorhinostomy as treatment for lower lacrimal pathway obstructions in adults: Review article. ALLERGY & RHINOLOGY 2015; 6:12-9. [PMID: 25860166 PMCID: PMC4388871 DOI: 10.2500/ar.2015.6.0116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Obstruction of the lacrimal pathway is manifested by epiphora, infection, and blurred vision as well as ocular and facial pain. Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice. Dacryocystorhinostomy (DCR) is recognized as the most suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or in the nasolacrimal duct. The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity. During the past 2 decades, advances in rigid endoscopic equipment and other instruments have made it possible to obtain more information about the anatomic landmarks of the nasolacrimal system, which led to the development of less-invasive and safer endoscopic techniques. However, many parts of the treatment process related to endoscopic endonasal dacryocystorhinostomy (EN-DCR) still remain controversial. This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.
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Affiliation(s)
- Elina Penttilä
- Department of Otorhinolaryngology, and University of Eastern Finland, and Kuopio University Hospital, Finland
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Shin JH, Kim YD, Woo KI. Impact of epiphora on vision-related quality of life. BMC Ophthalmol 2015; 15:6. [PMID: 25613683 PMCID: PMC4320496 DOI: 10.1186/1471-2415-15-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/10/2015] [Indexed: 11/30/2022] Open
Abstract
Background The study aimed to evaluate vision-related quality of life (QOL) in epiphora (excessive tear production) patients. Methods A total of 342 epiphora patients who visited ophthalmology clinics at 21 general hospitals during a 1-week period were enrolled; 245 females and 97 males with a mean age of 52 ± 13 years. Participants completed a self-administered questionnaire on the extent to which epiphora limited their daily activities. Questions on frequency of discomfort with daily activities were answered on scale of a 0–4. Daily activities that were assessed included reading, daytime and nighttime driving, working at a computer, watching TV, work-related activities, household activities, outdoor activities, interpersonal relations, and general happiness. A correlation analysis was performed between the scores and patient ages. Scores were compared with the clinical factors of gender, bilaterality, and lacrimal irrigation pattern. Presurgical and postsurgical scores in a subset of epiphora patients who underwent surgery were compared. Results Outdoor activities were among those that epiphora most significantly hindered. Age had a negative correlation with interpersonal relations scores. Female patients tended to have more discomfort than males in conducting household activities, outdoor activities, and interpersonal relations. Bilaterality showed no differences in QOL. Patients with complete obstruction of lacrimal irrigation recorded higher scores in all daily activities than those with partial or no obstruction. For vision-related QOL, post-surgical scores were improved significantly compared with pre-surgical scores. Conclusion Epiphora can affect a broad array of daily activities. Corrective measures for epiphora can improve vision-related QOL, and this may provide guidance for physicians in managing epiphora patients.
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Affiliation(s)
- Jae-Ho Shin
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro, Gangnam-gu, 135-710, Seoul, South Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro, Gangnam-gu, 135-710, Seoul, South Korea.
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Han S, Kim US. Symptom based diagnosis of infant under one year in outpatient clinic. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:241-5. [PMID: 24882958 PMCID: PMC4038730 DOI: 10.3341/kjo.2014.28.3.241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/04/2013] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We investigated chief complaints and ocular disorders in infants under one year of age and analyzed the association between complaints and disorders. METHODS The medical records of 815 infants were reviewed. Chief complaints were grouped into the following 11 categories: eyelid drooping, epiphora (tearing), ocular discharge, lid swelling, eyelashes touching the eyeball, abnormalities of the anterior segment, abnormal eyeball movement (e.g., squint or nystagmus), red eye, trauma, poor eye contact, and miscellaneous. We performed ophthalmologic examinations at the doctors' discretion and analyzed the relationship between chief complaint and final diagnosis. RESULTS Mean age of visiting the outpatient clinic was 6.09 ± 3.07 months. The most common complaint was ocular discharge, followed by abnormal eyeball movement, epiphora, and eye redness. Among infants with ocular discharge, most were attributed to congenital nasolacrimal duct obstruction (155 infants) and conjunctivitis (75 infants). A total of 160 guardians complained of abnormal eyeball movement and 86 of 160 infants (51.9%) suffered from pseudoesotropia. Additionally, exodeviation and esodeviation was found in 17.9% and 16.4% of infants, respectively. Eight guardian complained of poor eye contact in their infants and these infants were diagnosed with retinal disorders (3), congenital optic nerve disorders (2), cataract (1), glaucoma (1), and high hyperopia (1). CONCLUSIONS The most common ocular symptoms in infants under one year of age included ocular discharge, epiphora, and eye redness. However, infants with poor eye contact or suspected abnormal eye movement should undergo a full ophthalmologic examination.
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Affiliation(s)
- Sangyoun Han
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Ungsoo Samuel Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea. ; Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
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Ridyard E, Inkster C. Measuring quality of life in oculoplastic patients. Int J Ophthalmol 2014; 7:133-8. [PMID: 24634879 DOI: 10.3980/j.issn.2222-3959.2014.01.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/17/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate if there is any published evidence of impaired quality of life in conditions which are corrected by oculoplastic surgery and whether there is proven benefit in the quality of life such procedures. METHODS We searched a number of databases to determine the level of evidence available for common conditions amenable to oculoplastic surgery. Search terms concentrated on quality of life measures rather than anatomical correction of deformities. RESULTS The level of evidence available for different conditions was very variable. Certain conditions had extensive research documenting reduction in quality of life, with some evidence for improvement after surgery. Some other common conditions had little or no evidence supporting of reduction in quality of life to support the need for surgery. CONCLUSION The evidence is sparse for quality of life improvement after some of our most commonly performed procedures. Many of these procedures are now being identified by primary care trusts (PCTs) as of "low clinical value", and are no longer being routinely commissioned in certain parts of the UK. There is a need to address this lack of evidence to determine whether oculoplastic surgery should continue to be commissioned by PCTs.
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Affiliation(s)
- Edward Ridyard
- University of Manchester, Oxford Road, Manchester, Greater Manchester, M13 9PL, UK
| | - Clare Inkster
- The Eye Unit, Royal Bolton Hospital, Minerva Road, Farnworth, BL4 0JR, UK
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Tadic V, Hogan A, Sobti N, Knowles RL, Rahi JS. Patient-reported outcome measures (PROMs) in paediatric ophthalmology: a systematic review. Br J Ophthalmol 2013; 97:1369-81. [PMID: 23743433 DOI: 10.1136/bjophthalmol-2013-303350] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To identify patient-reported outcome measures (PROMs) specifically developed and used to assess the impact of ophthalmic disorders in children and to systematically assess their quality as a basis for recommendations about their use in clinical and research settings. METHODS A systematic review of the literature was performed in MEDLINE, EMBASE, PsychINFO, CINAHL and AMED, supplemented by a grey literature search. Papers reporting development and validation of questionnaire instruments for assessing patient-reported outcomes of an ophthalmic disorder in patients aged 2-18 years were included. Quality was assessed by examining the purpose and psychometric properties of the instruments. Strengths and limitations were summarised with recommendations regarding use. RESULTS Search identified 17 instruments. Of these, 11 were condition-specific and six were intended for a broader population of children and young people with visual impairment regardless of the ophthalmic condition. Three were developed for use in a specific trial and two are still in development. CONCLUSIONS Paediatric ophthalmology PROM development and application is a developing field and new instruments are needed. There is scope for improvement in this area through (a) clarity of definitions of the underlying constructs intended to be measured at the onset of development of new instruments, (b) application of child-centred approaches and (c) adherence to extant guidance and best practice in questionnaire instrument development.
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Affiliation(s)
- Valerija Tadic
- Medical Research Council (MRC) Centre of Epidemiology for Child Health at the Centre for Paediatric Epidemiology and Biostatistics, University College London (UCL) Institute of Child Health, , London, UK
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Yeniad B, Uludag G, Kozer-Bilgin L. Assessment of patient satisfaction following external versus transcanalicular dacryocystorhinostomy with a diode laser and evaluation if change in quality of life after simultaneous bilateral surgery in patients with bilateral nasolacrimal duct obstruction. Curr Eye Res 2012; 37:286-92. [PMID: 22283720 DOI: 10.3109/02713683.2012.658488] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To compare patient satisfaction and experience after external dacryocystorhinostomy (EX-DCR) versus transcanalicular DCR (TC-DCR) with a diode laser and to evaluate the change in quality of life following simultaneous bilateral DCR. METHODS Prospective evaluation of 38 eyes of 19 patients with bilateral nasolacrimal duct obstruction (NLDO) who underwent TC-DCR for the right eye (Group 1) and EX-DCR for the left eye (Group 2) simultaneously. The subjective outcomes (tearing, irritation, pain, discharge, swelling, and change in visual acuity) of the patients in the two groups at 1 week, 1 month, and 3 months were compared using a questionnaire. The patients answered the questions in the Glascow Benefit Inventory (GBI) to evaluate the change in quality of life after simultaneous bilateral DCR at 1 month and 3 months. The symptom scores were compared between Group 1 and Group 2 using a Mann-Whitney test. The Wilcoxon test was used for the comparison of intragroup differences. RESULTS The overall symptom scores significantly improved in both groups. The overall symptom score and six ocular symptom scores did not show a significant difference between the two groups at 1 week, 1 month, and 3 months. Quality of life of the patients significantly improved after simultaneous bilateral surgery according to GBI scoring at 1 month and 3 months. CONCLUSION The subjective outcomes significantly improved in similar ways after successful TC-DCR and EX-DCR during the early postoperative period. Our study shows that simultaneous bilateral DCR confers a significant quality of life improvement.
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Affiliation(s)
- Baris Yeniad
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Repka MX, Melia BM, Beck RW, Atkinson CS, Chandler DL, Holmes JM, Khammar A, Morrison D, Quinn GE, Silbert DI, Ticho BH, Wallace DK, Weakley DR. Primary treatment of nasolacrimal duct obstruction with nasolacrimal duct intubation in children younger than 4 years of age. J AAPOS 2008; 12:445-50. [PMID: 18595756 PMCID: PMC2604121 DOI: 10.1016/j.jaapos.2008.03.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 02/28/2008] [Accepted: 03/15/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the outcome of nasolacrimal duct intubation as the primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children younger than 4 years of age. METHODS A total of 182 eyes of 139 children receiving intubation with planned tube retention for 2 to 5 months were enrolled in a prospective, nonrandomized observational multicenter study (19 sites). Children were ages 6 months to <45 months at the time of surgery, with no previous nasolacrimal surgical procedures and had at least one of the following clinical signs of NLDO: epiphora, mucous discharge, and/or increased tear lake. RESULTS Treatment success was defined as absence of epiphora, mucous discharge, and increased tear lake at the outcome visit, 1 month after tube removal. The surgical outcome was assessed in 150 eyes (82% of cohort). The proportion of eyes treated successfully was 91% (95% CI: 86%-95%). The outcome dye disappearance test was normal in 125 (86%) eyes, indeterminate in 13 (9%), and abnormal in 7 (5%) of the 145 eyes tested. Monocanalicular tubes were used in 74% of cases. The tube was removed before the planned minimum retention time of 2 months in 61 eyes (41%). For 23 eyes, the early removal was attributed to inadvertent displacement by the patient. CONCLUSIONS In children 6 months to <45 months of age, nasolacrimal duct intubation in a nonrandomized and noncomparative trial was a successful primary treatment of NLDO in about 90% of cases not lost to follow-up.
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Affiliation(s)
| | | | | | | | | | | | - Jonathan M. Holmes
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN
| | - Alexander Khammar
- University of Illinois Eye and Ear Infirmary, Chicago IL
- Hope Children's Hospital, Oak Lawn, IL
| | - David Morrison
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN
| | - Graham E. Quinn
- Division of Ophthalmology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | | | - Benjamin H. Ticho
- University of Illinois Eye and Ear Infirmary, Chicago IL
- Hope Children's Hospital, Oak Lawn, IL
| | | | - David R. Weakley
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX
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Repka MX, Melia BM, Beck RW, Chandler DL, Fishman DR, Goldblum TA, Holmes JM, Perla BD, Quinn GE, Silbert DI, Wallace DK. Primary treatment of nasolacrimal duct obstruction with balloon catheter dilation in children younger than 4 years of age. J AAPOS 2008; 12:451-5. [PMID: 18929305 PMCID: PMC2743152 DOI: 10.1016/j.jaapos.2008.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 06/12/2008] [Accepted: 07/01/2008] [Indexed: 11/19/2022]
Abstract
PURPOSE To report the outcome of nasolacrimal duct balloon catheter dilation as the primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children younger than 4 years of age. METHODS One hundred two children (151 eyes) ages 12 to <48 months (mean, 23 months) at the time of surgery, who previously had not undergone a nasolacrimal surgical procedure and who presented with at least one of the following clinical signs of NLDO--epiphora, increased tear lake, and/or mucous discharge--were enrolled in a prospective, nonrandomized observational multicenter study (20 sites). All children received balloon catheter dilation of the nasolacrimal system of the affected eye(s). RESULTS Treatment success was defined as no epiphora, increased tear lake, and/or mucous discharge present at the outcome visit at 1 month after surgery. The proportion of eyes treated successfully was 82% (95% CI: 74%-88%). The dye disappearance test at outcome was normal in 105 (73%), indeterminate in 15 (10%), and abnormal in 23 (16%) of the 143 eyes tested. CONCLUSIONS In children 12 to <48 months of age, balloon catheter dilation as a primary treatment of NLDO was successful in approximately 80% of cases. Because we did not perform a randomized trial with a comparison group, we were unable to determine how this procedure's success rate compares with that of simple probing or nasolacrimal intubation in this age group.
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Affiliation(s)
| | | | | | | | | | | | - Todd A. Goldblum
- Family Eye Care / Children's Eye Center of New Mexico, Albuquerque, NM
| | - Jonathan M. Holmes
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Graham E. Quinn
- Division of Ophthalmology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
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Solans M, Pane S, Estrada MD, Serra-Sutton V, Berra S, Herdman M, Alonso J, Rajmil L. Health-related quality of life measurement in children and adolescents: a systematic review of generic and disease-specific instruments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:742-64. [PMID: 18179668 DOI: 10.1111/j.1524-4733.2007.00293.x] [Citation(s) in RCA: 379] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To identify currently available generic and disease-specific health-related quality of life (HRQOL) instruments for children and adolescents up to 19 years old, to describe their content, and to review their psychometric properties. STUDY DESIGN Previous reviews on the subject and a new literature review from 2001 to December 2006 (MEDLINE, the ISI Science Citation Index, HealthSTAR and PsycLit) were used to identify measures of HRQOL for children and adolescents. The characteristics (country of origin, age range, type of respondent, number of dimensions and items, name of the dimensions and condition) and psychometric properties (reliability, validity, and sensitivity to change) of the instruments were assessed following international guidelines published by the Scientific Committee of the Medical Outcomes Trust. RESULTS In total, 30 generic and 64 disease-specific instruments were identified, 51 of which were published between 2001 and 2005. Many generic measures cover a core set of basic concepts related to physical, mental and social health, although the number and name of dimensions varies substantially. The lower age limit for self-reported instruments was 5-6 years old. Generic measures developed recently focused on both child self-report and parent-proxy report, although 26% of the disease-specific questionnaires were exclusively addressed to proxy-respondents. Most questionnaires had tested internal consistency (67%) and to a lesser extent test-retest stability (44.7%). Most questionnaires reported construct validity, but few instruments analyzed criterion validity (n = 5), structural validity (n = 15) or sensitivity to change (n = 14). CONCLUSIONS The development of HRQOL instruments for children and adolescents has continued apace in recent years, particularly with regard to disease-specific questionnaires. Many of the instruments meet accepted standards for psychometric properties, although instrument developers should include children from the beginning of the development process and need to pay particular attention to testing sensitivity to change.
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Affiliation(s)
- Maite Solans
- Agency for Quality, Research and Assessment in Health (AQuRAHealth), formerly Catalan Agency for Health Technology Assessment and Research, Barcelona, Spain
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Repka MX, Chandler DL, Beck RW, Crouch ER, Donahue S, Holmes JM, Lee K, Melia M, Quinn GE, Sala NA, Schloff S, Silbert DI, Wallace DK. Primary treatment of nasolacrimal duct obstruction with probing in children younger than 4 years. Ophthalmology 2007; 115:577-584.e3. [PMID: 17996306 DOI: 10.1016/j.ophtha.2007.07.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 07/03/2007] [Accepted: 07/26/2007] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To report the outcome of nasolacrimal duct probing as the primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children younger than 4 years. DESIGN Prospective nonrandomized observational multicenter study (44 sites). PARTICIPANTS Nine hundred fifty-five eyes of 718 children 6 to <48 months old at the time of surgery with no prior nasolacrimal surgical procedure and with at least one of the following clinical signs of NLDO present: epiphora, mucous discharge, and increased tear lake. INTERVENTION Probing of the nasolacrimal system of the affected eye. MAIN OUTCOME MEASURE Treatment success was defined as no epiphora, mucous discharge, or increased tear lake present at the outcome visit 1 month after surgery. RESULTS Proportions of eyes treated successfully were 78% (95% confidence interval [CI], 75%-81%) overall, 78% for the 421 eyes in children 6 to <12 months old, 79% for the 421 eyes in children 12 to <24 months, 79% for the 37 eyes in children 24 to <36 months, and 56% for the 11 eyes in children 36 to <48 months. The probability of treatment success was lower in eyes operated in an office setting than in eyes operated in a surgical facility (adjusted relative risk, 0.88 [95% CI, 0.80-0.96]), with success reported in 72% (95% CI, 66%-78%) of probings performed in an office and 80% (95% CI, 77%-84%) of probings performed in a facility. The probability of treatment success was also lower in eyes of patients with bilateral disease (adjusted relative risk, 0.88 [95% CI, 0.81-0.95]). CONCLUSIONS In children 6 to <36 months old, probing is a successful primary treatment of NLDO in about three fourths of cases, with no decline in treatment success with increasing age. The study enrolled too few children ages 36 to <48 months to allow a conclusion regarding the probability of treatment success in this age group.
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