External dacryocystorhinostomy outcomes in patients with a history of dacryocystitis

Transcutaneous (External) Dacryocystorhinostomy with Reconstruction of the Ductus nasolacrimalis

BACKGROUND

Dacryocystorhinostomy (DCR) is regarded as the gold standard for the treatment of chronic dacryocystitis (CDC). Different modifications of the surgical procedure have been developed over the years.

METHODS

Patients with CDC due to postsaccal lacrimal stenosis and under treatment with DCR have been included in this retrospective study. Two groups of different surgical procedures were analysed: firstly DCR without reconstruction of the ductus nasolacrimalis (DNL, group 1) and secondly patients with reopening the DNL (group 2). Criteria for success were absence of permanent epiphora, absence of inflammation of the lacrimal sac (functional success), and no recurrent surgery with free patency of the lacrimal duct (anatomical success). This was obtained by questionnaire after a follow-up of at least 12 months. The impact of gender, ectasia of the lacrimal sac, dacryoliths, and prior lacrimal surgeries was analysed.

RESULTS

Overall, 248 surgeries were enrolled in this trial. Mean age in group 1 was 68 years (range: 22 to 92 years) and gender ratio was 3.2 to 1 (female : male). In that group, 68 operations could be followed up. In group 2, 62 operations on patients of a mean age of 63 years (range: 24 to 89 years) and a gender ratio of 2.9 to 1 (female : male) were observed. Complete success occurred in 75.0% in group 1 and 75.8% in group 2. Recurrent operations were necessary in one case of group 2 (1.6%) and 4 cases of group 1 (5.9%). Gender (group 1 p = 1; group 2 p = 0.115; between groups p = 0.511), ectasia of the lacrimal sac (group 1 p = 0.877; group 2 p = 0.674; between groups p = 0.878), dacryolith (group 1 p = 1; group 2 p = 0.465; between groups p = 1), and prior lacrimal surgery (group 1 p = 0.092; group 2 p = 0.051; between groups p = 0.520) did not influence the success rates in each group or between groups. Significantly more dacryoliths were found during operations of group 2 (p = 0.010).

CONCLUSION

Reconstruction of the DNL during DCR is a possible and easy modification, with a slightly better success rate in curing CDC. Intraoperatively, dacryoliths might not be apparent remain in the deeper parts of the lacrimal ducts. Therefore, these segments should be inspected during surgery.

A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options

Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral drooping of the upper eyelid that characterises ptosis can affect appearance and impair visual function, both of which can negatively impact quality of life. While there are several known forms of congenital ptosis, acquired ptosis (appearing later in life, due to a variety of causes) is the predominant form of the condition. This review summarises the prevalence, causes, identification, differential diagnosis, and treatment of acquired ptosis. Particular attention is paid to the differential diagnosis of acquired ptosis and emerging treatment options, including surgical and pharmacologic approaches.

Dacryocystitis Caused by Lymphoproliferative Infiltration in the Course of Lymphocytic Lymphoma: Case Report

Background: Lacrimal drainage system lymphomas are rare, accounting for less than 10% of lacrimal sac tumors. They often appear as a secondary involvement within the confines of systemic lymphoproliferative disorders, therefore detailed ophthalmological examination and auxiliary testing is necessary to have an accurate diagnosis.

Case report: We present the case of a 72-year-old woman with a medical history of chronic lymphocytic leukemia and small lymphocytic lymphoma. She presented to the ophthalmology clinic with a painful, discharging swelling in the right lacrimal sac area. Magnetic resonance imaging revealed a mass in the right nasolacrimal duct. A right external dacryocystorhinostomy was performed. The histological findings led to a diagnosis of small lymphocytic lymphoma.

Conclusions: Special attention is required in cases of known systemic hematological disorders that associate with nasolacrimal duct obstruction or epiphora. Quick recognition and a full history with multidisciplinary clinical and diagnostic workup are fundamental to plan the treatment.

Favorable Postoperative Evolution after Late Surgical Repair of Truncus Arteriosus Type 1: A Case Report

Truncus arteriosus communis (TA) is a rare cyanotic congenital heart defect, in which the aorta and the pulmonary artery have not been separated during the normal development of the fetal heart, so a single truncal artery is arising from the base of the heart. Most patients with TA present within the first weeks of life with heart failure. This anomaly is an important cause of pulmonary arterial hypertension. Corrective surgery is indicated in the first 3 months of life, to avoid the development of severe pulmonary arterial hypertension. We report the case of a 12-month-old male infant diagnosed by echocardiography with truncus arteriosus type 1 in whom, based on hemodynamic data, surgical treatment could be performed at the age of 1 year.