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Agarwal A, Naik M, Ali MJ, Bothra N. The role of CT-DCG in hardware - associated secondary acquired lacrimal duct obstruction: SALDO update study - (SUP) - Paper III. Am J Ophthalmol Case Rep 2024; 34:102026. [PMID: 38559363 PMCID: PMC10979134 DOI: 10.1016/j.ajoc.2024.102026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/12/2023] [Accepted: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To study cases of hardware-associated secondary acquired lacrimal duct obstructions (SALDO) and the role of computed tomography dacryocystography (CT-DCG) scans in its diagnosis and management. Observations Retrospective, interventional case review of four patients diagnosed as Hardware-associated SALDO, with primary maxillofacial repair performed elsewhere, were analyzed. The mean age was 36.5 years (range: 22-74 years), three of them being males. Left and right lacrimal systems were equally involved. Epiphora, swelling and discharge were the main presenting features. Three lacrimal sacs and nasolacrimal ducts on CT-DCG showed the screws of the orbital fracture plate directly piercing their walls, whereas a single case showed the sac displaced and pierced by the medial side of the orbital floor implant. Two cases underwent dacryocystorhinostomy with intubation, and the remaining two had to undergo dacryocystectomy due to extensive damage. Post-operatively all four cases were doing well at a mean follow-up of 2 months. Conclusions The present series highlights the role of CT-DCG in delineating spatial relationship of lacrimal drainage system with the surrounding structures, facilitating planning as well as choice of surgery, and anticipating the intraoperative challenges. It also signifies importance of interdisciplinary coordination between oculoplastic and maxillofacial surgeons to avoid iatrogenic trauma to the lacrimal drainage system.
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Affiliation(s)
- Ayushi Agarwal
- Govindram Seksaria Institute of Dacryology, L.V.Prasad Eye Institute, Hyderabad, 34, India
| | - Milind Naik
- Ophthalmic Plastic Surgery Services, L.V.Prasad Eye Institute, Hyderabad, 34, India
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V.Prasad Eye Institute, Hyderabad, 34, India
| | - Nandini Bothra
- Govindram Seksaria Institute of Dacryology, L.V.Prasad Eye Institute, Hyderabad, 34, India
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Kim Y, Lew H. Dacryoendoscopic Findings of Patients with Lacrimal Drainage Obstruction Associated with Cancer Treatment. Korean J Ophthalmol 2022; 36:509-517. [PMID: 36220641 DOI: 10.3341/kjo.2022.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To compare the diagnosis and treatment outcome of lacrimal drainage obstruction of patients who underwent systemic chemotherapy (CTx) or radioactive iodine treatment (RAI) by using dacryoendoscopy and at the same time performing dacryoendoscopy-guided silicone tube insertion (STI) to treat epiphora. METHODS From July 2017 to December 2020, the medical records of 11 patients (16 eyes) were diagnosed with lacrimal drainage obstruction after CTx or RAI and underwent dacryoendoscopy-guided STI were reviewed retrospectively. We tried to count the number of obstructive sites in total patients using slit-lamp examination and dacryoendoscopic findings. RESULTS A total of 11 patients, 16 eyes, were enrolled in this study. The onset of epiphora in the CTx group (3.0 ± 4.0 months) was significantly shorter than that in the RAI group (52.6 ± 36.5 months, p = 0.001). There were total 32 obstructive sites including 28 obstructive sites of dacryoendoscopic findings and four sites of punctual stenosis in total 16 cases. Using dacryoendoscopy, granulation findings was dominant in RAI patients (p = 0.038) and mucus finding was frequent mostly in lacrimal sac and canaliculus. In the CTx group, mucosal edema finding was dominant (p = 0.038) and fibrotic membrane finding was frequent in all levels of lacrimal drainage system. Regarding the obstructive location, lacrimal sac was the most frequently obstructed site in the two groups (p = 0.038). CONCLUSIONS The onset of epiphora in the CTx group was significantly earlier than in the RAI group. In the CTx group, mucosal edema finding was frequent in all levels of lacrimal drainage system. In the RAI group, granulation finding was frequent mostly in lacrimal sac and canaliculus. Since the clinical outcome was satisfactory, intervention with dacryoendoscopy-guided STI could be a treatment of choice in patients with epiphora after CTx or RAI.
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Affiliation(s)
- Yuri Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Abstract
AIMS To investigate the prevalence of subclinical anatomical and functional abnormalities of lacrimal drainage in fellow asymptomatic eyes of unilateral epiphora using dacryocystography and dacryoscintigraphy. METHODS Retrospective case note review of lacrimal imaging of adult patients presenting to a hospital Oculoplastic clinic with unilateral epiphora over 10 years. RESULTS A total of 172 patients with unilateral epiphora were included. The median age was 67 (range 18-96 years). A dacryoscintigraphy (DSG) abnormality was present in 54 (42%) asymptomatic eyes, and dacryocystography (DCG) abnormality in 10 (10%). The most common finding on DSG was no delay in 76 eyes (58%), and most common DSG abnormality was post sac delay in 51 (39%) eyes. The most common finding on DCG was no obstruction in 88 (90%) eyes, and the most common DCG abnormality was post sac stenosis (7.1%). Of the 92 asymptomatic eyes with both DCG and DSG, 53 (57%) showed neither an obstruction on DCG or delay on DSG, and 28 (30%) showed a post sac delay on DSG and no abnormality on DCG. CONCLUSION Greater than a third of asymptomatic eyes displayed post sac delay on DSG, frequently without accompanying anatomical obstruction on DCG. Subclinical DSG delay in asymptomatic eyes may represent physiological variation in tear transit time, subclinical lacrimal drainage dysfunction or anatomical stenosis undetected by DCG. Furthermore, the DSG results of fellow asymptomatic eyes in unilateral epiphora may not represent a normal standard that can be utilised for comparison. Further investigation with dacroyendoscopy, the use of control eyes, and long term follow up is required.
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Affiliation(s)
- Carmelo Macri
- Discipline of Ophthalmology and Visual Sciences, 1066The University of Adelaide, Adelaide, South Australia, Australia
- 1062The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Yinon Shapira
- 1062The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, 1066The University of Adelaide, Adelaide, South Australia, Australia
- 1062The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Jamshidian-Tehrani M, Kashkouli MB, Ghahvehchian H, Amini M. Lacrimal Canalicular Bypass Surgery with Autologous Superficial Temporal Artery Graft. J Curr Ophthalmol 2022; 34:486-488. [PMID: 37180525 PMCID: PMC10170988 DOI: 10.4103/joco.joco_98_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 05/16/2023] Open
Abstract
Purpose To describe superficial temporal artery graft as a new autologous tissue to reconstruct the upper lacrimal drainage system. Methods We explain the history of a 30-year-old female with upper lacrimal drainage system obstruction, in whom conjunctivodacryocystorhinostomy (CDCR) failed to resolve epiphora. A superficial temporal artery graft was harvested, intubated with Masterka tube, and implanted between the conjunctiva and nasal cavity. Masterka was replaced with a thicker dummy tube 12 weeks postoperatively. The adequacy of the graft was checked with irrigation tests in follow-up visits from 1 to 26 months after the procedure. Results Superficial temporal artery autograft successfully eliminated epiphora of the patient in whom (CDCR) with Jones tube failed to make her symptom free. Conclusion Superficial temporal artery autograft as an autogenous tissue with adequate characteristics can be considered in selective patients of upper lacrimal obstruction to reconstruct the lacrimal drainage system.
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Affiliation(s)
| | - Mohsen Bahmani Kashkouli
- Skull Base Research Center, Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghahvehchian
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Address for correspondence: Hossein Ghahvehchian, Rassoul Akram Hospital, Sattarkhan Niayesh St., Tehran 1455364, Iran. E-mail:
| | - Mohammad Amini
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Elahi E, Afshin EE, Paine KM, Friedman AH, Taub PJ. Congenital tooth-bearing tumor of the eyelid leading to lacrimal system obstruction. Am J Ophthalmol Case Rep 2021; 23:101157. [PMID: 34286161 PMCID: PMC8274294 DOI: 10.1016/j.ajoc.2021.101157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/19/2021] [Accepted: 06/28/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE We present an unusual case of a congenital lesion presenting with concomitant chronic dacryocystitis. The clinical presentation, examination, management, and histopathology are reviewed. OBSERVATIONS A healthy male infant born at 37 weeks gestation presented with an isolated painless 5mm congenital mass of the left medial lower eyelid. Parents also reported episodic epiphora and discharge from the left eye. A surgical excision of the mass revealed an underlying dacryocystitis and the presence of a formed tooth. A dacryocystorhinostomy was performed together with a repair of the soft tissue defect. Histopathology revealed components of disorganized epithelial and mesenchymal tissues including a tooth, skeletal muscle, fat, fibrous tissue, nonkeratinized epithelium, and myelinated nerves. A diagnosis of an odontogenic choristoma of the eyelid was made. Furthermore, a lacrimal sac culture was positive for oxacillin-susceptible Staphylococcus aureus with pathological evidence of chronic dacryocystitis. CONCLUSIONS AND IMPORTANCE Odontogenic choristoma is a very rare finding in the periocular region with only a few cases reported in the literature. Awareness of clinical findings from this case may allow for a more accurate clinical diagnosis and understanding of the embryologic mechanisms underpinning eyelid and nasolacrimal development. Timely management of this condition is critical to ensure normal oculofacial development and prevent future complications.
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Affiliation(s)
- Ebby Elahi
- Departments of Ophthalmology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA
| | - Evan E. Afshin
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, 1305 York Ave, New York, NY, USA
| | - Kaitlyn M. Paine
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA
| | - Alan H. Friedman
- Departments of Ophthalmology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA
| | - Peter J. Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA
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Imamura H, Tabuchi H, Nagasato D, Masumoto H, Baba H, Furukawa H, Maruoka S. Automatic screening of tear meniscus from lacrimal duct obstructions using anterior segment optical coherence tomography images by deep learning. Graefes Arch Clin Exp Ophthalmol 2021; 259:1569-1577. [PMID: 33576859 DOI: 10.1007/s00417-021-05078-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/23/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE We assessed the ability of deep learning (DL) models to distinguish between tear meniscus of lacrimal duct obstruction (LDO) patients and normal subjects using anterior segment optical coherence tomography (ASOCT) images. METHODS The study included 117 ASOCT images (19 men and 98 women; mean age, 66.6 ± 13.6 years) from 101 LDO patients and 113 ASOCT images (29 men and 84 women; mean age, 38.3 ± 19.9 years) from 71 normal subjects. We trained to construct 9 single and 502 ensemble DL models with 9 different network structures, and calculated the area under the curve (AUC), sensitivity, and specificity to compare the distinguishing abilities of these single and ensemble DL models. RESULTS For the highest single DL model (DenseNet169), the AUC, sensitivity, and specificity for distinguishing LDO were 0.778, 64.6%, and 72.1%, respectively. For the highest ensemble DL model (VGG16, ResNet50, DenseNet121, DenseNet169, InceptionResNetV2, InceptionV3, and Xception), the AUC, sensitivity, and specificity for distinguishing LDO were 0.824, 84.8%, and 58.8%, respectively. The heat maps indicated that these DL models placed their focus on the tear meniscus region of the ASOCT images. CONCLUSION The combination of DL and ASOCT images could distinguish between tear meniscus of LDO patients and normal subjects with a high level of accuracy. These results suggest that DL might be useful for automatic screening of patients for LDO.
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Affiliation(s)
- Hitoshi Imamura
- Department of Ophthalmology, Tsukazaki Hospital, 68-1 Waku, Aboshi-ku, Himeji City, Hyogo, 671-1227, Japan
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Tsukazaki Hospital, 68-1 Waku, Aboshi-ku, Himeji City, Hyogo, 671-1227, Japan.,Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School, Hiroshima, Japan
| | - Daisuke Nagasato
- Department of Ophthalmology, Tsukazaki Hospital, 68-1 Waku, Aboshi-ku, Himeji City, Hyogo, 671-1227, Japan. .,Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School, Hiroshima, Japan.
| | - Hiroki Masumoto
- Department of Ophthalmology, Tsukazaki Hospital, 68-1 Waku, Aboshi-ku, Himeji City, Hyogo, 671-1227, Japan.,Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School, Hiroshima, Japan
| | - Hiroaki Baba
- Department of Ophthalmology, Tsukazaki Hospital, 68-1 Waku, Aboshi-ku, Himeji City, Hyogo, 671-1227, Japan
| | - Hiroki Furukawa
- Department of Ophthalmology, Tsukazaki Hospital, 68-1 Waku, Aboshi-ku, Himeji City, Hyogo, 671-1227, Japan
| | - Sachiko Maruoka
- Department of Ophthalmology, Tsukazaki Hospital, 68-1 Waku, Aboshi-ku, Himeji City, Hyogo, 671-1227, Japan
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Abstract
BACKGROUND In addition to basic ophthalmologic diagnostic workup, different radiologic procedures can be performed for assessment of nasolacrimal duct obstruction. However, no gold standard imaging technique has yet been established. Using the results of the present study, the advantages of helical CT-dacryocystography (CT-DCG) are demonstrated, particularly when performed before endonasal endoscopic dacryocystorhinostomy. MATERIALS AND METHODS In 21 patients with uni- or bilateral epiphora, 24 low-dose helical CT-DCGs were performed with non-ionic iodine-containing contrast medium and including three-dimensional reconstruction. For 8 patients, digital subtraction angiography (DSA)-DCG results were available for comparison with CT-DCG. RESULTS Using low-dose helical CT-DCG, either the location of nasolacrimal duct pathology could be exactly identified (n = 19; stenosis presaccal n = 3, intrasaccal n = 11, postsaccal n = 5) or nasolacrimal system block could be definitively excluded as the cause of epiphora (n = 5). For imaging of the perilacrimal and periorbital bony structures, CT-DCG is significantly better than DSA-DCG. CONCLUSION Low-dose helical CT-DCG with reconstruction of the coronal and sagittal planes represents an ideal imaging technique with low exposure for detection of nasolacrimal duct obstruction. By demonstrating all relevant anatomic landmarks for endoscopic dacryocystorhinostomy, helical CT-DCG enables head and neck surgeons to plan surgery optimally.
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8
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Buttanri IB, Buttanri B, Serin D. Outcome of External Dacryocystorhinostomy and Monocanalicular Intubation in Patients with Total Obstruction of One Canalicus. Korean J Ophthalmol 2019; 33:138-141. [PMID: 30977323 PMCID: PMC6462472 DOI: 10.3341/kjo.2018.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/24/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose We sought to evaluate the outcomes of external dacryocystorhinostomy (DCR) and mono-canalicular intubation in patients with total obstruction of one canalicus. Methods Sixteen eyes of 16 patients with nasolacrimal duct obstruction and a single canaliculus obstruction who had undergone external DCR and monocanalicular intubation of the intact canaliculus were retrospectively included in the present study. The monocanalicular tube (Mini Monoka) was left in place for at least two months. Munk epiphora grading for the evaluation of epiphora and irrigation was performed both preoperatively and at 6 months postoperatively. Results Mean patient age was 46 ± 14.2 (range, 18 to 76) years. The inferior canaliculus was obstructed in nine eyes (group A) and the superior canaliculus was obstructed in seven eyes (group B), respectively. Eight eyes had chronic dacryocystitis and two of these eyes also had a history of acute dacryocystitis attack. Mean preoperative Munk scores were 3.89 in group A and 4.0 in group B. Ocular surface irritation occurred in one eye in group A. Artificial eye drops were prescribed and early tube removal was not performed. Spontaneous tube dislocation was recorded in one eye in group B. No other corneal, punctal, or canalicular complications were found. At six months, irrigation of intact canaliculus was patent in all eyes. Mucoid discharge, conjunctival hyperemia, and chronic conjunctivitis were also resolved. Postoperative Munk scores were 1.11 ± 0.9 in group A and 0.86 ± 0.9 in group B. Of note, preoperative and postoperative Munk scores were significantly different in both groups (group A, p = 0.006; group B, p = 0.017). The postoperative Munk scores were not statistically different between the two groups (p = 0.606). Conclusions In patients with nasolacrimal duct obstruction and a total of one canaliculus obstruction, external DCR and monocanalicular intubation of the intact canaliculus is an effective surgical option.
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Affiliation(s)
| | | | - Didem Serin
- Department of Ophthalmology, Medipol University Medical Faculty, Istanbul, Turkey
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Nguyen DT, Fayet B, Racy E, Sustronck P, Bremond Gignac D. Pediatric endonasal dacryocystorhinostomy and operative standardization. J Fr Ophtalmol 2019; 42:354-360. [PMID: 30905440 DOI: 10.1016/j.jfo.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/22/2018] [Accepted: 11/09/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to confirm that the standardized endonasal dacryocystorhinostomy (DCR) technique routinely performed in adults can be used in children. MATERIALS AND METHODS A consecutive series of children undergoing endonasal DCR between 2003 and 2017 was analysed. The surgical procedure consisted of: preoperative CT scan, anatomical localization of the ideal surgical zone, access to the nasal cavity via an optional planned enlargement, creation of a mucoperiosteal flap, osteotomy with rongeurs and equatorial resection of the medial wall of the lacrimal sac. This pediatric series was compared to a series of adult patients operated according to the same standardized technique. RESULTS A total of 20 DCRs (17 patients, with a mean age of 8 years (range: 4-16)) were included. Anatomical localization was effective in 100% of cases without the need for transillumination. With a mean follow-up of 4 years, the success rate was 95%, and no major complications were observed. Comparison with the same surgical technique in adults revealed similar results. DISCUSSION Our experience suggests that standardized endonasal DCR can be adapted to the nasal cavities of children. Anatomical localization is effective. The physiologically narrow nasal cavity does not constitute a major obstacle with the use of slightly smaller instruments. The results and complications are similar to those observed in adults. CONCLUSION The same standardized endoscopic endonasal DCR surgical technique can be used in adults and children with a similar good success rate.
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Affiliation(s)
- D-T Nguyen
- Service d'ophtalmologie, hôpital universitaire, Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université Paris V René Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - B Fayet
- Service d'ophtalmologie, hôpital universitaire, Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université Paris V René Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - E Racy
- Fondation Saint Jean de Dieu, 19, rue Oudinot, 75007 Paris, France
| | - P Sustronck
- Service d'ophtalmologie du centre hospitalier intercommunal de Créteil CHIC, 40, avenue de Verdun, 94000 Créteil, France
| | - D Bremond Gignac
- Service d'ophtalmologie, hôpital universitaire, Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université Paris V René Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France
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Lee SM, Chung SJ, Lew H. Evaluation of Tear Film Lipid Layer Thickness Measurements Obtained Using an Ocular Surface Interferometer in Naso lacrimal Duct Obstruction Patients. Korean J Ophthalmol 2018; 32:445-450. [PMID: 30549467 PMCID: PMC6288021 DOI: 10.3341/kjo.2018.0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/16/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare the tear film lipid layer thickness (LLT) between patients with incomplete nasolacrimal duct obstruction (NLDO) and normal controls and to analyze the changes in tear film LLT and blinking pattern after silicone tube intubation in NLDO patients. Methods We reviewed the medical records of 68 eyes in 52 incomplete NLDO patients who underwent silicone tube intubation from January 2017 to July 2017. The LLT, blinking pattern, and Meibomian gland image were measured with the LipiView II ocular surface interferometer. The Meibomian gland drop-out ratio was measured using the polygon selection tool in the Image J program. Tear meniscus height, which is the other lacrimal indicator, was assessed with spectral-domain optical coherence tomography. Results Tear meniscus height was significantly decreased after silicone tube intubation (p < 0.01). Preoperative minimum, maximum, and average LLT values were 62.4 ± 24.0, 86.7 ± 17.9, and 71.7 ± 23.3 nm, respectively. Significant changes in the minimum, maximum, and average LLT (74.8 ± 23.6, 98.8 ± 11.0, and 91.6 ± 16.1 nm, respectively) were observed after silicone tube intubation (p < 0.001, p = 0.001, and p < 0.001). The partial blinking/total blinking ratio in 20 seconds and the Meibomian gland drop-out ratio showed no significant change after silicone tube intubation. Conclusions Overall, the LLT was increased after silicone tube intubation. Silicone tube intubation may be helpful in maintaining LLT with a normalized of amount of tears.
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Affiliation(s)
- Sang Min Lee
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sok Joong Chung
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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Abstract
BACKGROUND The cardinal symptom of lacrimal stenosis is epiphora and a subjective high level of discomfort due to continuous dacryorrhea. OBJECTIVE The aim of the current paper is to present a structured review of common diagnostic and therapeutic strategies for lacrimal stenosis. MATERIALS AND METHODS The most important diagnostic and therapeutic approaches are analysed using the existing literature and by reporting the authors' own experiences. RESULTS A detailed patient history is crucial for diagnosis of lacrimal disorders. Precise inspection and palpation of the lacrimal and lid region may confirm lacrimal stenosis. Examinations of tear production, tear quality and the properties of the ocular surface are helpful. The most important diagnostic tool is lacrimal duct probing and syringing. Therapy is guided by underlying pathologies. Treatment of congenital lacrimal stenosis follows a staged concept. Epiphora in adults without signs of dacryocystitis should be treated with dacryoendoscopy. Dacryoendoscopy is also a therapeutic option for chronic dacryocystitis, but dacryocystorhinostomy may also be required. Lacrimal trauma should be reconstructed rapidly after the incident by lacrimal intubation. Neoplasia of the lacrimal excretory system requires histological classification to enable multidisciplinary management. CONCLUSION Basic ophthalmologic diagnostics are complemented by special symptom-based examinations. Due to ongoing improvement of available diagnostic and therapeutic options, patients' care is becoming increasingly individualised.
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Affiliation(s)
- J Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Deutschland.
| | - H-G Struck
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Deutschland
| | - A Glien
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle, Deutschland
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Kuriki R, Hata T, Nakayama K, Ito Y, Misawa K, Ito S, Tatematsu M, Kaneda N. Changes in tear volume and ocular symptoms of patients receiving oral anticancer drug S-1. J Pharm Health Care Sci 2018; 4:3. [PMID: 29445512 PMCID: PMC5803866 DOI: 10.1186/s40780-018-0100-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Most eye disorders are not fatal but may deteriorate the quality of life of a patient. The eye disorder that is most frequently reported in the cancer chemotherapy is associated with the combination of tegafur/gimeracil/potassium oxonate (S-1). However, preventive methods or treatment methods for the eye disorder have not yet been established. This study aimed to determine changes in tear volume and subjective ocular symptoms during the treatment period in patients receiving S-1 monotherapy for early detection of adverse effects in the eye and establishment of its treatment methods. Methods This study included eleven patients receiving S-1 monotherapy as a postoperative adjuvant chemotherapy for gastric cancer. Six subjective ocular symptoms including watering eyes were evaluated and changes in tear volume measured by the Schirmer’s test in patients receiving S-1 during the treatment period. In the present study, the patients were divided into “no watering eyes” (patients not experienced watering eyes) group and “watering eyes” (patients experienced watering eyes even once) group. Results Six out of eleven patients developed watering eyes after receiving S-1 monotherapy. Among these, the earliest onset occurred on the 2nd week after oral administration. Watering eyes and eye discharge were highly related in patients having a trouble in daily life due to the decreased QOL. Changes in tear volume in the “watering eyes” group significantly increased compared to the “no watering eyes” group during the treatment period, especially when the patients had no subjective symptom of the increased tear volume. Conclusions It is essential to prevent eye disorders including watering eyes as an adverse effect of S-1 administration. The present study recommends that the tear volume should be periodically measured using Schirmer’s test, and the patient should be interviewed regarding the subjective ocular symptoms for the early detection of watering eyes caused by S-1 administration. If the tear volume can not be measured periodically, medical staffs should pay attention to the patient with eye discharge.
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Affiliation(s)
- Reiko Kuriki
- 1Graduate School of Pharmacy, Meijo University, 150 Yagotoyama, Tempaku, Nagoya, 468-8503 Japan
| | - Tsuyoshi Hata
- 1Graduate School of Pharmacy, Meijo University, 150 Yagotoyama, Tempaku, Nagoya, 468-8503 Japan.,Department of Pharmacy, Tokai Hospital, 1-1-1 Chiyodabashi, Chikusa, Nagoya, 464-8512 Japan
| | - Kinuyo Nakayama
- 3Department of Nursing, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, 464-8681 Japan
| | - Yuichi Ito
- 4Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, 464-8681 Japan
| | - Kazunari Misawa
- 4Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, 464-8681 Japan
| | - Seiji Ito
- 4Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, 464-8681 Japan.,5Department of Operation, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, 464-8681 Japan
| | - Michiko Tatematsu
- 1Graduate School of Pharmacy, Meijo University, 150 Yagotoyama, Tempaku, Nagoya, 468-8503 Japan.,6Department of Pharmacy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, 464-8681 Japan
| | - Norio Kaneda
- 1Graduate School of Pharmacy, Meijo University, 150 Yagotoyama, Tempaku, Nagoya, 468-8503 Japan
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Bravo-Beltranena S, Zimmermann-Paiz MA. [Success in probing for congenital nasolacrimal duct obstruction. Ten years experience]. ARCH ARGENT PEDIATR 2018; 116:77-80. [PMID: 29333844 DOI: 10.5546/aap.2018.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/17/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The congenital nasolacrimal duct obstruction is a common pathology, with low morbidity, but not exempt of complications without the correct diagnosis and management. METHODS Retrospective study from 2005 to 2015 in patients who were submitted to a probing procedure. We identified age at procedure, gender, laterality and presence or absence of success with the procedure. RESULTS One hundred thirty-seven eyes were analyzed. The median age was 17 months and the total success rate was 85.4%. CONCLUSION In congenital nasolacrimal duct obstruction there is a high rate of spontaneous resolution with the proper initial conservative management and, in patients older than 12 months, probing has a high rate of success.
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Affiliation(s)
- Sofía Bravo-Beltranena
- Unidad de Oftalmología Pediátrica, Estrabismo y Neurooftalmología "Dra. Ana María Illescas Putzeys", Hospital de Ojos y Oídos "Dr. Rodolfo Robles V.", Instituto de Ciencias de la Visión, Benemérito Comité Pro Ciegos y Sordos de Guatemala, Guatemala.
| | - Martín A Zimmermann-Paiz
- Unidad de Oftalmología Pediátrica, Estrabismo y Neurooftalmología "Dra. Ana María Illescas Putzeys", Hospital de Ojos y Oídos "Dr. Rodolfo Robles V.", Instituto de Ciencias de la Visión, Benemérito Comité Pro Ciegos y Sordos de Guatemala, Guatemala
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Lee MJ, Khwarg SI, Kim IH, Choi JH, Choi YJ, Kim N, Choung HK. Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy. Korean J Ophthalmol 2017; 31:383-387. [PMID: 28913995 PMCID: PMC5636713 DOI: 10.3341/kjo.2016.0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/26/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes. METHODS We reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomy for primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location and extent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimal duct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimal sac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significant inflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical success rate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups. RESULTS Of 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases (56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%) showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis of the lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and the other 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success rate was 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, the functional success rate was lower in cases with significant lacrimal sac change (p = 0.044). CONCLUSIONS Even in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sac changes, and those changes were associated with lower functional success rate.
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Affiliation(s)
- Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
| | | | - Jeong Hoon Choi
- Department of Ophthalmology, Korean Armed Forces Capital Hospital, Seongnam, Korea
| | - Youn Joo Choi
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Kyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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Lee JJ, Lee HM, Lim HB, Seo SW, Ahn HB, Lee SB. Learning Curve for Endoscopic Endonasal Dacryocystorhinostomy. Korean J Ophthalmol 2017; 31:299-305. [PMID: 28752696 PMCID: PMC5540984 DOI: 10.3341/kjo.2016.0081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/16/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose To elucidate the learning curve for endoscopic endonasal dacryocystorhinostomy (EE-DCR) based on the results of EE-DCR performed by three surgeons at three different tertiary hospitals. Methods A retrospective review of the medical records of 386 eyes of 337 patients who had undergone EE-DCR by three surgeons at three tertiary hospitals and who were available for a >6-month postoperative observation period was conducted. The success of a given surgery was determined based on the results of a test performed during the patient's last outpatient visit to the hospital. The learning curve was identified by dividing the patients into four groups (20, 30, 40, and 50 eyes in each respective group) and comparing their success rates. Results The overall success rate of the entire study population was 86.3%. The success rates for each of three surgeons was 83.3%, 85.6%, and 88.1%, respectively. After dividing the patients into groups of 30 eyes each, all three surgeons showed a significant increase in surgery success rates after their first group of 30 eyes (p < 0.05). The overall success rate excluding the first 30 eyes was 92.9%, and all three surgeons exhibited a significantly improved success rate of >90% (A, 94.4%; B, 90.8%; C, 95.4%). Conclusions A surgeon should be required to perform at least 30 EE-DCR procedures to obtain stable surgical skill for this procedure.
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Affiliation(s)
- Jong Joo Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Han Min Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyung Bin Lim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea.,Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam, Korea
| | - Seong Wook Seo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hee Bae Ahn
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea.
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Choi SC, Choi HS, Jang JW, Kim SJ, Lee JH. Comparison of the Efficacies of 0.94 mm and Double Silicone Tubes for Treatment of Canalicular Obstruction. Korean J Ophthalmol 2017; 31:1-8. [PMID: 28243017 PMCID: PMC5327169 DOI: 10.3341/kjo.2017.31.1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/05/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To compare the clinical effects of the single wide-diameter bicanalicular silicone tube and the double bicanalicular silicone tube in endonasal dacryocystorhinostomy (DCR) with canalicular trephinization for canalicular obstruction. METHODS We retrospectively reviewed the records of 121 patients with monocanalicular or common canalicular obstruction who had undergone endonasal DCR with random bicanalicular insertion of either double silicone tubes (insertion of two tubes into each canaliculus) or a single wide-diameter (0.94 mm) silicone tube. The tubes were removed at around 3 months after surgery. RESULTS This study included 79 eyes of 61 patients in the double-tube intubation group and 68 eyes of 60 patients in the single wide-diameter tube intubation group. Anatomical success, evaluated by syringing, was achieved in 72 of the 79 eyes (91.1%) in the double-tube intubation group and 60 of the 68 eyes (88.2%) in the single wide-diameter tube intubation group. Functional success was achieved in 65 of the 79 eyes (82.3%) in the double-tube intubation group and 61 of the 68 (89.7%) eyes in the single wide-diameter tube intubation group. There were no significant differences in the success rates of surgery between the two groups. One patient in the double-tube intubation group underwent conjunctivodacryocystorhinostomy (CDCR) and two in the wide-diameter tube intubation group underwent CDCR or reintubation to treat recurrence. CONCLUSIONS Intubation using a single wide-diameter tube during endonasal DCR is as effective as double-tube intubation for the treatment of canalicular obstruction, with a lower rate of complications such as inflammation or patient discomfort.
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Affiliation(s)
- Seong Chan Choi
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Hye Sun Choi
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Jae Woo Jang
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Sung Joo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Jung Hye Lee
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
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Matsumura N, Goto S, Yamane S, Fujita T, Inoue M, Inamura M, Kadonosono K. High-resolution dacryoendoscopy for observation for pediatric lacrimal duct obstruction. Am J Ophthalmol Case Rep 2016; 1:23-25. [PMID: 29503884 PMCID: PMC5757344 DOI: 10.1016/j.ajoc.2016.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/18/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to describe high-resolution dacryoendoscopy findings for nasolacrimal duct obstruction (NLDO) in three representative pediatric cases with different etiologies. OBSERVATIONS In a case of congenital NLDO, a mucosal membranous obstruction was observed at the distal end of the nasolacrimal duct (NLD), and a slit-shaped opening of the NLD was observed after perforation. In a case of acquired NLDO secondary to an adenoviral infection, a membranous obstruction was observed at the proximal NLD. In a case of NLDO with chronic dacryocystitis in a patient with Down syndrome, diffuse fibrous obstruction was observed. CONCLUSION AND IMPORTANCE High-resolution dacryoendoscopy enables a clearer visualization of pediatric lacrimal duct obstructions, leading to an improved understanding of their features.
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Affiliation(s)
- Nozomi Matsumura
- Department of Ophthalmology, Kanagawa Children's Medical Center, Japan
| | - Satoshi Goto
- Department of Ophthalmology, The Jikei University School of Medicine, Katsushika Medical Center, Japan
| | - Shin Yamane
- Department of Ophthalmology, Yokohama City University, Department of Ophthalmology and Micro-technology, Japan
| | - Takeshi Fujita
- Department of Ophthalmology, Kanagawa Children's Medical Center, Japan
| | - Maiko Inoue
- Department of Ophthalmology, Yokohama City University, Department of Ophthalmology and Micro-technology, Japan
| | | | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University, Department of Ophthalmology and Micro-technology, Japan
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Hitter A, Lamblin E, Morand B, Bertolo A, Atallah I, Righini CA. [Congenital dacryocystocele: Surgical treatment or routine follow-up?]. ACTA ACUST UNITED AC 2016; 117:15-9. [PMID: 26809596 DOI: 10.1016/j.revsto.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 06/30/2015] [Accepted: 08/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Congenital dacryocystoceles are rare and often misunderstood pathologies. Their treatment varies and consists in simple follow-up, lacrimal catheterization or endoscopic surgical drainage, depending on medical teams. The aim of our study was to discuss the place of endoscopic drainage in the treatment of congenital dacryocystocele. METHODS We conducted a retrospective review on 18 cases of congenital dacryocystoceles taken in charge in a tertiary care center between 2009 and 2012. RESULTS Thirteen newborns, including five bilateral cases, were taken in charge. The average age was 14.6 days. Six newborns presented with an acute dacryocystitis at the time of diagnosis. No respiratory complications were observed. Spontaneous drainage of the dacryocystocele was observed in 38.8% of the cases, occurring at 22 days of life on average. Endonasal endoscopic drainage was performed in 66.6% of the cases. No recurrence or complication was observed after surgery. After spontaneous drainage, one recurrence was observed. The mean follow-up period of these patients was 8.8 months. DISCUSSION Spontaneous drainage is common. Conservative management may therefore be considered in absence of infection. In case of infection and/or persistence of dacryocystocele after 4 weeks of life, endonasal surgical drainage should be considered. Imaging of the facial structure should be performed before any surgical treatment.
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Affiliation(s)
- A Hitter
- Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, hôpital Michallon, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France.
| | - E Lamblin
- Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, hôpital Michallon, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France
| | - B Morand
- Service de chirurgie plastique et maxillo-faciale, hôpital Michallon, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France
| | - A Bertolo
- Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, hôpital Michallon, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France
| | - I Atallah
- Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, hôpital Michallon, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France
| | - C A Righini
- Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, hôpital Michallon, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France; Laboratoire Inserm U 578, institut Albert-Bonniot, rond point de la Chantourne, 38706 La Tronche cedex, France
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Ng DS, Chan E, Yu DK, Ko ST. Aesthetic assessment in periciliary "v-incision" versus conventional external dacryocystorhinostomy in Asians. Graefes Arch Clin Exp Ophthalmol 2015; 253:1783-90. [PMID: 26156681 DOI: 10.1007/s00417-015-3098-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/21/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the functional and aesthetic outcomes of periciliary "v-incision" external dacryocystorhinostomy (DCR) and to compare with conventional approach. METHOD Charts review of consecutive cases of "v-incision" (VDCR) or conventional DCR performed in a single institute, between January 2007 and March 2014. All procedures were performed or supervised by a single surgeon. Two periciliary incisions were made near the skin-mucosal junction at the upper and lower eyelid margins medial to the punctum joining at the medial canthal angle to form a "v" shape. Subcutaneous dissection was carried out inferomedially to reach the anterior lacrimal crest. DCR was then performed in the usual manner. Functional success was defined as no persistent or recurrent epiphora and patency on irrigation of the lacrimal drainage system at least 6 months post-surgery. A cross-sectional aesthetic survey was conducted by asking the patients to rate their scar appearance satisfaction on a visual analogue scale (VAS). External photographs were graded by two independent, masked physicians using VAS as well as the Stony Brook scar evaluation scale (SBSES). RESULTS Sixty-one patients with median age of 64 years met the inclusion criteria, with median follow-up duration of 28 months. Thirty-eight eyes underwent VDCR, and 23 had conventional DCR. The functional success rate for VDCR was 83.3, 95 % confidence intervals (95%CI) [lower 0.68, upper 0.92] and for conventional DCR was 73.9 %, 95%CI [lower 0.54, upper 0.87]; without statistically significant difference (p = 0.38). VDCR patients rated higher aesthetic outcome on VAS (mean scores 95.5 ± 16.8 vs 82.9 ± 25.1, p = 0.03). On the SBSES, both observers gave higher aesthetic scores to the VDCR group (observer #1 4.6 ± 1.1 and #2 4.7 ± 1.2, p < 0.01) than conventional DCR (observer #1 3.1 ± 2.8 and #2 2.8 ± 2.1, p < 0.01). More patients reported that they could wear spectacles within 1 week post-VDCR (44.7 vs 4.3 %, p < 0.01). CONCLUSION "V-incision" external DCR has a similar functional success rate to that of the conventional approach and has superior aesthetic outcomes as reported by surgeons and patients. However, a higher proportion of trainees under supervision performed conventional DCR, and it is uncertain whether the outcomes were also influenced by the level of surgeon's expertise.
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Heichel J, Bachner F, Schmidt-Pokrzywniak A, Struck HG, Stuhlträger U, Bredehorn-Mayr T. [Treatment of congenital lacrimal duct obstruction: A prospective clinical cohort study]. Ophthalmologe 2015; 112:840-7. [PMID: 26070835 DOI: 10.1007/s00347-015-0067-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pressurized probing and irrigation is the method of choice for congenital lacrimal duct obstruction after conservative therapeutic strategies have failed. The aim of this study was to evaluate age dependence and success rates of different therapeutic options. MATERIAL AND METHODS A prospective cohort study of children with congenital lacrimal duct obstruction was performed. All children treated during the period between May 2009 and June 2010 were included. Surgical success was defined as the absence of epiphora and mucous discharge for a postoperative follow-up of 3 months. Odds ratios (OR) and 95 % confidence intervals (CI) of different variables were estimated using logistic regression. RESULTS A total of 111 children (137 eyes) underwent treatment for congenital lacrimal duct obstruction. The mean age of the children was 7.7 months (range 1-30 months). The success rate of probing under local anesthesia was 85.5 % (n = 100). Probing under general anesthesia without intubation of the lacrimal pathway was successful in 28.6 % (n = 2). Treatment under general anesthesia with intubation of the lacrimal pathway had a success rate of 94.2 %. If the primary treatment was complicated the OR was 1.9 (95 % CI: 0.7-5.1), for males the OR was 1.7 (95 % CI: 0.8-3.5) and in cases of a positive family history the OR was 1.5 (95 % CI: 0.7-3.3). With every increasing month of age the risk not to be treated successfully increased (OR: 1.3, 95 % CI: 1.2-1.5). CONCLUSION Syringing under local anesthesia is an effective therapy. The highest success rates were found at the ages of 1-6 months. Therapy with additional silicone tube intubation was highly successful.
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Affiliation(s)
- J Heichel
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - F Bachner
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - A Schmidt-Pokrzywniak
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - H-G Struck
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - U Stuhlträger
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - T Bredehorn-Mayr
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
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Dehghani N, Fouladivanda MR, Ghobadifar MA, Safshekan-Esfahani G, Akbarzadeh A. Nine-Month Follow-up Results of Treatment for Naso lacrimal Duct Obstruction by Probing with Adjunctive Mitomycin C in Adults: A Prospective Randomized Placebo-Controlled Trial. Chonnam Med J 2015; 51:19-25. [PMID: 25914876 PMCID: PMC4406990 DOI: 10.4068/cmj.2015.51.1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/14/2015] [Accepted: 03/16/2015] [Indexed: 12/28/2022] Open
Abstract
The current study aimed to determine the efficacy of probing with adjunctive mitomycin C (MMC) as a treatment for nasolacrimal duct obstruction (NLDO) in adults and to study the association of probing success with demographic and obstruction characteristics. This was a prospective, randomized, double-blind, placebo-controlled trial including 140 patients (each with a unilateral NLDO) scheduled for nasolacrimal probing who were randomly assigned to receive MMC (0.2 mg/ml, 70 patients; group A) or placebo (normal saline, 70 patients; group B). Irrigation was carried out with 0.5 cc of MMC (0.2 mg/mL) in the duct with a nasal pack for 10 minutes in group A. Patients' postprobing epiphora was evaluated at 2 weeks and 1, 3, 6, and 9 months postoperatively. Probing was judged to be a success if there was no or mild watering for at least 9 months after the procedure. There were no significant differences between the two study groups in demographic characteristics or duration of the operation (p=0.062). The overall success rate of probing with MMC was 47/70 (67.1%), which was significantly higher than the success rate of the procedure with placebo (p=0.0027). When the sex of the patients was controlled for by logistic regression, a significant association between the failure rate of probing and increasing age was found in cases and controls (p=0.004 vs. p=0.006, respectively). No significant side effects of probing with MMC were noted after 9 months of follow-up. Administering MMC in a dosage of 0.2 mg/mL during nasolacrimal probing significantly increased the success rate of probing. The failure rate of probing increased with age. A low dose of MMC is cheap, safe, and easily accessible; thus, it is recommended during nasolacrimal probing, especially in patients who refuse dacryocystorhinostomy surgery.
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Affiliation(s)
- Nader Dehghani
- Department of Ophthalmology, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | | | | | - Armin Akbarzadeh
- Department of Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Kim YH, Lee YJ, Song MJ, Han BH, Lee YH, Lee KS. Dacryocystocele on prenatal ultrasonography: diagnosis and postnatal outcomes. Ultrasonography 2014; 34:51-7. [PMID: 25475649 PMCID: PMC4282226 DOI: 10.14366/usg.14037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/16/2014] [Accepted: 09/27/2014] [Indexed: 12/03/2022] Open
Abstract
Purpose: To report the incidence of dacryocystoceles detected by prenatal ultrasonography (US) and their postnatal outcomes and to determine the factors associated with the postnatal persistence of dacryocystoceles at birth. Methods: We retrospectively reviewed the prenatal US database at our institution for the period between January 2012 and December 2013. The medical records of women who had fetuses diagnosed with dacryocystocel larger than 5 mm were reviewed for maternal age, gestational age (GA) at detection, size and side of the dacryocystoceles, delivery, and postnatal information, such as GA at delivery, delivery mode, and gender of the neonate. Results: A total of 49 singletons were diagnosed with a dacryocystocele on prenatal US, yielding an overall incidence of 0.43%. The incidence of dacryocystoceles was the highest at the GA of 27 weeks and decreased toward term. Of the 49 fetuses including three of undeter mined gender, 25 (54%) were female. The mean GA at first detection was 31.2 weeks. The dacryocystocele was unilateral in 29 cases, with a mean maximum diameter of 7 mm. Spontaneous resolution at birth was documented in 35 out of 46 neonates (76%), including six with prenatal resolution. Multivariate analysis demonstrated that GA at delivery was a significant predictor of the postnatal persistence of dacryocystoceles (P=0.045). Conclusion: The overall incidence of prenatal dacryocystoceles was 0.43%; the incidence was higher in the early third trimester and decreased thereafter. Prenatal dacryocystoceles resolved in 76% of the patients at birth, and the GA at delivery was a significant predictor of postnatal persistence.
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Affiliation(s)
- Young-Hwa Kim
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Catholic Kwandong University College of Medicine, Seoul, Korea
| | - Yu-Jin Lee
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Catholic Kwandong University College of Medicine, Seoul, Korea
| | - Mi Jin Song
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Catholic Kwandong University College of Medicine, Seoul, Korea
| | - Byoung Hee Han
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Catholic Kwandong University College of Medicine, Seoul, Korea
| | - Young-Ho Lee
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Catholic Kwandong University College of Medicine, Seoul, Korea
| | - Kyung Sang Lee
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Catholic Kwandong University College of Medicine, Seoul, Korea
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Taupin T, Ltaief Boudrigua A, Taief Boudrigua Aicha L, Baggio E, Gensburger M, Pialat JB. [Comparison of 3T dacryo-MRI by instillation with dacryo-CT scan for evaluation of epiphora]. J Fr Ophtalmol 2014; 37:526-34. [PMID: 24972894 DOI: 10.1016/j.jfo.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 02/01/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Epiphora is frequently related to stenosis of the lacrimal drainage pathways. In the evaluation of stenosis, dacryo-CT scan remains the gold standard, despite the need for radiation and catheterization of the lacrimal passages. Evaluation by high field 3T MRI compared to the gold standard in the morphological study of the lacrimal passages and quantification of the stenosis is attractive considering the lack of radiation and non-invasive nature of the technique. METHODS Twenty-four patients were included, including 9 with bilateral epiphora, representing 33 pathological drainage systems out of 48. Twenty-three drainage systems underwent subsequent surgery (18 patients, 5 patients bilaterally). RESULTS The average diameter on CT scan images of the superior canaliculus was 0.70 mm (± 0.46), of the inferior canaliculus 0.69 (±0.42), the common canaliculus 0.68 (± 0.58), the lacrimal sac 4.32 (± 2.10), and the nasolacrimal duct 1.15 mm (±1.42). 3T dacryo-MRI overestimated the diameters by 0.35 to 1mm (up to 20 % of the lacrimal sac size), and the concordance between dacryo-CT scan and 3T dacryo-MRI was of average value (kappa 0.5, P<0.05) concerning the diagnosis of stenosis. Furthermore, dacryo-CT scan demonstrated higher sensitivity (72.7 %) than 3T dacryo-MRI (42.4 %). CONCLUSIONS The two techniques are not equivalent in the diagnosis of stenosis. An optimization of protocols and an evaluation on a larger cohort remain necessary before dacryo-CT scan can be replaced by dacryo-MRI in routine practice.
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Affiliation(s)
- T Taupin
- Service de radiologie, centre Léon-Bérard, FNCLCC, 28, promenade Léa-et-Napoléon-Bullukian, 69373 Lyon, France.
| | | | - L Taief Boudrigua Aicha
- Service de radiologie ostéo-articulaire et neurologique, pavillon B, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon, France
| | - E Baggio
- Centre ophtalmologique Kleber, 50, cours Franklin-Roosevelt, 69006 Lyon, France
| | - M Gensburger
- Service d'ophtalmologie, centre hospitalier Lyon-Sud, 130, rue Jules-Guesde, 69495 Pierre-Bénite cedex, France
| | - J B Pialat
- Service de radiologie ostéo-articulaire et neurologique, pavillon B, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon, France
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Kirtane MV, Lall A, Chavan K, Satwalekar D. Endoscopic dacryocystorhinostomy with flap suturing. Indian J Otolaryngol Head Neck Surg 2014; 65:236-41. [PMID: 24427653 DOI: 10.1007/s12070-011-0354-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 11/10/2011] [Indexed: 11/24/2022] Open
Abstract
Multiple reports have demonstrated the efficacy of endoscopic dacryocystorhinostomy (DCR). However the results of the same have varied from centre to centre. Many still regard external DCR as the gold standard. To describe an endoscopic DCR technique which anatomically simulates an external DCR and assess its results. Prospective, nonrandomized and noncomparative interventional case series. Clinical charts of patients with nasolacrimal duct obstruction based on symptomatic, clinical and radiological basis were included in the study. All surgeries were done endonasally using standard operative technique. The modification in the standard technique included creating a wide exposure of the lacrimal sac, incising the sac and the suturing the medial wall of the lacrimal sac with the lateral nasal wall. The same was achieved by using either vascular clips or 5.0 vicryl sutures. Twenty (11 females and 9 males) were included in the study. The average age of the patients was 56.86 years old (range 27-85 years old). The main presenting symptom was epiphora and 1 patient with mucocele. Successful outcome was measured in terms of relief of sympto anatomical patency assessed by sac syringing and nasal endoscopy showing a wide patent lumen. A primary success rate of 95% and ultimate rate of 100% was achieved in the cases with a nasolacrimal duct (NLD) block while an overall success rate of 82.6% was noted when the cases with NLD block and common canalicular block were considered together. Endoscopic DCR can now easily replace external DCR as a standard. It is not only minimally invasive, but has minimal complications and using this technique, we have been able to achieve very high success rates.
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Affiliation(s)
- Milind V Kirtane
- P D Hinduja Hospital & Medical Research Centre, Mahim, Mumbai, India
| | - Abhineet Lall
- P D Hinduja Hospital & Medical Research Centre, Mahim, Mumbai, India ; Kirtane Clinic, 1st Floor, Amar Bhuvan, French Bridge, Near Opera House, Mumbai, 400007 India
| | - Kashmira Chavan
- P D Hinduja Hospital & Medical Research Centre, Mahim, Mumbai, India
| | - Dhruv Satwalekar
- P D Hinduja Hospital & Medical Research Centre, Mahim, Mumbai, India ; Cumballa Hill Hospital, Mumbai, India
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Choi JC, Jin HR, Moon YE, Kim MS, Oh JK, Kim HA, Choi MY, Shim WS. The surgical outcome of endoscopic dacryocystorhinostomy according to the obstruction levels of lacrimal drainage system. Clin Exp Otorhinolaryngol 2009; 2:141-4. [PMID: 19784407 DOI: 10.3342/ceo.2009.2.3.141] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 06/14/2009] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Many factors influence the outcome of endoscopic dacryocystorhinostomy (DCR). One of the most important prognostic factors is the level of obstruction in the lacrimal drainage system. The main objective of this report is to evaluate both the frequency of obstruction by anatomical region of the lacrimal drainage system on dacryocystography (DCG) and the surgical outcome of endoscopic DCR according to the obstruction level. METHODS A retrospective series of 48 patients (60 eyes) who had undergone endoscopic DCR from January 2005 to November 2007 were enrolled. Preoperative evaluation consisted of a standard examination which included lacrimal irrigation, probing, DCG and osteomeatal unit (OMU) computed tomography. Patients were classified into four groups according to the obstruction level on DCG. Surgical outcome was evaluated postoperatively by subjective improvement of epiphora and patent rhinostomy opening on nasal endoscopic exam. RESULTS Of 60 eyes, the levels of obstruction were the common canaliculus in 14 eyes (23.3%), the lacrimal sac in 13 eyes (21.7%), the duct-sac junction in 13 eyes (21.7%) and the nasolacrimal duct (NLD) in 20 eyes (33.3%). The ductsac junction obstruction was treated most successfully (100%), followed by NLD obstruction (90%), common canaliculus obstruction (78.6%) and saccal obstruction (69.2%). CONCLUSION In patients with lacrimal drainage system obstruction, preoperative evaluation of obstruction level using DCG may be helpful for predicting the surgical outcome of endoscopic DCR. The saccal obstruction may have a worse prognosis than the other obstruction levels.
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