[Comparative analysis of the results of balloon dacryoplasty for stenoses at different levels of the vertical portion of lacrimal pathways]

[Disorders of lacrimal drainage: the way from theory to practice]

The article summarizes the results of research conducted over the past decade concerning the current problems of dacryology, analyzes the improvements made to the methods of diagnostics used in disorders of lacrimal passages on the basis of modern imaging and functional studies, describes the techniques aimed at improving the clinical effectiveness of the intervention, as well as drug and non-drug methods of intraoperative prevention of excessive scarring in the area of the artificial ostium. The article also analyzes the experience of using balloon dacryoplasty in relapses of tear duct obstruction after dacryocystorhinostomy, and presents the modern minimally invasive surgical techniques, including nasolacrimal duct intubation, as well as balloon dacryoplasty and endoscopic plastic surgery of the ostium of the nasolacrimal duct. Additionally, the work lists the fundamental and applied tasks of dacryology and outlines promising directions of its development.

[Modern methods in treatment of lacrimal system vertical part obliteration]

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.

[Meatoplasty - an effective method for surgical treatment of patients with nasolacrimal duct ostium stenosis]

The authors proposed a novel approach to the surgical correction of distal nasolacrimal duct stenosis - the meatoplasty of the nasolacrimal duct.

AIM

To evaluate the effectiveness of the developed surgical technique in cases of nasolacrimal duct ostium stenosis.

METHODS

78 patients (90 cases) with nasolacrimal duct stenosis at the level of it's ostium were included and divided into three comparable groups depending on the type of performed surgery: - the meatoplasty of the nasolacrimal duct in group 1, the meatoplasty with concomitant recanalization and bicanalicular silicone intubation of nasolacrimal duct by Ritleng in group 2 and recanalization with bicanalicular silicone intubation of nasolacrimal duct by Ritleng in group 3. A comparative analysis of the surgical treatment effectiveness of the patients of three groups was carried out.

RESULTS

The best effectiveness of treatment was noted in group 2 (positive outcomes in 90.0% of cases). The positive outcomes were obtained in 76.7% of cases in group 1 and in 66.7% of cases in group 3.

CONCLUSION

The developed surgical technique of meatoplasty with concomitant recanalization and bicanalicular silicone intubation of nasolacrimal duct is a highly-efficient and safe minimally invasive method for treatment of nasolacrimal duct ostium stenosis and it can be recommended in a wide clinical practice.

A Systematic Review of Patient-Reported Outcomes for Surgically Amenable Epiphora

PURPOSE

In evaluating epiphora and its management, the bottom line for all stakeholders is whether an intervention confers any real benefit on quality of life. A review was conducted to identify and appraise patient-reported outcome measures (PROMs) in surgically amenable epiphora.

METHODS

A systematic search was conducted of studies relating to surgical intervention for epiphora. Patient-reported outcome measures were identified and assessed against standard criteria.

RESULTS

Of 30,544 identified articles, 227 were eligible for data extraction. Of these, 69% reported a PROM as the primary outcome. PROMs identified included single-item symptom scores (48% of primary outcome PROMs), single-item reports of improvement (30%), the Glasgow Benefit Inventory (3%), Lacrimal Symptom Questionnaire (0.5%), Nasolacrimal Duct Obstruction Symptom Score (0.5%), Ocular Surface Disease Index (0.5%), Visual Function Questionnaire-25, the Short Form-36 Health Survey, and 3 other symptom scores. None were developed through consultation with the target population, and there was inadequate testing of content validity. The strengths and limitations of each PROM are presented, with regard to interpretation, responsiveness, reliability, and validity.

DISCUSSION

The importance of robust and psychometrically sound PROMs is essential if the under-reporting of quality of life improvement in patients treated for epiphora is to change. Recommendations for the use of each identified PROM are discussed.

CONCLUSIONS

Several PROMs have been used in the recent literature to evaluate patients undergoing surgery to treat epiphora. Assessed against standard criteria, no PROM has proven to be both psychometrically robust and clinically meaningful for use in this population. Future PROM development should be guided by this standard framework.

[Radio-wave surgery in the treatment of dacryocystitis]

By improving the existing surgical technologies for dacryocystitis, one enhances the effectiveness of patient rehabilitation.

AIM

To evaluate the effectiveness of radio-wave surgery in the treatment of dacryocystitis and lacrimal sac abscesses.

MATERIAL AND METHODS

The clinical group consisted of 207 patients ranging in age from 7 to 89 years (the mean age of 41±7.3 years). For 39% of patients this was a repeated treatment, while 9.3% had undergone 4-5 surgical interventions. The following types of surgical interventions were performed: dacryocystorhinostomy with external approach and lacrimal stent placement - 128, dacryocystectomy for stenosing dacryocystitis with lacrimal stent placement - 21, dacryocystectomy without lacrimal stent placement in somatically complicated patients after repeated dissection of the abscess who developed fistula and granulation - 23, and lacrimal sac abscess drainage - 35. In all patients, the treatment involved high-frequency radio-wave surgery (3.8 to 4 MHz). The article contains a detailed description of the four types of interventions and provides an explanation of the choice of electrode, mode and power level.

RESULTS

Positive changes were observed in all cases of chronic dacryocystitis and lacrimal sac abscess. The patency of the lacrimal system, including canalicular and nasolacrimal tests, was assessed 6 months after dacryocystorhinostomy. The results were judged positive in all cases despite slowed dye evacuation in 11 cases. The severity of epiphora (Munk scores) decreased from 3.45±0.7 at baseline to 1.0±0.7 (p<0.05). In 5 dacryocystorhinostomy patients the stoma occluded.

CONCLUSION

Positive characteristics of radio-wave surgery help increase the effectiveness of surgical treatment of dacryocystitis, improve surgical performance, reduce duration of the procedure and postoperative care, reduce the number of complications, and achieve a better cosmetic effect.

[The multidisciplinary approach to the diagnostics and surgical treatment of the lacrimal passages]

The primary objective of the present study was to highlight the current state of research on the pathology of the lacrimal organs based on the results of the analysis of the relevant publications in the domestic and foreign scientific literature. Special attention in this review is given to the problems of diagnostics, indications for the probing, the treatment and stenting strategies. The authors report their original observations contributing to the better understanding of the anatomical features of the nasolacrimal passages. In addition, the data on the principal pathogenic agents are presented together with certain peculiarities of the surgical treatment of the pathology under consideration.