Multidisciplinary approach to lacrimal system diseases

Bibliometric and visualized analysis of research hotpots and future prospects in lacrimal duct obstruction disease (1900 to 2024)

AIM

To reveal the research hotspots, trends, and future prospects of lacrimal duct obstruction disease (LDOD) from 1900 to 2024 through the bibliometric and visualized analysis, providing a directional guidance for research in this field.

METHODS

The Web of Science Core Collection database was used to retrieve relevant literature. Data analysis and visualization were conducted using VOSviewer 1.6.20 and CiteSpace 6.3.1, including annual publication volume, trends, research areas, country/region and institution distribution, journal and co-cited journal analysis, author and co-cited author analysis, keyword and burst keyword analysis, etc.

RESULTS

The study included a total of 1481 articles, revealing an overall upward trend in research on LDOD, with ophthalmology being the predominant field. While the United States previously led research efforts, India and China have emerged as key contributors since 2015. Mohammad Javed Ali stands out as the most influential author in this research area. Ophthalmic Plastic and Reconstructive Surgery has published the highest number of related articles, whereas Ophthalmology has the highest co-citation. The current focal points of research include minimally invasive and precise modifications to dacryocystorhinostomy, along with intubation, new materials for stents, and disease pathogenesis.

CONCLUSION

LDOD research has garnered widely attention and exhibits a steady upward trend. Since 1900, the United States, China, and India have been the leading contributors to this field. Ophthalmologists continue to be the primary driving force behind LDOD research. The findings of this study suggest that at the forefront of LDOD research, our focus has long been on refining and innovating surgical treatment. The minimally invasive and precise modification of lacrimal surgery, represented by dacryocystorhinostomy, is the ongoing developmental direction of this field. Rapid interdisciplinary integration and in-depth exploration of pathogenesis and allergic inflammation will lead to the emergence of new materials, innovative technologies, and safer clinical treatment protocols.

Three-dimensional semi-autotamatic segmentation of nasolacrimal duct morphometry on computed tomography images

PURPOSE

Given the potential role of nasolacrimal duct (NLD) morphometry in the aetiology of primary acquired obstructions, it is imperative that clinicians have access to detailed anatomical information. The aim of this study was to determine normative data on nasolacrimal duct morphometry in the Turkish population sample and to provide guidelines for clinicians.

METHODS

The study included retrospectively computed tomography images of a healthy Turkish population sample of 151 individuals, 79 of whom were female and 72 of whom were male. Images were modeled and analyzed using 3D Slicer version 5.2.2.

RESULTS

The total volume and area of the NLD were smaller in females than in males. The right- and left-sided volume of the NLD were smaller in females than in males (In male, right side 219.28 ± 77.53 mm3 and left side 213.14 ± 73.82 mm3; in female, right side 193.82 ± 75.71 mm3, left side, 190.34 ± 82.54 mm3). Although the anteroposterior and transverse diameters of the right-sided NLD were not statistically different between the genders, the anteroposterior and transverse diameters of the left-sided NLD and distance between right and left NLD were smaller in female than in males. The volume and surface area of the right-sided NLD and the distance between the right and left NLD were larger with increasing age. The anteroposterior diameter was observed to be larger on the right side than on the left in both sexes, whereas the transverse diameter was larger on the right side than on the left side exclusively in females.

CONCLUSION

The results of this study may assist clinicians in the surgical approaches.

Genome-wide association studies with prolapsed gland of the third eyelid in dogs

Cherry eye, the common name for the prolapse of the third eyelid gland in dogs, is a widespread ophthalmic disease affecting dogs of various breeds. This condition severely affects the quality of life of affected dogs, and its underlying cause remains unresolved. In this study, 170K SNP microarray data were collected from 653 brachycephalic dogs and 788 brachycephalic and mesocephalic dogs. These two datasets were analyzed separately in genome-wide association studies (GWAS) involving 12 dog breeds affected by cherry eye. The GWAS analysis of 653 short-headed dogs revealed that four SNPs in the CFA3:15627075-15983629 bp region exceeded the genome-level significance threshold. Association analysis of this region also indicated that these four SNPs were strongly associated. Gene annotation showed that the region contained genes such as KIAA0825, FAM172A, and NR2F1, of which NR2F1 was associated with eye development. The results showed that GWAS analysis performed on 788 short- and medium-headed dogs identified five SNPs in the CFA22:15627075-15983629 bp region that exceeded the genome-level significance threshold, and association analysis was performed in this region, which showed that these five SNPs were strongly associated. In addition, 104 annotated genes were identified in both GWAS. To explore the genes involved in cherry eyes, we performed GO functional enrichment analysis. The genes involved in the high pathway were DIO3 and TTC8. In addition, an in-depth analysis revealed 33 genes associated with eye development and diseases. Our study provides new perspectives for further understanding cherry eye in dogs.

External dacryocystorhinostomy: A critical overview of the current evidence

PURPOSE

External dacryocystorhinostomy (ext-DCR) is still considered the gold standard in the treatment of distal lacrimal duct obstruction. Despite an overall high success rate, some patients do relapse after surgery and the ideal perioperative management has not been identified yet. The purpose of this study is to critically discuss the published evidence in the last five years on the medical and surgical management of external dacryocystorhinostomy. Furthermore, the drawbacks of the available literature and the perspectives in this field will be also highlighted.

METHODS

Systematic review of the literature in the last 5 years by using PubMed and Google Scholar.

RESULTS

A total of 64 articles were included. Many technical modifications and surgical refinements have been proposed but a formal comparison among the various techniques is hampered by methodological heterogeneity. The use of local anesthesia, and the perioperative adjunctive techniques to reduce the risk of restenosis are also gaining popularity but the level of evidence remains weak.

CONCLUSION

Ext-DCR offers satisfactory clinical outcomes even though there are many gray areas that need to be addressed in future high-quality studies.

Endoscopic and external dacryocystorhinostomy: A therapeutic proposal for distal acquired lacrimal obstructions

Endoscopic (END-DCR) and external dacryocystorhinostomies (EXT-DCR) are nowadays considered the gold standard techniques for non-oncologic distal acquired lacrimal disorders (DALO). However, no unanimous consensus has been achieved on which of these surgeries is the most suitable to the individual patient. Herein, we review the available literature of the last 30 years with the aim of defining a simple and reproduceable treatment algorithm to treat DALO. A search of PubMed, EMBASE, Scopus and Cochrane databases was last performed in December 2021 to examine evidence regarding the role of END-DCR and EXT-DCR in primary and revision surgeries. If considered primary surgeries, END-DCR should be preferred in case of intranasal comorbidities, given the possibility to directly visualize and treat potential intranasal pathologies. Conversely, EXT-DCR should be chosen in case of need/preference for local anesthesia, given the major historical experience and wider surgical field that helps to resolve intra-operatory complications (e.g., bleeding) in an uncollaborative patient. In the absence of the abovementioned conditions, the decision of one or other approach should be discussed with the patient. In recurrent cases, END-DCR should be considered the treatment of choice given the major likelihood to visualize the causes of primary failure and directly resolve it. In conclusion, END-DCR should be considered the treatment of choice in revision cases or in primary ones associated with intranasal pathologies, whereas EXT-DCR should be chosen if local anesthesia is needed. In the absence of these scenarios, it is still open to debate which of these two approaches should be used.

The importance of clinical presentation on long-term outcomes of external dacryocystorhinostomies: Our experience on 245 cases

PURPOSE

External dacryocystorhinostomy (EXT-DCR) is a surgical approach commonly used to treat post-canalicular acquired lacrimal obstruction whose success rate has been described, equally with endoscopic DCR, to be superior to other available treatments.

METHODS

At San Raffaele Hospital, Milan (Italy), from January 2008 to December 2020, 245 EXT-DCRs were performed. All patients underwent routine pre-operative work-up including Jones tests and probing and irrigation of the lacrimal pathway; when necessary, a multidisciplinary approach with nasal endoscopy was performed. The surgical approach was followed by positioning of a bicanalicular stent which was left in place for 6 months. Success was defined as resolution of clinical signs/symptoms and free lacrimal flow on functional test.

RESULTS

Of the cases enrolled, 26.9% were treated for recurrent epiphora (group 1), and 73.1% for epiphora associated with chronic dacryocystitis (group 2). After a median follow-up of 71 months, group 1 had success at T0 (1 month) and T1 (long-term) of 81.8% and 60.6%, respectively, compared to 93.8% and 77.7% in group 2. Statistical analysis showed a significant association with surgery both at T0 (p = 0.018) and T1 (p = 0.012) with group 2 showing better outcomes. Additionally, the cosmetic outcome of the external scar was defined as invisible in 91.8% of cases and slightly visible in 8.2%.

CONCLUSIONS

External dacryocystorhinostomy provides long-term reliable results particularly in case of chronic dacryocystitis. Moreover, the optimal esthetic outcome of the external scar should be no longer considered the only guiding principle of treatment modality, particularly in the elderly.

Application of a symptoms score questionnaire after conjunctivodacryocystorhinostomy: outcomes

Objective

To evaluate medium/long term outcomes and patient satisfaction through relief of symptoms and improved quality of life (QoL) after Jones tube conjunctivodacryocystorhinostomy (JT-CDCR) using the Naso Lacrimal Duct Obstruction symptom-score (NLDO-SS).

Methods

We conducted a retrospective, non-comparative, multicentric study including patients with complete obstruction of the superior and inferior proximal lacrimal drainage system. All patients underwent JT-CDCR, and the patency of the tube was evaluated with saline irrigation and endoscopic examination. We assessed patient satisfaction and quality of life administering the NLDO-SS.

Results

We enrolled 16 patients, for a total of 21 eyes operated. The success rate for procedures was 81%. The success rate for single parameters was globally 95.9%; if considered separately, ocular symptoms and nasal symptoms were respectively 94.3% and 100%.

Conclusions

JT-CDCR was a reliable procedure, able to solve symptoms in a majority of patients and guaranteed a good quality of life over a long period of time.