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Hu JQ, Men CJ, Afshari NA, Liu CY, Korn BS, Kikkawa DO. Cost-effectiveness analysis of endoscopic dacryocystorhinostomy using Markov modelling. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e233-e238. [PMID: 37001560 DOI: 10.1016/j.jcjo.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of endoscopic dacryocystorhinostomy (DCR). METHODS We constructed a Markov model in which patients with nasolacrimal duct obstruction received endoscopic DCR or no surgery. Incremental cost-effectiveness ratios, 1-way sensitivity analyses, and probabilistic sensitivity analyses were used to evaluate for model sensitivity to multiple model inputs. RESULTS Endoscopic DCR was found to be cost-effective with an incremental cost-effectiveness ratio of US$2162 per quality-adjusted life-year. The model was most sensitive to the health utility deduction from epiphora. Probabilistic sensitivity analysis found endoscopic DCR to be cost-effective over no surgery 93.7% of the time. CONCLUSIONS Endoscopic DCR is a cost-effective treatment for patients with epiphora. The model is very sensitive to the negative effect epiphora has on quality of life. With the advancement of health care technology and surgical techniques, the success rates of endoscopic DCR continue to improve and to be an even more efficacious and economical treatment for nasolacrimal duct obstruction.
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Affiliation(s)
- Jenny Q Hu
- Shiley Eye Institute, University of California San Diego, La Jolla, CA.
| | - Clara J Men
- Byers Eye Institute, Stanford University, Palo Alto, CA
| | - Natalie A Afshari
- Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Catherine Y Liu
- Shiley Eye Institute, University of California San Diego, La Jolla, CA; Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Bobby S Korn
- Shiley Eye Institute, University of California San Diego, La Jolla, CA; Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California San Diego, La Jolla, CA; Division of Plastic Surgery, Department of Surgery, University of California San Diego, La Jolla, CA
| | - Don O Kikkawa
- Shiley Eye Institute, University of California San Diego, La Jolla, CA; Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California San Diego, La Jolla, CA; Division of Plastic Surgery, Department of Surgery, University of California San Diego, La Jolla, CA
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Nteli Chatzioglou G, Önal V, Gayretli Ö. Morphometric and morphological evaluation of the nasolacrimal groove in 150 dry bones in the Anatolian population. Surg Radiol Anat 2024; 46:559-566. [PMID: 38393369 DOI: 10.1007/s00276-024-03311-2] [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: 11/05/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
PUPOSE In this study, we aimed to evaluate the anatomical features of the nasolacrimal groove in detail by providing a morphological classification based on morphometric evaluations of the nasolacrimal groove. METHODS A total of 150 sagittal dry bones in the Department of Anatomy, Faculty of Medicine, Istanbul University were evaluated. The length and the width at different points of the nasolacrimal canal were calculated. According to the widths of the nasolacrimal canal ten different morphological types were revealed. RESULTS The length of the canal was found as mean 13.62 ± 2.42 mm on the right and 12.44 ± 2.68 mm on the left side. The entrance, the base, the upper and the lower thirds of nasolacrimal canal were 6.22 ± 1.19 mm, 7.95 ± 1.85 mm, 5.85 ± 1.06 mm, 6.60 ± 1.54 mm, on the right and 6.08 ± 1.16 mm, 7.24 ± 1.64 mm, 5.45 ± 1.29 mm, 6.23 ± 1.48 mm, on the left side, respectively. The width of the entrance of the nasolacrimal canal was the narrowest width compared to the base, upper and lower thirds in 7/10 types of 71/150 cranial bones. CONCLUSION This comprehensive morphological classification of the nasolacrimal groove sheds new light on its complex variations. We support that the finding of this study has the potential to improve the precision of diagnostic assessments and guide specific therapeutic interventions for patients with lacrimal drainage disorders.
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Affiliation(s)
- Gkionoul Nteli Chatzioglou
- Department of Anatomy, Faculty of Medicine, Istanbul Health and Technology University, İmrahor St., Beyoglu, 34015, Istanbul, Turkey.
| | - Vildan Önal
- Department of Anatomy, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Özcan Gayretli
- Department of Anatomy, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Gungab AGNL, Lee Boniao E, Lim BXH, Sundar G, Ali MJ. Practice patterns in revision dacryocystorhinostomy. Orbit 2024; 43:69-73. [PMID: 37155323 DOI: 10.1080/01676830.2023.2203757] [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: 03/11/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE This study aimed to report the practice patterns while performing revision dacryocystorhinostomy (RevDCR) amongst oculoplastic surgeons from several regions across the globe. METHODS The survey consisted of 41 specific questions sent via email that contained a link to the Google forms. The questions covered several aspects of the respondents' practice profiles, evaluation methods, pre-operative choices, surgical techniques, and follow-up preferences while dealing with patients of prior failed DCRs. Questions were answerable either as multiple choice or free text typing. The survey respondents were anonymized. The responses were collected and analyzed, and data were tabulated to understand the preferred practice trends. RESULTS A total of 137 surgeons completed the survey. Most respondents identified themselves as experienced surgeons managing failed DCRs (76.6%, total respondents (n) = 137). The commonly preferred modalities for evaluation of a failed DCR were lacrimal irrigation (91.2%) and nasal endoscopy (66.9%). About 64% (87/137) of the respondents performed a combination of nasal endoscopy, lacrimal irrigation, and probing to localize the area of the failed DCR. A majority of the respondents used anti-metabolites (73.3%, n = 131) and stents (96.4%, 132/137) during the revision surgery. Most surgeons preferred endoscopic approach (44.5%), (61/137) for revising a failed DCR and most preferred general anaesthesia with local infiltration (70.1%, 96/137). Aggressive fibrosis with cicatricial closure was identified as the most frequently encountered cause of failure (84.6%, 115/137). The osteotomy was performed on an as-needed basis by 59.1% (81/137) of the surgeons. Only 10.9% of the respondents used navigation guidance while performing a revision DCR, mainly for post-trauma scenarios. Most of the surgeons completed the revision procedure within 30-60 minutes (77.4%, 106/137). The self-reported outcomes of revision DCRs were good (80-95%, median-90%, n = 137). CONCLUSION A significantly high percentage of oculoplastic surgeons who responded to this survey from across the globe performed nasal endoscopy in their pre-operative evaluations, preferred endoscopic surgical approach, and used antimetabolites and stents while performing revision DCRs.
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Affiliation(s)
| | | | | | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, Singapore
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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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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Ali MJ. Nasolacrimal Duct Coronary Stent Recanalization (NCR): First Cadaver Experience and Its Potential as an Alternative to DCR. Ophthalmic Plast Reconstr Surg 2023; 39:558-562. [PMID: 36877544 PMCID: PMC10624404 DOI: 10.1097/iop.0000000000002381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To investigate the feasibility of implanting a drug-eluting cobalt-chromium alloy coronary stent in the nasolacrimal ducts (NLDs) of human cadavers. METHODS The pilot study was carried out in 5 NLDs of 4 adult human cadavers. Sirolimus-eluting coronary stents of 2 mm in width and lengths of 8 and 12 mm, which were mounted on balloon catheters, were used. Following dilatation of the NLDs, the balloon catheters were introduced into the NLDs under direct endoscopy guidance. The stents were delivered following dilatation of the balloon to 12 ATMs and secured in a locked (spring out) position. The balloon is then deflated and securely extubated. The dacryoendoscopy confirmed the stent position. The lacrimal system was then dissected to assess several key parameters like the uniformity of the NLD expansion, anatomical interactions of the NLD mucosa with the stent rings and struts, integrity of the soft and bony NLD, stent movement on mechanical push and pull, and ease of manual removal. RESULTS The cobalt-chromium alloy coronary stents could be delivered with ease and secured in the cadaveric NLDs. Its position was confirmed by a dacryoendoscopy and later by the direct NLD dissection. The NLD was uniformly dilated 360° with a wide and uniform lumen. NLD mucosa was noted to be uniformly distributed in spaces between the stent rings without influencing the expanded lumen. Following the lacrimal sac's dissection, the NLD stent showed significant resistance to downward movement but could be easily retrieved with forceps. The 12-mm stents could reach the near total length of the NLD with good luminal expansion. The integrity of the bony and soft-tissue NLD was maintained. The learning curve is shallow if the surgeon is adept with the techniques of balloon dacryoplasty. CONCLUSION Drug-eluting cobalt-chromium alloy coronary stents can be precisely deployed and secured within the human NLDs. The study is the first of its kind to demonstrate the technique of NLD coronary stent recanalization in human cadavers. It is a step forward in the journey to evaluate their use in patients with primary acquired NLD obstructions and other NLD disorders.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Hyderabad, India
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Goel R, Ojha S, Gaonker T, Shah S, Meher R, Arya D, Khanam S, Kumar S. Outcomes of 8 × 8 mm osteotomy in powered external dacryocystorhinostomy. Indian J Ophthalmol 2023; 71:2569-2574. [PMID: 37322681 PMCID: PMC10418034 DOI: 10.4103/ijo.ijo_3328_22] [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: 12/22/2022] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To study the endoscopic ostium characteristics and outcome of 8 × 8 mm osteotomy in external dacryocystorhinostomy (DCR) using the microdrill system. Methods This prospective interventional pilot study was performed on 40 eyes of 40 patients with primary acquired nasolacrimal duct obstruction (NLDO) from June 2021 to September 2021 in patients undergoing external DCR. An 8 × 8 mm osteotomy was performed using round, cutting burr attached to a microdrill system. Success was defined as patent ostium on lacrimal syringing (anatomical) and a Munk score <3 (functional) at 12 months. Postoperative endoscopic ostium evaluation was done using a modified DCR ostium (DOS) scoring system at 12 months. Results The mean age of the study participants was 42.41 ± 11.77 years and the male-to-female ratio was 1:4. The mean duration of surgery was 34.15 ± 1.66 minutes and that for osteotomy creation was 2.5 ± 0.69 minutes. The mean intraoperative blood loss was 83.37 ± 11.89 ml. Anatomical and functional success rates were 95% and 85%, respectively. The mean modified DOS score was "excellent" in 34 patients (85%), "good" in 1 patient (2.5%), "fair" in 4 patients (10%), and "poor" in 1 patient (2.5%). Complications included nasal mucosal injury in 10% (4/40) of patients, complete cicatricial closure of ostium in 2.5% (1/40), incomplete cicatricial closure in 10% (4/40), nasal synechiae in 5% (2/40), and canalicular stenosis in 2.5% (1/40). Conclusion An 8 × 8 mm-sized osteotomy created by powered drill and covered by lacrimal sac-nasal mucosal flap anastomosis in external DCR is an effective technique that has minimal complications and shorter surgical time.
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Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sweta Ojha
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Tanvi Gaonker
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Shalin Shah
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Ravi Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
| | - Deepanjali Arya
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Samreen Khanam
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sushil Kumar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
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Tomita K, Matsuyama H, Akimoto M. Two cases of nasolacrimal duct obstruction operated by endoscopic dacryocystorhinostomy after orbital fracture reconstruction with an implant. Am J Ophthalmol Case Rep 2023; 30:101853. [PMID: 37168519 PMCID: PMC10165391 DOI: 10.1016/j.ajoc.2023.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 05/13/2023] Open
Abstract
Purpose To report two cases of nasolacrimal duct obstruction (NLDO) caused by orbital fracture reconstruction with an implant successfully treated with endoscopic dacryocystorhinostomy (EnDCR). Observations Two patients presented with NLDO after orbital fracture reconstruction with an implant. Case 1 was a 67-year-old female. She became aware of epiphora in her left eye after undergoing orbital fracture reconstruction with an implant for a left orbital floor fracture 14 years previously. Dacryocystitis was diagnosed based on a lacrimal syringing test because of pus reflux. Computed tomography (CT) showed that the implant was inserted on the left orbital floor, crossing into the lacrimal sac; dacryoendoscopy showed that the implant blocked the nasolacrimal duct. EnDCR was performed without implant removal. The symptoms resolved postoperatively. Case 2 involved a 6-year-old male who had been aware of epiphora in his left eye since undergoing orbital fracture reconstruction with an implant for a left orbital floor fracture one month prior. Dacryocystitis was diagnosed based on a lacrimal syringing test because of pus reflux. CT showed an unclear implant location, but dacryoendoscopy showed that the implant blocked the nasolacrimal duct. The implant was removed. However, EnDCR was performed because there was no improvement in NLDO. The symptoms resolved after EnDCR. Conclusions and importance One previous report of NLDO after orbital floor fracture reconstruction was performed with external dacryocystorhinostomy with implant removal. Dacryoendoscopy and CT are useful for confirming the location of the implant and obstruction. Depending on the implant's location, it may be possible to perform EnDCR without removing the implant.
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Affiliation(s)
- Kosei Tomita
- Corresponding author. Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555, Japan.
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Güven YZ, Akay F. Primary transcanalicular diode laser-assisted dacryocystorhinostomy: long-term success rates and risk factors for recurrence. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:118-124. [PMID: 36332743 DOI: 10.1016/j.jcjo.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/17/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the long-term success rates of transcanalicular endolaser dacryocystorhinostomy (TC-DCR) surgery along with the factors that possibly affect surgical success. METHODS Patients (n = 300) who underwent unilateral TC-DCR operations in the department of ophthalmology of our university hospital between January 2011 and June 2021 were included in the study. The subjects were divided into 2 groups, with group 1 showing no recurrence (n = 205) and group 2 showing recurrence (n = 95). RESULTS The mean follow-up period for the 300 patients was 26.7 ± 7.0 months (range, 11-33 months). The overall success rate was 205 of 300 (∼68%). Although, based on the univariate risk analysis, age, operative time, total laser power, tube removal time, septum deviation, fistulisation, and intraoperative hemorrhage were found to be risk factors, in multivariate risk analysis, only total laser power, septum deviation, and intraoperative bleeding were determined to be the main risk factors. CONCLUSION The success rate of TC-DCR was lower than that of traditional external DCR, but because TC-DCR is a minimally invasive aesthetic surgery with a short operative time, it may become a preferred option by more ophthalmologists, especially for young patients without intranasal pathology and coagulation disorders and elderly patients at risk for general anaesthesia. It should be taken into account that the chances of success are relatively lower among patients with total laser power applied during surgery, intraoperative hemorrhage, fistulization, and septum deviation. In TC-DCR, bleeding control, short operative time, and low laser power are important to achieve a high success rate. Also, 1 year after TC-DCR, even the presence of anatomic drainage may lower the functional success of patients, so follow-up should be continued.
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Affiliation(s)
- Yusuf Ziya Güven
- Department of Ophthalmology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey.
| | - Fahrettin Akay
- Department of Ophthalmology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
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Van Swol JM, Myers WK, Nguyen SA, Eiseman AS. Revision dacryocystorhinostomy: systematic review and meta-analysis. Orbit 2023; 42:1-10. [PMID: 35942566 DOI: 10.1080/01676830.2022.2109178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The goal of this study is to determine if a certain revision DCR approach (external, endoscopic endonasal, laser transcanalicular) is superior to others. Additionally, this investigation evaluates the effect of the primary surgery on success of revision. METHODS This investigation is a systematic review and meta-analysis. All studies specifying type of primary DCR and revision DCR were included. Proportion of successes of each revision for every primary surgery was obtained from the included studies. Meta-analyses were performed to determine cumulative proportions of successes across studies. OUTCOME MEASURES Significant differences in the proportions yielded by meta-analysis of successes among different surgical approaches. RESULTS The type of primary surgery did not significantly influence overall revision success if the same procedure was used for the revision. Overall successes per each revision type were not significantly different. When performing subgroup analyses per each primary surgery, all methods of revisions were similar in efficacy with one exception: when the primary surgery was done using the laser transcanalicular approach, external revision outperformed repetition of the primary method. CONCLUSIONS Regarding success of re-operation, surgeons can use the method they are most comfortable with to perform DCR revisions. However, primary transcanalicular laser DCRs should be revised, if necessary, using the external approach.
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Affiliation(s)
- Joshua M Van Swol
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Walter K Myers
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew S Eiseman
- Department of Ophthalmology-Oculoplastic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Kothandaraman K, Gupta R. Idiopathic acquired dacryocystocele in an adult: case report of a rare entity. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Background
Idiopathic acquired dacryocystocele in adults is a rare disorder of the lacrimal drainage pathway. Only 20 cases have been reported in the literature. It presents with a triad of epiphora, medial canthal swelling, and recurrent dacryocystitis. Patients presenting without recurrent dacryocystitis is quite uncommon. This presentation can be confused with secondary nasolacrimal duct obstruction and other non-inflammatory pathologies. Dacryocystorhinostomy with stenting is the treatment employed in most reported cases.
Case presentation
A 24-year-old male presented with epiphora and medial canthal swelling for 3 years. Examination revealed features of left nasolacrimal duct obstruction. Imaging was suggestive of a cystic, homogenous, non-enhancing lesion in the left lacrimal sac region without bone destruction. Findings were suggestive of dacryocystocele. Patient underwent endoscopic dacryocystorhinostomy without stenting. Postoperatively, the swelling and epiphora resolved. Patient is symptom-free on follow-up.
Conclusion
Idiopathic dacryocystocele must be considered in evaluation of a medial canthal mass with epiphora without dacryocystitis. Conservative treatment is ineffective. Endoscopic dacryocystorhinostomy is safe and effective.
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Vinciguerra A, Resti AG, Rampi A, Bussi M, Bandello F, Trimarchi M. Endoscopic and external dacryocystorhinostomy: A therapeutic proposal for distal acquired lacrimal obstructions. Eur J Ophthalmol 2022; 33:1287-1293. [PMID: 36254409 PMCID: PMC10152216 DOI: 10.1177/11206721221132746] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck Department, Ophthalmology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Rampi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck Department, Ophthalmology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
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Khatri MS, Kharaya A. Clinical Trial to Compare Success Rate of Endonasal Dacryocystorhinostomy and External Dacryocystorhinostomy for Treatment of Primary Acquired Nasolacrimal Duct Obstruction. Indian J Otolaryngol Head Neck Surg 2022; 74:1266-1273. [PMID: 36452658 PMCID: PMC9701984 DOI: 10.1007/s12070-020-02352-4] [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: 08/25/2020] [Accepted: 12/23/2020] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study is to compare the success rates of endoscopic endonasal dacryocystorhinostomy (EN-DCR) and external DCR (EX-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANLDO). Prospective randomized comparative study. Study was conducted for 2 years duration in a teaching hospital with 300 cases of endoscopic and 300 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analyzed and compared using χ2 test. In our study, the overall success rate of DCR for PANLDO was 92.6%, there was difference in terms of anatomical or functional success rate between EN-DCR (93.6%) and EX-DCR (91.6%). The incidence rate of post operative complication in our study was lower in Endonasal DCR (27.33%) as compared to External DCR (48%). Patients who underwent EN-DCR had shorter recovery time, less complications and higher satisfaction due to lack of external incision, although final surgical outcomes were comparable between two groups.
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Affiliation(s)
| | - A. Kharaya
- Department of ENT, Dr. PDMMC, Amravati, India
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13
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Tang DM, Goli R, Higgins TS, Ting JY, Illing EA, Wu AW. Medical Malpractice Trends in Dacryocystorhinostomy and Orbital Decompression. Am J Rhinol Allergy 2022; 36:835-840. [DOI: 10.1177/19458924221118139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Objective This study aims to evaluate the medicolegal trends related to 2 common orbital surgeries: orbital decompression and dacryocystorhinostomy (DCR). These procedures are performed by ophthalmologists, otolaryngologists, and multidisciplinary teams of both specialists. Methods The Westlaw database was reviewed from 1980 to 2020 for medical malpractice cases involving orbital decompression and DCR surgeries. Data were compiled on plaintiff and defendant demographics, procedure performed, legal allegation, nature of injury, and verdict or settlement awards. The Ophthalmic Mutual Insurance Company was also queried for all malpractice cases pertaining to orbital decompression and DCR from 1995 to 2021. Results The Westlaw database included 60 cases (34 orbital decompression, 26 DCR); of these, 8 orbital decompression and 6 DCR cases met inclusion criteria. Of the 7 orbital decompression cases that were tried, a verdict in favor of the plaintiff occurred in 4 cases (57%). Of the 5 DCR cases that were tried, a verdict in favor of the plaintiff occurred in 2 cases (40%). A search of all claims at OMIC yielded 31 cases (15 orbital decompression, 16 DCR). 22 of 31 cases were either dismissed or resulted in no payment. The remainder was settled out of court, with only one case being tried and the verdict supporting the defendant. Conclusion Despite several thousand orbital decompressions and DCR surgeries being performed annually in the US, very few lawsuits involving these complex surgeries have gone to trial. However, of the cases that did go to trial, a relatively high proportion of verdicts for plaintiffs was observed.
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Affiliation(s)
- Dennis M Tang
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rachna Goli
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University, Indianapolis, Indiana
| | - Elisa A Illing
- Department of Otolaryngology, Indiana University, Indianapolis, Indiana
| | - Arthur W Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California
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Chi YC, Lai CC. Endoscopic dacryocystorhinostomy with short-term, pushed-type bicanalicular intubation vs. pulled-type monocanalicular intubation for primary acquired nasolacrimal duct obstruction. Front Med (Lausanne) 2022; 9:946083. [PMID: 35966838 PMCID: PMC9367212 DOI: 10.3389/fmed.2022.946083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Dacryocystorhinostomy (DCR) has been a primary treatment for adults with nasolacrimal duct obstruction, while the optimal approach and technique remain controversial. With the advancement of endoscopic DCR and the silicone stents, an update of the surgical outcomes and preferable approaches is required. This study aims at comparing the surgical outcomes of endoscopic DCR using pushed bicanalicular intubation (BCI) to pulled monocanalicular intubation (MCI) in adults with primary acquired nasolacrimal duct obstruction (PANDO). Forty five eyes of 45 patients were enrolled, including 22 eyes of 22 patients treated with endoscopic DCR with pulled MCI and 23 eyes of 23 patients with pushed BCI from January 2014 to June 2021. The success rates at stent removal, 1 month and 3 months after removal were 95, 91, and 82%, respectively, in the MCI group, and 100, 87, and 87% in the BCI group. The BCI group had better success rates but failed to reach a significant difference (p = 0.49, p = 0.67, p = 0.24, respectively). After analyzing with binary logistic regression, the implant material was demonstrated as the predictive of surgical success (p = 0.045). There was no significant difference in success rates between patients with dacryocystitis and those without dacryocystitis. We conclude that endoscopic DCR with pushed BCI is easily manipulated and has a promising surgical outcome over pulled MCI. Stent indwelling duration as well as history of dacryocystitis have less influence on the success rates.
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Affiliation(s)
- Yi-Chun Chi
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Chieh Lai
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Chun-Chieh Lai
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15
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First-Onset Dacryocystitis: Characterization, Treatment, and Prognosis. Ophthalmol Ther 2022; 11:1735-1741. [PMID: 35788550 PMCID: PMC9437150 DOI: 10.1007/s40123-022-00544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction To assess the risk of recurrent dacryocystitis after first-onset dacryocystitis and to obtain a demographic profile and treatment characteristic for patients with first-onset dacryocystitis. Methods A retrospective study was performed on patients who had first-onset dacryocystitis during the years 2010–2013. Patients were followed up for 3 years. The analysis focused on the recurrence of dacryocystitis, demographics, medical treatment, and choice of lacrimal surgery. Results The inclusion criteria were met by 52 patients. Of these 15 (29%) had one or more recurrence of dacryocystitis, and 18 patients (34.6%) underwent lacrimal surgery. The mean age was 51.6 years (median 55.5, range 0–93). The female-to-male ratio was slightly under 3:1 (73.1%). The most frequent medical treatment was flucloxacillin capsules combined with chloramphenicol eye drops or ointment. Conclusions The majority of patients with first-onset dacryocystitis had no further episodes of dacryocystitis. Some patients experienced recurrent and complicated infections requiring surgery and were thus a significant burden on the healthcare services. Various surgical options were used to clear the nasolacrimal obstruction causing dacryocystitis. Dacryocystorhinostomy was the most common procedure and showed excellent success rate.
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16
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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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Is Nasal Packing Necessary After Endoscopic Dacryocystorhinostomy Without Stent and Mucosal Flaps Preservation? J Craniofac Surg 2021; 32:2107-2109. [PMID: 33534303 DOI: 10.1097/scs.0000000000007386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of nasal packing on the surgical success and postoperative complications of endoscopic dacryocystorhinostomy (EnDCR) without using stents and mucosal flaps. METHODS The retrospective study comprised of 75 eyes of 65 consecutive patients undergoing EnDCR with the biting and removing technique. The patients were assigned to 2 groups depending on whether the biodegradable synthetic polyurethane foam was used or not (the packing group, 34 eyes; the nonpacking group, 41 eyes). At least 6 months after the EnDCR, the postoperative outcomes including anatomical and functional successes, and the postoperative complications such as synechia, granuloma, and bleeding were compared between the packing and nonpacking groups. RESULTS Synechia was lower in the packing group (23.5% versus 24.4%) but it was not statistically significant (P = 0.93). There were also no significant differences in the granuloma and bleeding complications between the 2 groups (respectively, P = 0.72, P = 0.08). The success rates of anatomical and functional reached 88% in the packing group compared with 82.9%, and 75.6% in the nonpacking group (respectively, P = 0.74, P = 0.76). CONCLUSIONS The present study findings suggest that both groups have no superiorities over each other in the surgical outcomes after the EnDCR. However, further randomized studies are recommended before the generalization can be made.
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Ghosal A, Khilar J, Rout N, Chaudhury P, Kumar S. Epidemiology, clinical profile, complications and treatment outcomes of chronic dacryocystitis in a tertiary care hospital in post lockdown era: An observational study. IP INTERNATIONAL JOURNAL OF OCULAR ONCOLOGY AND OCULOPLASTY 2021; 7:151-156. [DOI: 10.18231/j.ijooo.2021.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 07/19/2023]
Abstract
to study the epidemiological factors, clinical features, complications and treatment outcomes of chronic dacryocystitis in Odisha after nationwide lockdown in 2020. An observational study was designed from July 2020 to December 2020 in Regional Institute of Ophthalmology, Cuttack, Odisha. Total of 187 patients presenting with chronic dacryocystits were evaluated thoroughly in various epidemiological parameters. The history and clinical features were noted. After proper evaluation and conservative treatment, those patients were subjected for surgery and the surgical outcomes are followed-up upto 3 more months, i.e. March 2021.: The prevalence of chronic dacryocystitis was around 1.224%. Among the 187 patients, 112 were females (59.9%). The disease was found in highest proportion in the age group of 51-60 years (30.5%) followed by 25.7% in the age group of 61-70 years. 90.4% were from rural population. Socioeconomic status and living standard was found to be a significant factor, people belonging to class 4 & 3 were affected more. Majority of the affected were housewives (39.6%) and farmers (21.9%) followed by small businessmen (13.9%) and wage laborers (12.9%). Epiphora was the commonest presenting symptom in 71.6%, followed by mucopurulent discharge in 29.9% and swelling near the medial canthus in 12.3% cases. Complications like conjunctivitis, keratitis, preseptal cellulitis, cutaneous fistula were present in 6.4%, 8.4%, 7.5% and 5.9% cases respectively in our study group. The success rate of external DCR was reported as 85.8% in this study. Chronic Dacryocystitis, though a common problem of lacrimal drainage system, is much less recognized disease, specially in rural population and in lower socio-economic community in Odisha. Thus patients may present late with one or more complications, e.g. conjunctivitis, keratitis, preseptal cellulitis, lacrimal abscess, mucocele, cutaneous fistula, which is the current scenario in post-lockdown 2020 era. Maintaining all precautions and guidelines for COVID-19, we should not delay treating these patients with surgical measures. The surgical success rate (85.8%) however was not affected much in spite of all these factors.
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Affiliation(s)
- Antarlin Ghosal
- Regional Institute of Ophthalmology, S.C.B. Medical College and Hospital, Cuttack, Odisha, India
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Changes in Eyelid Position Following Silicone Tube Insertion and Removal in Dacryocystorhinostomy. J Craniofac Surg 2021; 33:e223-e226. [PMID: 34261970 DOI: 10.1097/scs.0000000000007966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS The authors sought to assess the changes in eyelid position after silicone tube insertion and removal in endoscopic dacryocystorhinostomy. METHODS The authors retrospectively reviewed 60 eyes of 48 consecutive patients who underwent endoscopic dacryocystorhinostomy operation at Korea University Guro Hospital, Seoul, Republic of Korea, between April 2019 and November 2019. All cases were evaluated to discern eyelid positioning, focusing on the marginal reflex distance 1, medial palpebral fissure, central palpebral fissure (PF-2), lateral palpebral fissure (PF-3), and medial canthal angle (MCA) before surgery and at 1 week and 1, 2, 3, and 4 months postoperatively. RESULTS Twelve patients (25%) were operated on bilaterally and 36 patients (75%) were operated on unilaterally. The average patient age was 56.5 years and 9 men (18.8%) and 39 women (81.3%) were included in this study. At 2 months postoperatively, all values of interest (marginal reflex distance 1 , medial palpebral fissure, PF-2, PF-3, and MCA) had decreased significantly (P < 0.05, Friedman test), but the changes in PF-3 immediately after surgery were not significant (P = 0.062, Wilcoxon rank-sum test). From 2 to 3 months after surgery, all 5 indicators of interest increased significantly. After silicone tube removal, whereas there was no statistically significant difference in medial palpebral fissure, PF-3, and marginal reflex distance 1 values; the changes in PF-2 and MCA values as compared with before surgery was 0.47 mm (P = 0.02, Wilcoxon test) and 3.25° (P = 0.000, Wilcoxon test), respectively, which was significantly different. However, with these small gaps, it will be difficult to notice the changes in PF-2 and MCA values during clinical examination. CONCLUSION Insertion of a silicone tube during endoscopic dacryocystorhinostomy leads to temporary deformation of the lid position. However, after silicone tube removal, all eyelids recovered to their original shape.
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Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies. Eur Arch Otorhinolaryngol 2021; 279:1929-1935. [PMID: 34251520 PMCID: PMC8273032 DOI: 10.1007/s00405-021-06975-3] [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: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Purpose Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction. Methods At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test. Results Among 14 patients included and after a mean follow-up of 19.5 months (range 13–51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported. Conclusion Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.
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Aspiration Pneumonia After External Dacryocystorhinostomy Under Local Anesthesia Without Sedation: A Case Report. Ophthalmic Plast Reconstr Surg 2021; 37:S162-S164. [PMID: 32991495 DOI: 10.1097/iop.0000000000001836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Amid the global coronavirus disease 2019 (COVID-19) outbreak, an 89-year-old male with chronic kidney disease presented with acute dacryocystitis and a persistent dry cough. After a course of antibiotics, external dacryocystorhinostomy was performed under local anesthesia without sedation. During planned hemodialysis in the early hours after the procedure, the patient developed nausea and hematemesis followed by severe dyspnea and hypoxemia. The patient was diagnosed with aspiration pneumonia, a previously unreported complication in lacrimal surgery.
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Pirola F, De Virgilio A, Di Maria A, Russo E, Di Bari M, Costantino A, Ferreli F, Mercante G, Colombo G, Spriano G, Malvezzi L. Applying the Exoscope to Lacrimal Surgery: Preliminary Experience. ORL J Otorhinolaryngol Relat Spec 2021; 83:381-386. [PMID: 33735886 DOI: 10.1159/000513529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the study was to investigate the role of the exoscope as an assisting tool in endoscopic dacryocystorhinostomy (e-DCR). MATERIALS AND METHODS In this observational retrospective study, the application of the VITOM® exoscope was studied in a group of 21 patients undergoing mono- or bilateral DCR. The primary endpoint was to evaluate resolution of symptoms (epiphora/dacryocystitis) at the 6-month follow-up and time for surgery. Qualitative features of the exoscope (intraoperative view of the surgical field) and comparison with the typical setting for DCR were analyzed as secondary endpoints. A questionnaire was administered to surgical team members (ENT surgeon, ophthalmologist, and scrub nurse) to evaluate the perceived quality of this new technology (12 items valued as "good" = 2, "acceptable" = 1, and "not acceptable" = 0). A questionnaire score of 24 out of 24 was valued as "completely approved," score 20-23 as "moderately approved," and score ≤19 as "weakly approved." Patients were divided into 3 consecutive groups, and questionnaire scores by each team member were analyzed for tendencies. Statistical analysis was performed to test significance at p < 0.05. Local Ethical Committee approval was obtained. RESULTS No significant differences were found between exoscope-set DCR and classic setting for concerned patient outcomes (failure rate: 3.2 vs. 3.8%, respectively, p = 0.896) and mean time for surgery (20' vs. 23', respectively, p = 0.091). The exoscope was valued by surgical team members as "completely approved" in 55.5% of cases, "moderately approved" in 39.7%, and "weakly approved" in 4.8%. Questionnaire scores by the ENT, ophthalmologist, and scrub nurse showed an average increase in the 3 consecutive groups (p = 0.119, p = 0.024, and p < 0.001, respectively). CONCLUSIONS The exoscope is a new tool that may support e-DCR. It has no effects on symptom outcomes (epiphora/dacryocystitis) and time for surgery compared to classic DCR. Based on self-perception, this new technology was accepted by all team members.
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Affiliation(s)
- Francesca Pirola
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy, .,Department of Biomedical Sciences, Humanitas University, Milan, Italy,
| | - Armando De Virgilio
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandra Di Maria
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Ophthalmology, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Elena Russo
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Matteo Di Bari
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Costantino
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Fabio Ferreli
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Mercante
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Colombo
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Spriano
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Malvezzi
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Chiabo J, Fevrier E, Nahon-Estève S, Ghetemme C, Lagier J, Delas J, Baillif S, Martel A. Incidence of Dacryocystorhinostomy (DCR) in France: A Nationwide Study over the 2010-2019 Period. Ophthalmic Epidemiol 2021; 28:526-532. [PMID: 33576300 DOI: 10.1080/09286586.2021.1880605] [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: 12/20/2022]
Abstract
BACKGROUND To assess the annual incidence, surgical technique preferred (i.e. external versus endonasal) and the characteristics of patients undergoing a Dacryocystorhinostomy (DCR) in France over a 10-year-period. METHODS A national observational cohort study was conducted in France between January 2010 and December 2019. Data were collected from the national PMSI (Programme de Médicalisation des Sytèmes d'Information) database provided by the CNAM (Caisse Nationale de l'Assurance Maladie). All patients undergoing a DCR were included. RESULTS Twenty-one thousand one hundred ninety-nine patients, with a mean age of 70.4 years, were included. A female predominance (78%) was noted. The mean annual number of DCRs was 2481 (2366-2633), corresponding to a mean incidence of 3.8 per 100,000 person-years. This number remained stable over the study period (p = .966). Of the 24,808 DCRs, external DCRs were more prevalent compared to endonasal procedures (70.8% vs. 29.2%, p = .0001). Six hundred and fifteen (2.5%) associated acts were performed intraoperatively, mainly during endonasal DCR (96.3%). A total of 10,857 (43.8%) silicone stents were placed intraoperatively. Bicanalicular silicone stenting was preferred over the monocanalicular stenting. All the regions performed more likely external DCR except the Île-de-France area where endonasal DCR was performed in 75.6% of procedures. DCRs were mainly performed by an ophthalmologist (80%). CONCLUSION The mean annual incidence of external and endonasal DCRs remained stable over the study period. Endonasal DCR was more likely performed by the otorhinolaryngologists, emphasizing the need to develop personalized endonasal training in the ophthalmology residency program.
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Affiliation(s)
- Jeremy Chiabo
- Ophthalmology department, University hospital of Nice, Cote d'Azur University, Nice, France
| | - Edouard Fevrier
- Ophthalmology department, University hospital of Nice, Cote d'Azur University, Nice, France
| | - Sacha Nahon-Estève
- Ophthalmology department, University hospital of Nice, Cote d'Azur University, Nice, France
| | - Cédric Ghetemme
- Ophthalmology department, University hospital of Nice, Cote d'Azur University, Nice, France
| | - Jacques Lagier
- Ophthalmology department, University hospital of Nice, Cote d'Azur University, Nice, France
| | - Jérôme Delas
- Ophthalmology department, University hospital of Nice, Cote d'Azur University, Nice, France
| | - Stephanie Baillif
- Ophthalmology department, University hospital of Nice, Cote d'Azur University, Nice, France
| | - Arnaud Martel
- Ophthalmology department, University hospital of Nice, Cote d'Azur University, Nice, France
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The Anatomy of the Frontal Process of the Maxilla in the Medial Wall of the Lacrimal Drainage System in East Asians. Ophthalmic Plast Reconstr Surg 2020; 37:439-443. [PMID: 33237673 DOI: 10.1097/iop.0000000000001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the anatomical structure characteristics of the frontal process of the maxilla in the medial wall of the lacrimal drainage system for endoscopic dacryocystorhinostomy based on the cone-beam computed tomography images. METHODS One hundred eight sides of orbits were retrospectively evaluated in this study. The angulation and thickness of the frontal process of the maxilla in the medial wall of the lacrimal drainage system were measured and compared at 2 different levels: lacrimal sac level and nasolacrimal duct level. The vertical height between the 2 measurement levels was also measured. Data were compared between males and females. RESULTS The average angulation and thickness of the frontal process of the maxilla were found significantly larger at the lacrimal sac level than at the nasolacrimal duct level (83.1 ± 11.3° vs. 61.7 ± 10.9° and 2.7 ± 0.9 mm vs. 1.1 ± 0.4 mm) (p < 0.001). The vertical height between the 2 levels was significantly higher in males than in females (8.6 ± 1.8 mm vs. 7.8 ± 1.7 mm) (p = 0.015). CONCLUSIONS We found the angulation and thickness of the frontal process of the maxilla in the medial wall of the lacrimal drainage system decreased from the upper to the lower level. Starting the osteotomy during endoscopic dacryocystorhinostomy might be easier and safer at the midpoint level of the maxillary line.
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Sun H, Ding JW, Li DM, Wang NL. Comparison of Hasner valvulotomy outcomes in pediatric and adult patients: does age matter? Chin Med J (Engl) 2020; 133:2422-2428. [PMID: 32960846 PMCID: PMC7575182 DOI: 10.1097/cm9.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hasner valve incision has been recently introduced as a new treatment for ophthalmic patients with epiphora symptoms. The aim of this study was to examine whether surgical outcomes of Hasner valve incision for inferior nasolacrimal duct obstruction were different between pediatric and adult patients. METHODS A total of 53 eyes of 52 patients who underwent Hasner valve incision in the Beijing Tongren Hospital from October 2016 to November 2019 were retrospectively observed. Patients were divided into two groups, including pediatric group (23 eyes of 22 patients, <18 years old) and adult group (30 eyes of 30 patients, ≥18 years old). Success rate of surgery was determined by both subjective measure (complete resolution of epiphora) and objective measure (lacrimal passage irrigation and tear meniscus height). Fisher exact test was conducted. RESULTS By conducting Fisher exact test and comparing complete resolution of epiphora (P = 0.627), lacrimal passage irrigation (P = 0.663), measurement of Tear Meniscus Height (P = 0.561), and appearance of complication (P = 0.339), there was no statistically significant difference of surgical outcomes between pediatric and adult patients (P > 0.05). CONCLUSION Hasner valve incision was effective for both adult and children with inferior nasolacrimal duct obstruction, with no difference in surgical outcomes between the two groups.
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Affiliation(s)
- Hua Sun
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Abstract
PURPOSE Aim of this work is to highlight the advantages of a new surgical technique performed over 15 patients affected dacryocystitis and treated by using a venous catheter.The arrangement of a 30 mm venous catheter used at the end of a dacryocystectomy (DCT) was performed in 15 patients with dacryocystitis. The venous catheter was removed at 30 days after the surgery.The use of the venous catheter allows washing the lacrimal drainage system, reducing the risk of postoperative infections and supports the recanalization of the lacrimal drainage system 30 days after surgery.The presented cases demonstrated how the technique is easy and it reduces the possibility of the post-operative infection. It could be performed under regional anesthesia. Furthermore, after the surgery the recanalization of the lacrimal drainage system with a significant reduction of the epiphora in 6 months after surgery has been observed.
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Pirola F, Spriano G, Malvezzi L. Preliminary experience with exoscope in lacrimal surgery. Eur Arch Otorhinolaryngol 2020; 278:285-288. [PMID: 32989494 DOI: 10.1007/s00405-020-06379-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endoscopic dacryocystorhinostomy (e-DCR) is the mainstay for lacrimal sac/duct conditions. The purpose is to investigate the role of the exoscope as assisting tool in e-DCR. METHODS Primary endpoint were symptoms resolution (epiphora/dacryocystitis) and time for surgery. Qualitative features of the exoscope were analyzed: a questionnaire administered to the surgical team allowed to evaluate the perceived quality of this technology. CONCLUSIONS The exoscope is a new tool that may support e-DCR. It has comparable results on symptoms outcomes and time for surgery than classic e-DCR. This new technology was accepted by all team members and showed great teaching potential.
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Affiliation(s)
- Francesca Pirola
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Giuseppe Spriano
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Luca Malvezzi
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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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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Indelicato P, Vinciguerra A, Giordano Resti A, Trimarchi M. A case of endonasal balloon-assisted dacryoplasty after failure of endonasal dacryocystorhinostomy. Clin Case Rep 2020; 8:1605-1609. [PMID: 32983459 PMCID: PMC7495747 DOI: 10.1002/ccr3.2956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Endonasal balloon-assisted dacryoplasty is a minimally invasive technique that uses a high-pressure balloon catheter introduced into the lacrimal pathway through the nasal fossa into the neorhinostomy to treat recurrent epiphora after primary dacryocystorhinostomy. This procedure can be considered to be a reliable technique in patients unfit for general anesthesia.
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Affiliation(s)
- Pietro Indelicato
- Division of Head and Neck DepartmentOtorhinolaryngology unitIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Alessandro Vinciguerra
- Division of Head and Neck DepartmentOtorhinolaryngology unitIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Antonio Giordano Resti
- Division of Head and Neck DepartmentOphthalmologic unitIRCCS San Raffaele Scientific InstituteMilanoItaly
| | - Matteo Trimarchi
- Division of Head and Neck DepartmentOtorhinolaryngology unitIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
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30
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Jang JK, Lew H. Tube Position and Culture in the Nasal Cavities of Patients Treated with Silicone Tube Intubation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.7.711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Indelicato P, Vinciguerra A, Giordano Resti A, Bussi M, Trimarchi M. Endoscopic endonasal balloon-dacryoplasty in failed dacryocystorhinostomy. Eur J Ophthalmol 2020; 31:2076-2081. [PMID: 32664743 DOI: 10.1177/1120672120942692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Endoscopic endonasal balloon-assisted dacryoplasty is a minimally-invasive surgical procedure that can be used in recurrent epiphora, a common pathology in both adulthood and childhood. STUDY DESIGN/SETTINGS We present a retrospective case series of eight patients who underwent trans-nasal balloon-assisted dacryoplasty after a failed external or endoscopic dacryocystorhinostomy, from March 2019 to January 2020, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. SUBJECTS AND METHODS All patients underwent routine preoperative work-up including fluorescein test (Jones test I-II), probing and irrigation of the lacrimal pathway and nasal endoscopy. Because of the recurrent nature of the pathology, pre-operatory computed tomography scan or dacryocystography was not performed. The surgical procedure was based on enlargement of the stenotic neorhinostomy created by primary dacryocystorhinostomy through the use of a high-pressure balloon catheter. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. RESULTS Anatomic and functional success was achieved in 100% of patients. Operative time ranged from 9 to 22 min (mean 16 min). No significant complications were reported. CONCLUSION Our results indicate that trans-nasal balloon-assisted dacryoplasty can be considered as a safe and reliable surgical approach after a failed primary dacryocystorhinostomy. The shorter surgical time and reduced post-operative complication rates are the main advantages of this procedure.
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Affiliation(s)
- Pietro Indelicato
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Vinciguerra
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department, Ophthalmologic unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Mario Bussi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Matteo Trimarchi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
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Allon R, Cohen O, Bavnik Y, Milstein A, Halperin D, Warman M. Long-term Outcomes for Revision Endoscopic Dacryocystorhinostomy-The Effect of the Primary Approach. Laryngoscope 2020; 131:E682-E688. [PMID: 32521057 DOI: 10.1002/lary.28795] [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: 04/08/2020] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Revision endoscopic dacryocystorhinostomy (END-DCR) is the preferred approach for failed primary surgeries, yet quality data on long-term outcomes are lacking. This study aimed to evaluate three aspects of revision END-DCR: 5-year success rates, patient satisfaction, and the primary surgical approach's possible impact on revision. METHODS This retrospective study included all revision END-DCRs conducted at Kaplan Medical Center between the years 2002 and 2015. For long-term follow-up analysis, two subgroups of first and second revision END-DCRs with a minimum of documented 5-year follow-up after surgery were defined. Data were analyzed according to the primary surgical approach. Surgical success was defined by either anatomical (observed patent lacrimal flow) or functional (symptoms cessation) success. Patient satisfaction was measured by a questionnaire. RESULTS After exclusions, a total of 45 eyes from 38 patients who underwent revision END-DCR surgeries were included in the study. The yearly success rates from immediate to 5 years following the first revision were 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9% for the entire cohort, respectively. Immediate and 5-year success rates following the second revision were 88.8% and 77.8%, respectively. Primary END-DCR showed favorable 5-year success rates and patient satisfaction over primary external dacryocystorhinostomy (EXT-DCR) in both first and second revisions, but this did not reach significance. CONCLUSIONS Revision END-DCR carries an excellent short-term success rate, which decreases mainly throughout the first 2 years following surgery. Postoperative follow-up should be maintained within this timeframe. Revision END-DCR following either primary endoscopic or EXT-DCR produces comparable surgical outcomes and patient-reported satisfaction. LEVEL OF EVIDENCE 3b Laryngoscope, 131:E682-E688, 2021.
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Affiliation(s)
- Raviv Allon
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Oded Cohen
- 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
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, 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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Vinciguerra A, Nonis A, Giordano Resti A, Bussi M, Trimarchi M. Best treatments available for distal acquired lacrimal obstruction: A systematic review and meta‐analysis. Clin Otolaryngol 2020; 45:545-557. [DOI: 10.1111/coa.13551] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Alessandro Nonis
- CUSSB University Centre for Statistics in the Biomedical Sciences San Raffaele Hospital Vita‐Salute University Milano Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department Ophthalmologic unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Mario Bussi
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Matteo Trimarchi
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
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Phelps PO, Abariga SA, Cowling BJ, Selva D, Marcet MM. Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Database Syst Rev 2020; 4:CD012309. [PMID: 32259290 PMCID: PMC7138426 DOI: 10.1002/14651858.cd012309.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nasolacrimal duct obstruction (NLDO) is a condition that results in the overflow of tears (epiphora) or infection of the nasolacrimal sac (dacryocystitis). The etiology of acquired NLDO is multifactorial and is not fully understood. Dacryocystorhinostomy (DCR) is the surgical correction of NLDO, which aims to establish a new drainage pathway between the lacrimal sac and the nose. The success of DCR is variable; the most common cause of failure is fibrosis and stenosis of the surgical ostium. Antimetabolites such as mitomycin-C (MMC) and 5-fluorouracil (5-FU) have been shown to be safe and effective in reducing fibrosis and improving clinical outcomes in other ophthalmic surgery settings (e.g. glaucoma and cornea surgery). Application of antimetabolites at the time of DCR has been studied, but the utility of these treatments remains uncertain. OBJECTIVES Primary objective: To determine if adjuvant treatment with antimetabolites improves functional success in the setting of DCR compared to DCR alone. Secondary objectives: To determine if anatomic success of DCR is increased with the use of antimetabolites, and if the surgical ostium is larger in participants treated with antimetabolites. SEARCH METHODS We searched the Cochrane Register for Controlled Trials (CENTRAL) (which contains the Cochrane Eye and Vision Trials Register) (2019, Issue 9), Ovid MEDLINE, Embase.com, PubMed, LILACS (Latin American and Caribbean Health Sciences Literature database), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic searches. We last searched the electronic databases on 6 September 2019. SELECTION CRITERIA We only included randomized controlled trials. Eligible studies were those that compared the administration of antimetabolites of any dose and concentration versus placebo or another active treatment in participants with NLDO undergoing primary DCR and reoperation. We only included studies that had enrolled adults 18 years or older. We also included studies that used silicone intubation as part of the DCR procedure. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened the search results, assessed risk of bias, and extracted data from the included studies using an electronic data collection form. MAIN RESULTS We included 31 studies in the review, of which 23 (1309 participants) provided data relating to our primary and secondary outcomes. Many of the 23 studies evaluated functional success, while others also assessed our secondary outcomes of anatomic success or ostium size, or both. Study characteristics Participant characteristics varied across studies, with the age of participants ranging from 30 to 70 years. Participants were predominantly women. These demographics correspond to those most frequently affected by nasolacrimal duct obstruction. Almost all of the studies utilized MMC as the antimetabolite, with only one using 5-FU. We assessed most trials as at unclear risk of bias for most domains. Conflicts of interest were not frequently reported, although the antimetabolites used are generic medications, and studies were not likely to be conducted for financial interest. Findings Twenty studies provided data on the primary outcome of functional success, of which 7 (356 participants) provided data at 6 months and 14 (909 participants) provided data beyond 6 months. At six months, the results showed no evidence of effect of antimetabolite on functional success (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.98 to 1.29; low-certainty evidence). Beyond six months, the results favored the antimetabolite group (RR 1.15, 95% CI 1.07 to 1.25; moderate-certainty evidence). Fourteen studies reported data on the secondary outcome of anatomic success, of which 4 (306 participants) reported data at 6 months and 12 (831 participants) provided data beyond 6 months. Results at six months showed no evidence of effect of antimetabolite on anatomic success (RR 1.02, 95% CI 0.95 to 1.11; low-certainty evidence). Beyond six months, participants in the antimetabolite group were more likely to achieve anatomic success than those receiving DCR alone (RR 1.09, 95% CI 1.04 to 1.15; moderate-certainty evidence). At six months and beyond six months follow-up, two studies reported mean change in ostium size. We did not conduct meta-analysis for the various follow-up periods due to clinical, methodological, and statistical heterogeneity. However, point estimates from these studies at six months consistently favored participants in the antimetabolite group (low-certainty evidence). Beyond six months, while point estimates from one study favored participants in the antimetabolite group, estimates from another study showed no evidence of a difference between the two groups. The certainty of evidence at both time points was low. Adverse events Adverse events were rare. One study reported that one participant in the MMC group experienced delayed wound healing. Other studies reported no significant adverse events related to the application of antimetabolites. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that application of antimetabolites at the time of DCR increases functional and anatomic success of DCR when patients are followed for more than six months after surgery, but no evidence of a difference at six months, low-certainty of evidence. There is low-certainty evidence that combining antimetabolite with DCR increases the size of the lacrimal ostium at six months. However, beyond six months, the evidence remain uncertain. Adverse effects of the application of antimetabolites were minimal.
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Affiliation(s)
- Paul O Phelps
- NorthShore University HealthSystemDepartment of Surgery2050 Pfingsten Rd.Suite 280GlenviewILUSA60026
- University of ChicagoDepartment of OphthalmologyChicagoIllinoisUSA60637
| | - Samuel A. Abariga
- Johns Hopkins Bloomberg School of Public HealthEpidemiology615 N. Wolfe StreetBaltimoreMarylandUSA
| | - Benjamin J Cowling
- University of Hong KongDivision of Epidemiology and Biostatistics, School of Public Health624‐627, 6/F, Core F, Cyberport 3, 100 Cyberport RoadCyperportHong Kong00000
| | - Dinesh Selva
- University of AdelaideSouth Australian Institute of OphthalmologyLevel 8, Health Sciences Building 16/910AdelaideAustralia5000
| | - Marcus M Marcet
- University of Hong KongDepartment of OphthalmologyRm 301, Blk B, Cyberport 4, 100 Cyberport RoadCyberportHong Kong00000
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Yartsev V, Gabashvili A, Atkova E, Melnikov P, Nesterova T. Study of Dosage-Dependent Effects of Cytostatic Drugs Using a Fibroblast Cell Culture of the Human Nasal Mucosa. Int Arch Otorhinolaryngol 2020; 24:e206-e210. [PMID: 32256842 PMCID: PMC6986950 DOI: 10.1055/s-0039-1697996] [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: 11/26/2018] [Accepted: 08/19/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction
Knowing a concentration at which cytostatic drugs are toxic for the nasal fibroblasts will enable the use cytostatic drugs in the clinical practice to prevent excessive cicatrization.
Objective
To determine the cytostatic concentrations of mitomycin С, doxorubicin, and 5-fluorouracil affecting nasal mucosa fibroblasts.
Methods
We obtained material during an endonasal dacryocystorhinostomy with the patient's informed consent. The cells were cultivated. Second- to fourth-passage cells were used in the experiments. The cells were stained for vimentin and cluster of differentiation 90 (CD90). An MTS test 3 (3-(4,5-dimethylthiazole-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium); cell viability test was performed.
Results
The cytostatic drugs have a toxic effect on cultivated fibroblasts of the nasal mucosa. This effect is dose-dependent. In terms of reducing the level of tissue fibrotisation in the nasal cavity, the most justified approach is to carry out an experimental study of the effect of mitomycin C, doxorubicin, and 5-fluorouracil at the concentrations of 0.25 mg/ml, 0.25 mg/ml, and 12.5 mg/ml respectively.
Conclusion
The authors argue that it is inappropriate to use these cytostatic drugs to conduct studies with the goal of analyzing their antifibrotic effect on the nasal mucosa at concentrations that are either lower or higher than the aforementioned ones.
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Affiliation(s)
- Vasily Yartsev
- Department of Lacrimal Pathology, Scientific Research Institute of Eye Diseases, Moscow, Russian Federation
| | - Anna Gabashvili
- Fundamental Laboratory, Scientific Research Institute of Eye Diseases, Moscow, Russian Federation.,Cell Laboratory, Naucno-issledovatel'skij Institut Biomedicinskoj Himii Imeni V N Orehovica, Moscow, Russian Federation
| | - Eugenia Atkova
- Department of Lacrimal Pathology, Scientific Research Institute of Eye Diseases, Moscow, Russian Federation
| | - Pavel Melnikov
- Cell Laboratory, Serbsky Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Tatiana Nesterova
- Cell Laboratory, Scientific Research Institute of Eye Diseases, Moscow, Russian Federation
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Cui YH, Zhang CY, Liu W, Wu Q, Yu G, Li L, Wei WB. Endoscopic dacryocystorhinostomy to treat congenital nasolacrimal canal dysplasia: a retrospective analysis in 40 children. BMC Ophthalmol 2019; 19:244. [PMID: 31796021 PMCID: PMC6889731 DOI: 10.1186/s12886-019-1256-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the therapeutic effectiveness and safety of endoscopic dacryocystorhinostomy (EN-DCR) to treat congenital nasolacrimal canal dysplasia (CNCD). METHODS Forty children (50 eyes) with congenital nasolacrimal duct obstruction (CNLDO) and lacrimal bony dysplasia, including 8 children with bony atresia (10 eyes) and 32 with bony stenosis (40 eyes), were recruited in this retrospective study. Standardized EN-DCR was performed in all cases. The postoperative observations included relief of symptoms, fluorescein dye disappearance test (FDDT), syringing of lacrimal passages and anastomotic patency under nasal endoscopy. Patients were followed up for 8-18 months. RESULTS Standardized EN-DCR surgery had a success (cure and improvement) rate of 100%, including a cure rate of 82% and an improvement rate of 18%. The cure rate among 40 cases of bony nasolacrimal duct stenosis was 82.5%, while that of 10 cases of bony nasolacrimal duct atresia was 80%. Statistical analysis showed that nether the receipt of other treatments before surgery nor the type of bony nasolacrimal duct dysplasia affected the cure rate. No significant complications were observed during postoperative follow-up except for four cases (4 eyes) that suffered middle turbinate and nasal mucosal adhesion and two cases with sinusitis. CONCLUSIONS CNCD is a type of CNLDO that does not respond to conservative and conventional treatment. EN-DCR represents a safe and effective treatment for children with CNCD. In addition, the combination of EN-DCR with lacrimal CT scanning provides advantages over traditional lacrimal surgery in that it has a high success rate with a low incidence of complications.
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Affiliation(s)
- Yan-Hui Cui
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, National Key Discipline of Pediatrics, Capital Medical University, Ministry of Education, Beijing, 100045, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, 1 Dong Jiao Min Xiang, Dong Cheng District, Beijing, 100730, China
| | - Cheng-Yue Zhang
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, National Key Discipline of Pediatrics, Capital Medical University, Ministry of Education, Beijing, 100045, China
| | - Wen Liu
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, National Key Discipline of Pediatrics, Capital Medical University, Ministry of Education, Beijing, 100045, China
| | - Qian Wu
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, National Key Discipline of Pediatrics, Capital Medical University, Ministry of Education, Beijing, 100045, China
| | - Gang Yu
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, National Key Discipline of Pediatrics, Capital Medical University, Ministry of Education, Beijing, 100045, China
| | - Li Li
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, National Key Discipline of Pediatrics, Capital Medical University, Ministry of Education, Beijing, 100045, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, 1 Dong Jiao Min Xiang, Dong Cheng District, Beijing, 100730, China.
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Kshirsagar RS, Vu PQ, Liang J. Endoscopic versus external dacryocystorhinostomy: temporal and regional trends in the United States Medicare population. Orbit 2019; 38:453-460. [PMID: 30712428 DOI: 10.1080/01676830.2019.1572767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
Purpose: Endoscopic surgeries, such as dacryocystorhinostomy (DCR), are increasingly performed for orbital and lacrimal conditions. This study describes and compares recent trends in endoscopic DCR with open, or external, DCR in the United States (US). Methods: Medicare-Part-B National Summary data files were analyzed from 2000 to 2015 for temporal and geographic trends in endoscopic and external DCR. Medicare Physician and Other Supplier public use files detailing provider information were collected and analyzed from 2012 to 2015. Results: Between 2000 and 2015, the number of external DCRs remained relatively unchanged (8008 to 7086, -0.7% average annual growth), while the number of endoscopic DCRs steadily increased (881 to 1674, 4.6% average annual growth). The greatest number of endoscopic DCRs were performed in the South Atlantic region, whereas the Mountain region had the greatest number per capita. From 2000 to 2015, the average payment per procedure for external DCR was $526.63, compared with $512.45 for endoscopic DCR. Of endoscopic DCRs performed from 2012 to 2015, 831 (79%) were performed by Ophthalmology, 184 (18%) were performed by Otolaryngology, and the remainder by other subspecialties. Conclusions: The number of endoscopic DCR surgeries increased over the last 15 years while the number of external DCR surgeries remained stable and continued to surpass endoscopic procedures. While ophthalmologists perform the overwhelming majority of endoscopic DCR, otolaryngologists are performing a growing number.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Oakland , Oakland , CA , USA
| | - Priscilla Q Vu
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine , Irvine , CA , USA
| | - Jonathan Liang
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Oakland , Oakland , CA , USA
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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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Trimarchi M, Giordano Resti A, Vinciguerra A, Danè G, Bussi M. Dacryocystorhinostomy: Evolution of endoscopic techniques after 498 cases. Eur J Ophthalmol 2019; 30:998-1003. [DOI: 10.1177/1120672119854582] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Endoscopic dacryocystorhinostomy is a well-known surgical practice used to treat nasolacrimal duct obstruction and widely considered as a valid alternative to external approaches. Purpose: We present a retrospective case series of 498 endoscopic dacryocystorhinostomies on 401 patients, from July 2004 to May 2018, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. Methods: Of the 498 procedures, 426 were unilateral and 72 were bilateral dacryocystorhinostomy. All patients underwent routine preoperative workup including fluorescein test (Jones test 1–2), probing and irrigation of the lacrimal way, nasal endoscopy, and maxilla-facial computed tomography scan. Surgical technique was based on nasal endoscopic dacryocystorhinostomy followed by positioning of a Catalano’s silicone stent, which was left in place for about 3 months. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. Results: Anatomic success was achieved in 91.54% cases in primary dacryocystorhinostomy and in 89.36% after revision, whereas functional success was obtained in 90.4% in primary and 85.1% in secondary dacryocystorhinostomies. After a second revision of endoscopic dacryocystorhinostomy, anatomical success was achieved in 90.1% and functional success in 88.7% of procedures. Conclusion: Our results confirm that endoscopic dacryocystorhinostomy can be considered as a valid surgical approach to primary nasolacrimal duct obstruction and revision cases. The key aspects in achieving functional and anatomical results are meticulous surgical procedure and precise follow-up.
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Affiliation(s)
- Matteo Trimarchi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Ophthalmology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Vinciguerra
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Giulia Danè
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Mario Bussi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
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Han PS, Kim Y, Herford AS, Inman JC. Complications and Treatment of Delayed or Inadequately Treated Nasoorbitoethmoid Fractures. Semin Plast Surg 2019; 33:138-142. [PMID: 31037052 DOI: 10.1055/s-0039-1685474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Delayed or improper repair of nasoorbitoethmoid (NOE) fractures can lead to debilitating outcomes including diplopia, epiphora, nasal obstruction, facial asymmetry, and poor cosmesis. As such, NOE fractures should be repaired promptly and properly to prevent these unwanted sequelae. Treating patients with delayed, untreated, or inadequately reduced NOE fractures is challenging due to scarring and contracture. Saddle nose deformity, telecanthus, enophthalmos, nasolacrimal duct obstruction, and soft-tissue scarring are often encountered in the secondary management of NOE fractures and should be addressed in the overall context of reestablishing facial symmetry and function.
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Affiliation(s)
- Peter S Han
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Yohanan Kim
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Alan S Herford
- Department of Oral and Maxillofacial Surgery, Loma Linda University, Loma Linda, California
| | - Jared C Inman
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
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Cavada MN, Grayson JW, Sacks R. Endoscopic Dacryocystorhinostomy. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00236-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tang C, Rickert S, Mor N, Blitzer A, Leib M. Dacryocystorhinostomy with a thulium:YAG laser-a case series. EAR, NOSE & THROAT JOURNAL 2018; 97:E39-E42. [PMID: 30138525 DOI: 10.1177/014556131809700808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We conducted a retrospective chart review of 27 patients-7 men and 20 women, aged 47 to 94 years (mean: 71.3)-with symptomatic epiphora secondary to dacryostenosis who had undergone thulium: YAG (Tm:YAG) laser dacryocystorhinostomy (DCR). Among them, dacryostenosis had been documented in 35 eyes by dacryocystography. The Tm:YAG procedure involved the administration of local anesthesia, after which a 600-μm laser fiber was inserted into the lacrimal canaliculi and then into the nasolacrimal duct. Under endoscopic visualization, the DCR was performed anterior and inferior to the middle turbinate, which created an opening. Silicone stents were then inserted and tied intranasally. In the immediate postoperative period, all 27 patients noted initial improvement. During a follow-up of 22 days to 25 months (mean: 11.3 mo), 24 of the 27 patients (89%) remained symptom-free, while the remaining 3 patients (11%) experienced a treatment failure and required revision surgery. To the best of our knowledge, only two articles on thulium laser therapy for DCR have been previously published, both approximately 25 years ago; both involved the use of a thulium along with holmium and chromium in cadavers. As far as we know, our case series is the largest in the English-language literature that has documented the use of the thulium in laser therapy for DCR, and it is the only in vivo study. We found that DCR with the Tm:YAG laser was an effective and affordable option for patients with symptomatic epiphora secondary to lacrimal obstruction.
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Affiliation(s)
- Christopher Tang
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center, 450 6th Ave., 2nd Floor, San Francisco, CA 94118, USA.
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Polysaccharide-based superhydrophilic coatings with antibacterial and anti-inflammatory agent-delivering capabilities for ophthalmic applications. J IND ENG CHEM 2018. [DOI: 10.1016/j.jiec.2018.07.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Herzallah IR, Marglani OA, Muathen SH, Obaid AA. Endoscopic and Radiologic Findings in Failed Dacryocystorhinostomy: Teaching Pearls for Success. Am J Rhinol Allergy 2018; 33:247-255. [DOI: 10.1177/1945892418815044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Although several studies have commented on causes of dacryocystorhinostomy (DCR) failure, detailed description of anatomical findings in such cases remains insufficient. Objective Our objective was primarily to analyze radiologic, endoscopic, and intraoperative findings in patients presenting with failed DCR and secondarily to assess the outcome of revision endoscopic DCR (endo-DCR) carried out at our institution. Methods Twenty-four failed DCRs presenting to our tertiary care center were retrospectively analyzed. Data collection included patients’ history, diagnostic, and management data, as well as thorough analysis of sinonasal CT scans, along with endoscopic and intraoperative findings. Outcome was also assessed in 21 cases with revision endo-DCR performed. Results The anterior part of uncinate process was not previously removed in 15 sides (62.5%), with unopened agger nasi in 13 sides (54.2%). The lacrimal bone was detected covering the posterior sac despite removal of the anterior ascending process of maxilla in 9 sides (37.5%). Rhinostoma was anterior to lacrimal sac in 2 sides (8.3%) and was below the sac in 7 sides (29.2%). Fibrous membrane covered the rhinostoma despite removal of all sac-overlying bones in 6 sides (25%). Other findings included intranasal adhesions, septal deviation, lateralized middle turbinate, granulation tissue, foreign body reaction, and chronic sinusitis. Nineteen of the 21 revision endo-DCRs were successful (90.5%). Conclusion This study provides a precise anatomical description of findings in cases of failed DCR. Such information is paramount in helping surgeons enhance their learning curve, refine the surgical technique, and improve patients’ outcome.
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Affiliation(s)
- Islam R. Herzallah
- Department of Otorhinolaryngology – Head & Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- ENT, Head and Neck and Skull Base Center, King Abdullah Medical City (KAMC-HC), Makkah, Saudi Arabia
| | - Osama A. Marglani
- ENT, Head and Neck and Skull Base Center, King Abdullah Medical City (KAMC-HC), Makkah, Saudi Arabia
- Department of Ophthalmology & Otolaryngology, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Sumaiya H. Muathen
- ENT, Head and Neck and Skull Base Center, King Abdullah Medical City (KAMC-HC), Makkah, Saudi Arabia
| | - Arwa A. Obaid
- Department of Otolaryngology-Head & Neck Surgery, Albaha University, Al Bahah, Saudi Arabia
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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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Ing EB, Bedi H, Hussain A, Zakrewski H, Ing R, Nijhawan N, Al-Sayyed A, Winn BJ. Meta-analysis of randomized controlled trials in dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol 2018; 53:466-470. [DOI: 10.1016/j.jcjo.2017.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 11/06/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
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Affiliation(s)
- Akshay Gopinathan Nair
- Advanced Eye Hospital & Institute, Ophthalmic Plastic Surgery & Ocular Oncology Services, Navi Mumbai, India
- Ophthalmic Plastic Surgery & Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, India
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | | | | | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, India
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Bothra N, Naik MN, Ali MJ. Outcomes in pediatric powered endoscopic dacryocystorhinostomy: a single-center experience. Orbit 2018; 38:107-111. [PMID: 29787339 DOI: 10.1080/01676830.2018.1477808] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE The purpose of the article is to report the outcomes of powered endoscopic dacryocystorhinostomy (PEnDCR) in pediatric patients. METHODS A single-center, single surgeon, retrospective, interventional, non-comparative case series was performed on all pediatric patients who underwent PEnDCR between July 2014 and July 2017. Patients with associated congenital anomalies like single punctum agenesis or lacrimal fistula were excluded. Surgery was performed as per standard protocols published earlier. Data collected include demographics, clinical presentations, past interventions, indications for the surgery, intraoperative and postoperative complications, postoperative ostium characteristics, and anatomical and functional success. RESULTS Ninety-one eyes of 83 children underwent PEnDCR during the study period. Mean age was 8.32 years and epiphora was the most common presentation (81%, 74/91). The most common indication for PEnDCR was persistent congenital nasolacrimal duct obstruction refractory to earlier interventions of probing or intubation. Postoperative ostium assessment at 4 weeks showed a well-healed ostium with a dynamic internal common opening in 86.8% of the eyes. Edge granulomas of the ostium were the most common abnormal finding in the postoperative period (9.8%, 9/91) and all except one could be managed conservatively. At 6 months follow-up, five eyes showed anatomical failure and additional two eyes showeXd functional failure. Two of anatomical failure group and one of functional failure underwent a second intervention. The final anatomical and functional success were noted in 96.7% (88/91) and 95.6% (87/91), respectively. CONCLUSIONS This study shows that PEnDCR is a safe surgery for pediatric populations with a high success rate of beyond 95%.
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Affiliation(s)
- Nandini Bothra
- a Govindram Seksaria Institute of Dacryology , L.V. Prasad Eye Institute , Hyderabad , India
| | - Milind N Naik
- a Govindram Seksaria Institute of Dacryology , L.V. Prasad Eye Institute , Hyderabad , India
| | - Mohammad Javed Ali
- a Govindram Seksaria Institute of Dacryology , L.V. Prasad Eye Institute , Hyderabad , India
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Avoiding dacryocystorhinostomy in cases of epiphora caused by inferior meatus obstruction. Eye (Lond) 2018; 32:1406-1410. [PMID: 29773879 DOI: 10.1038/s41433-018-0103-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 11/08/2022] Open
Abstract
AIMS To determine the role of inferior meatus pathologies as an underdiagnosed cause of epiphora. METHODS This study was conducted in the oculoplastic institution of Tel Aviv medical center-a regional referral center. A retrospective review of files of patients presenting to the lacrimal clinic with nasolacrimal duct obstruction between October 2010 and September 2016. Cases in which a pathology of the inferior meatus was identified and treated are presented in this article. RESULTS During this time frame, we preformed 186 endoscopic dacryocystorhinostomy surgeries. Out of those, eight patients (4.3%) were diagnosed and treated for pathology causing an obstruction of the inferior meatus. Seven of our patients were females; the mean age was 24 years. A wide range of pathologies were found: cysts, dacryoliths, membranes obstructing the inferior meatus, and concheal obstruction. All patients went through endoscopic treatment targeted at the cause of obstruction. During follow-up (average 35 months) only two patients remained symptomatic and were referred for an endonasal endoscopic dacryocystorhinostomy. CONCLUSIONS Inferior meatus obstruction is an underdiagnosed cause of epiphora. Multiple pathologies may co-exist in the same patient. In select cases of NLDO, diagnosis and treatment can be done endoscopically, avoiding the need for dacryocystorhinostomy.
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Ciğer E, Balci MK, Arslanoğlu S, Eren E. Endoscopic-Powered Dacryocystorhinostomy Without Stenting: Long-term Outcomes of 120 Procedures. Am J Rhinol Allergy 2018; 32:303-309. [PMID: 29745245 DOI: 10.1177/1945892418773638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The necessity of silicone stenting in endoscopic dacryocystorhinostomy (DCR) procedures is a controversial subject in the literature. Objective The purpose of the present study is to assess the long-term anatomical and functional outcomes of endoscopic-powered DCR (EP-DCR) without stenting or mucosal flaps. Methods One hundred twenty EP-DCR procedures were performed in 107 patients. Anatomical success was defined as a patent ostium on irrigation and functional success as free flow of dye from the ostium and resolution of epiphora. Results The mean follow-up was 46.5 months (range: 24-87). Of the 120 procedures, 13 were bilateral and 94 were unilateral. Anatomical and functional success rates of 92.5% were obtained. Conclusion EP-DCR without stenting is a safe and economic technique that provides satisfactory long-term results and could be considered as the treatment of choice for patients with postsaccal nasolacrimal duct obstruction.
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Affiliation(s)
- Ejder Ciğer
- 1 Department of Otorhinolaryngology, Ataturk Training and Research Hospital, Katip Celebi University, İzmir, Turkey
| | - Mustafa K Balci
- 1 Department of Otorhinolaryngology, Ataturk Training and Research Hospital, Katip Celebi University, İzmir, Turkey
| | - Seçil Arslanoğlu
- 1 Department of Otorhinolaryngology, Ataturk Training and Research Hospital, Katip Celebi University, İzmir, Turkey
| | - Erdem Eren
- 1 Department of Otorhinolaryngology, Ataturk Training and Research Hospital, Katip Celebi University, İzmir, Turkey
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