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Lan S, Yu J, Ke F, Li D, Liu Z. Comparison of Endoscopic Dacryocystorhinostomy Outcomes With or Without Bicanalicular Silicone Tube Intubation in Acquired Lacrimal Sac Mucocele. J Craniofac Surg 2023; 34:e671-e675. [PMID: 37582258 DOI: 10.1097/scs.0000000000009581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/03/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE This paper was established to validate the necessity of bicanalicular silicone tube intubation (BSTI) in patients with acquired lacrimal sac mucocele (ALSM) receiving endoscopic dacryocystorhinostomy (DCR). METHODS In total, 92 patients (92 eyes) diagnosed with ALSM undergone endoscopic DCR from November 2016 to December 2021 were recruited for our research. Patients were allocated into 2 equal treatment groups: group A (patients undergoing BSTI) and group B (patients not receiving this procedure). The tubes were removed 2 months postoperation in group A. Surgical outcomes and related complications were evaluated 12 months postoperation. RESULTS Ultimately, this study included 83 patients with ALSM, consisting of 43 patients in group A and 40 patients in group B. All patients exhibited notable mass shrinkage with the opening of the lacrimal sac during the surgery and the swelling in the lacrimal sac area was completely relieved within 5 days postoperation. At the 12-month follow-up, no distinct difference was observed in the anatomic success rate between the 2 groups (group A: 93.0%; group B: 90.0%) ( t = 0.010, P > 0.05). However, patients in group A presented higher functional success rates (90.7%) in contrast to those patients in group B (72.5%) ( t = 4.635, P < 0.05). In both groups, the failure of the lacrimal passage reconstruction was attributed to granulation tissue formation or scar formation at the ostium. No sac mucocele recurrence occurred during the follow-up. CONCLUSION Endoscopic DCR treatment for ALSM achieves satisfactory postoperative effects without recurrence, and BSTI may improve the functional success rate.
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Affiliation(s)
- Shan Lan
- Department of Radiology, Renmin Hospital, Hubei University of Medicine
| | - Jinqiang Yu
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Feng Ke
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Dekun Li
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Zhenkai Liu
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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Chang KF, Shen YD. Endonasal endoscopic nasolacrimal duct dissection for primary nasolacrimal duct obstruction. Taiwan J Ophthalmol 2019; 10:116-120. [PMID: 32874840 PMCID: PMC7442105 DOI: 10.4103/tjo.tjo_111_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/15/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE: The purpose of this study is to describe the results of endonasal endoscopic nasolacrimal duct dissection (EE-NLDD); a surgical technique used for the treatment of primary nasolacrimal duct obstruction (NLDO). MATERIALS AND METHODS: Before the operation, the patency of the nasolacrimal duct (NLD) was evaluated through irrigation and probing. The EE-NLDD surgical procedure involved the removal of the bony structure covering the NLD. The NLD mucosa was dissected and marsupialized with nasal mucosa, creating a mucosa-covered ostium. The bone surrounding the lacrimal fossa and lacrimal sac mucosa was preserved throughout procedure. The postoperative anatomical and functional outcomes were evaluated through irrigation, endonasal endoscopic fluorescein dye test, and subjective descriptions of the patients. STUDY DESIGN: This is a retrospective chart review study which included all patients with primary NLDO treated with EE-NLDD surgical technique from February 2012 to July 2016 in Taipei Medical University Shuang Ho Hospital by a single surgeon (YD, Shen). RESULTS: The mean follow-up time for the 39 patients (43 eyes) was 14.7 months (range: 0.5–46 months). Anatomical patency was achieved in all patients. Under endonasal endoscopy, fluorescein dye was observed at the internal orifice after the dye was instilled into the conjunctival sac in all patients. The complete resolution of the epiphora was reported in 36 patients (39 eyes) and two patients (2 eyes) exhibited an improvement of the epiphora after surgery. However, one patient (2 eyes) reported persistent bilateral epiphora without improvement even under solid evidence of anatomical patency. No major complications were noted intraoperatively or postoperatively. CONCLUSIONS: The results suggested that the EE-NLDD is a safe and effective procedure and has a success rate comparable with that of conventional endonasal dacryocystorhinostomy.
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Affiliation(s)
- Ko-Fang Chang
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yun-Dun Shen
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Sng J, Loon LT, Bondoc MJO, Siow JK, Chew YC. Late dacryocystorhinostomy failure from lacrimal sump syndrome with pseudo-sac formation. Can J Ophthalmol 2018; 53:e144-e148. [PMID: 30119809 DOI: 10.1016/j.jcjo.2017.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Affiliation(s)
- James Sng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Novena, Singapore.
| | - Lee Tian Loon
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Novena, Singapore
| | - Margarita Justine O Bondoc
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Novena, Singapore; Cardinal Santos Medical Center, Manila Philippines
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Park J, Lee J, Lee H, Baek S. Effectiveness of indocyanine green gel in the identification and complete removal of the medial wall of the lacrimal sac during endoscopic endonasal dacryocystorhinostomy. Can J Ophthalmol 2017; 52:494-498. [PMID: 28985810 DOI: 10.1016/j.jcjo.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/26/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We investigated the effect of using indocyanine green (ICG) gel, a mixture of ICG and Viscoat, on complete removal of the medial wall of the lacrimal sac as well as the success rate of endoscopic endonasal dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction. METHODS Consecutive cases of endoscopic endonasal DCR between January and December 2010 were included in a retrospective, comparative manner. A total of 91 patients with primary acquired nasolacrimal duct obstruction were enrolled. Surgical method was selected according to time period. In the ICG gel group, we used ICG gel, which is a fluorescent-colored viscoelastic substance made of ICG dye (25 mg) and Viscoat. ICG gel was injected into the lacrimal sac via the inferior canaliculus prior to lacrimal sac dissection. The anatomic and functional surgical success rates of endoscopic endonasal DCR in each group were compared. RESULTS Our study included 49 cases in the ICG gel group and 42 cases in the control group. The functional success rate of endoscopic endonasal DCR reached 93.9% (46 of 49) in the ICG gel group compared with 71.4% (30 of 42) in the control group (Pearson's χ2 test, p value = 0.004). In contrast, there was no statistically significant correlation between use of ICG gel and anatomic success rate of endoscopic endonasal DCR. CONCLUSIONS Using ICG gel during lacrimal sac dissection may enhance the functional success rate of endoscopic endonasal DCR for primary acquired nasolacrimal duct obstruction by facilitating easier identification and subsequent complete removal of the medial wall of the lacrimal sac.
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Affiliation(s)
- Jinhwan Park
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Jongsuk Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Hwa Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Sehyun Baek
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
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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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Goel R, Kishore D, Kumar S, Agarwal T, Nagpal S, Apoorva AG. Case report of sump syndrome after laser conjunctivodacryocystorhinostomy. Case Rep Ophthalmol 2015; 6:115-9. [PMID: 25960734 PMCID: PMC4410507 DOI: 10.1159/000381450] [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] [Indexed: 12/04/2022] Open
Abstract
The sump syndrome was initially described in relation to patients who had undergone external dacryocystorhinostomy. Here we report a case of sump syndrome that developed following laser conjunctivodacryocystorhinostomy (CDCR) due to tube displacement after a bout of forceful sneezing. Unlike cases of external dacryocystorhinostomy where flaps are sutured, there is a potential space created by the sac remnants in laser CDCR. Hence, any displacement of the tube will lead to the improper drainage of secretions with superadded infections of the contents (as occurred in this case). Therefore, in laser CDCR, it is imperative to create an appropriately placed osteotomy with a correctly sized tube that is well secured to avoid displacement along with patient education regarding tube care.
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Affiliation(s)
- Ruchi Goel
- Maulana Azad Medical College, New Delhi, India
| | | | | | | | | | - A G Apoorva
- Maulana Azad Medical College, New Delhi, India
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Kim C, Kacker A, Pearlman AN, Lelli GJ. Results of combined multispecialty endoscopic dacryocystorhinostomy. Orbit 2013; 32:235-8. [PMID: 23662729 DOI: 10.3109/01676830.2013.788674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To characterize the pre- and post-operative findings in patients undergoing endoscopic dacryocystorhinostomy (eDCR) performed jointly by ophthalmologists and otolaryngologists. METHODS Retrospective case series consisting of all the patients who underwent eDCR for nasolacrimal duct obstruction at New York Presbyterian Hospital/Weill Cornell Medical College between the 2009-2012 academic years. Patients were followed post-operatively for at least six months. The primary endpoint assessed in this study was symptom recurrence (epiphora). RESULTS A total of 20 patients (25 total cases) underwent eDCR within the study interval. Of the 25 cases, 7 (28.0%) represented reoperations due to recurrent symptoms. All 20 patients in the study exhibited sinus pathology, as determined during a pre-operative otolaryngology assessment. As a result, 16 of these patients (80.0%) underwent concurrent sinonasal surgery at the time of eDCR. The success rate in cases without prior DCR was 83.3% (15/18). Only 57.1% of revision cases (4/7) reported resolution of epiphora following surgery. CONCLUSION While a joint approach to eDCR did not appear to significantly improve efficacy, it offered the advantage of having an otolaryngologist assess and treat concurrent sinonasal pathology, which was seen in every patient in our series. Given our findings, as well as the technical difficulty often associated with the procedure, there may be great utility in performing eDCR in conjunction with an otolaryngologist.
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Affiliation(s)
- Charles Kim
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
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Yoo JH, Lee H, Shin HH, Lee JM, Jang MW, Baek SH. The Effects of Transcanalicular Diode Laser-Assisted Revision Surgery for Failed Dacryocystorhinostomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.4.493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jun Ho Yoo
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Hwa Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | | | - Jong Mee Lee
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Wook Jang
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Se Hyun Baek
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Utilization Patterns for Diagnostic Imaging in the Evaluation of Epiphora Due to Lacrimal Obstruction: A National Survey. Ophthalmic Plast Reconstr Surg 2010; 26:168-71. [DOI: 10.1097/iop.0b013e3181b8c747] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saratziotis A, Emanuelli E, Gouveris H, Babighian G. Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction: creating a window with a drill without use of mucosal flaps. Acta Otolaryngol 2009; 129:992-5. [PMID: 18979270 DOI: 10.1080/00016480802495396] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION Success and complication rates of endoscopic dacrycystorhinostomy (DCR) creating a window with a drill and without using mucosal flaps are similar to those of external DCR. Moreover, any intranasal or paranasal disease can be treated simultaneously and a superior cosmetic result is achieved. OBJECTIVES To present success and complication rates of a case series of patients treated with the same technique of endoscopic DCR for acquired nasolacrimal duct obstruction (NLDO). PATIENTS AND METHODS This was a retrospective case review of 46 patients (25 female, 21 male; mean age 57 years). All patients had acquired NLDO with epiphora. Additionally, chronic dacryocystitis was evident at presentation in five patients. The cause of NLDO was primary acquired NLDO in 35 patients and lacrimal sac mucocele in 11 patients. An endonasal endoscopic approach using a drill was performed. Temporary silicone stenting of the nasolacrimal duct system was applied. In 19 patients additional surgery (11 FESS, 3 septoplasties, 5 FESS and septoplasty) was necessary. Patient follow-up ranged between 3 and 27 months. RESULTS A successful functional result was obtained in 97.8% of patients. No major complications were observed. Minor complications (acute dacryocystitis or periorbital ecchymosis) occurred in four patients and were treated with antibiotics or resolved spontaneously.
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Athanasiov PA, Prabhakaran VC, Mannor G, Woog JJ, Selva D. Transcanalicular Approach to Adult Lacrimal Duct Obstruction: a Review of Instruments and Methods. Ophthalmic Surg Lasers Imaging Retina 2009; 40:149-59. [DOI: 10.3928/15428877-20090301-04] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee TS, Kim JW. Clinical Usefulness of Laser Cystectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.11.1717] [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)
- Tae Soo Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Jung Wan Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Lee S, Goldberg RA, Ben Simon GJ. Postoperative complications in ophthalmic plastic and reconstructive surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.6.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Woog JJ, Sindwani R. Endoscopic Dacryocystorhinostomy and Conjunctivodacryocystorhinostomy. Otolaryngol Clin North Am 2006; 39:1001-17, vii. [PMID: 16982259 DOI: 10.1016/j.otc.2006.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intranasal approaches to the correction of lacrimal outflow obstruction initially were described more than 100 years ago, but they have gained renewed popularity with the recent development of the field of endoscopic sinus surgery. Endoscopic dacryocystorhinostomy (EDCR) surgery may be considered in many patients who have lacrimal outflow obstruction. It may be particularly advantageous in patients who have concomitant sinonasal disease, patients with a history of radiation therapy, pediatric patients, and in revision procedures. Advantages of the endoscopic technique include excellent visualization, the ability to evaluate the location and size of the rhinostomy site thoroughly, and the avoidance of a facial scar. Recent studies suggest that the success rates of EDCR are comparable to those achieved through traditional external dacryocystorhinostomy.
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Affiliation(s)
- John J Woog
- Department of Ophthalmology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Hong JE, Hatton MP, Leib ML, Fay AM. Endocanalicular Laser Dacryocystorhinostomy. Ophthalmology 2005; 112:1629-33. [PMID: 16087238 DOI: 10.1016/j.ophtha.2005.04.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 04/10/2005] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To describe the outcomes of endocanalicular laser dacryocystorhinostomy (ECL DCR) for patients with nasolacrimal duct obstruction (NLDO). DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS One hundred eight consecutive patients who underwent ECL DCR. METHODS The records of the patients who underwent ECL DCR at 1 of 2 academic centers were reviewed and the data analyzed. MAIN OUTCOME MEASURES Success was defined as the resolution of symptoms or unobstructed lacrimal irrigation. RESULTS One hundred eighteen consecutive ECL DCR surgeries performed on 108 patients between June 1997 and June 2003 were reviewed, excluding 6 lost to follow-up. Endocanalicular laser DCR was the initial surgical intervention for all cases except 6 that had previously undergone surgery (external or endonasal DCR) at outside hospitals. Twenty-seven of the surgeries were considered failures on the basis of recurrent epiphora or discharge, or reflux on nasolacrimal irrigation. One of the failures was permanently corrected with balloon dacryoplasty. Nine of the other failures had a repeat procedure, with 7 remaining patent after one repeat procedure and an additional one remaining patent after a third procedure. All 6 ECL DCR procedures that were performed after external or endonasal DCR at an outside institution remained patent. Among the 102 initial lacrimal surgeries in this series, there was a 73.6% success rate. The overall success, including repeat procedures, was 81.5%. The success of this technique as a repeat procedure after previous external, endonasal, or ECL DCRs was 87.5%. CONCLUSIONS Endocanalicular laser DCR offers a minimally invasive alternative procedure for the treatment of NLDO. In our series, the success rates are comparable to those previously reported. The technique had a high success rate when used to treat recurrent NLDO after previous lacrimal surgery.
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Affiliation(s)
- Jenny E Hong
- Ophthalmic Plastic and Orbit Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts 02114, USA
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Alañón Fernández MA, Alañón Fernández FJ, Martínez Fernández A, Cárdenas Lara M, Rodríguez Domínguez R, Ballesteros Navarro JM, Sainz Quevedo M. Dacriocistorrinostomía endonasal y endocanalicular con láser diodo. resultados preliminares. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2004; 55:171-6. [PMID: 15359663 DOI: 10.1016/s0001-6519(04)78503-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM OF THE STUDY To describe the surgical technique and to evaluate the clinical results after having performed the transcanalicular and endocanalicular dacryocystorhinostomies by diode laser, including the advantages and limits of this technique. METHODS 34 were performed by diode laser in patients with clinical history of epiphora, with or without mucopurulent secretion, for nasolacrimal duct obstruction. The study was prospective, interventional, non randomized and non comparative. Diode laser was used to realize vaporization of lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean of surgical time was 15 minutes (range 7 to 29 minutes). Bicanalicular intubation was performed with a silicone tube and prolene filament for two months in all cases. Postsurgical follow-up was between 4 and 11 months. The degree of epiphora was evaluated by the Munk scale and lacrimal permeability was evaluated by endoscopic functional staining test in all cases. RESULTS Out of the 34 DCR-EDN+ENC that were performed, 32 cases (94.11%) remain asymptomatic. Two of them (5.88%) required endonasal dacryocystorhinostomies by drilling, because the bony perforation was impossible to achieve by laser fiber. Two cases (5.88%) presented fibrosis and lacrimal and lower canaliculi obstruction, without epiphora because the superior canaliculi was permeable. CONCLUSION Endonasal and endocanalicular dacryocystorhinostomy technique performed by diode laser is a valid method. It does not cause cutaneous scarring, it decreases thermic canalicular damage, it respects the lacrimal pump, it minimizes pain and bleeding, it needs less surgical time and it has turned into an out-patient procedure with a minimal surgical and postsurgical morbility.
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Abstract
Dacryocystorhinostomy is an important treatment in the relief of tearing. Through the years, there have been several advances in this procedure. Once performed only from an external approach, the advent of rigid endoscopes and endoscopic instrumentation has made the endonasal approach a reality. Advantages of the endonasal approach include lack of a cutaneous incision and excellent visualization of intranasal pathology, which is often the cause of dacryocystorhinostomy failure. Preoperative evaluation including a detailed medical history, physical examination with office endoscopy, and imaging, as well as postoperative care are important. Surgical technique with detailed knowledge of intranasal anatomy and meticulous attention to hemostasis are critical. Endonasal laser-assisted dacryocystorhinostomy is also performed today, and special preoperative considerations and key features of the lasers available are important in the selection of a laser for tissue or bone ablation during the procedure. Endoscopic conjunctivodacryocystorhinostomy is performed today, and given the critical nature of proper length and placement of the Jones tube intranasally, provides the significant advantage of intranasal visualization. Endoscopic dacryocystorhinostomy in children is also performed today; however, challenges such as small nasal anatomy and maintenance of the intranasal osteomy postoperatively in a child are significant issues.
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Affiliation(s)
- Lynnette M Watkins
- Ophthalmic Plastic, Orbital, Reconstructive, and Cosmetic Surgery, Department of Ophthalmology, Boston, MA, USA
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Yazici B, Meyer DR. Selective antibiotic use to prevent postoperative wound infection after external dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 2002; 18:331-5; discussion 335. [PMID: 12352818 DOI: 10.1097/00002341-200209000-00003] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The use of systemic antibiotic prophylaxis in lacrimal drainage surgery is controversial. Some studies have reported high rates of postoperative infection and surgical failure after lacrimal drainage surgery when systemic antibiotic prophylaxis was not routinely administered. Many ophthalmologists have traditionally used antibiotics only in selected patients undergoing dacryocystorhinostomy (DCR), and this study evaluates the success of this strategy. METHODS This was a retrospective interventional case series of 138 consecutive patients who underwent 163 external DCR procedures. Antibiotics were given only when inflammatory signs were present in the medial canthal region or when purulent material was noted during surgery. Patients with persistent external medial canthal inflammatory signs received amoxicillin/clavulanate or cephalexin orally 3 to 7 days before and 1 week after surgery. Patients in whom purulent lacrimal sac material was noted during surgery received cefazolin intravenously. RESULTS Postoperative results were evaluated in terms of wound infection and related complications and surgical success. Systemic antibiotics were given in 15 of 163 (9%) cases. Nine (6%) cases received intraoperative (intravenous) antibiotics; 5 (3%) cases received perioperative (oral) antibiotics; and 1 (1%) case received both. None of the patients had postoperative deep soft tissue infection (cellulitis). Skin changes compatible with superficial wound infection occurred in 2 (1%) cases and responded well to topical treatment. Surgery was successful in 157 of 163 (96%) cases. Of 6 failures, none were associated with postoperative wound infection. CONCLUSIONS Selective use of antibiotics limited to patients with signs of lacrimal sac inflammation appears sufficient to prevent soft tissue infection after DCR.
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Affiliation(s)
- Bulent Yazici
- Lions Eye Institute, Department of Opthalmology, Albany Medical College, Albany, New York 12208, USA
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El-Guindy A, Dorgham A, Ghoraba M. Endoscopic revision surgery for recurrent epiphora occurring after external dacryocystorhinostomy. Ann Otol Rhinol Laryngol 2000; 109:425-30. [PMID: 10778899 DOI: 10.1177/000348940010900414] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recurrent epiphora after external dacryocystorhinostomy (DCR) can be a frustrating experience for both the patient and the physician. We present the results of a retrospective study of 18 patients with epiphora recurring after external DCR who were operated upon to recreate lacrimal drainage through an endoscopic endonasal approach. The procedure was successful in 83.3% of cases, with no major complications. The results are comparable to those of an external approach, but the cosmetic advantages are clear. It is a 1-stage procedure that permits correction of associated intranasal disease that may be a causative factor in the recurrence of lacrimal obstruction. The endoscopic endonasal approach is a relatively safe and reliable option in the management of recurrent epiphora.
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Affiliation(s)
- A El-Guindy
- Department of Otolaryngology, Tanta School of Medicine, Egypt
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