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Li J, Wang J, Sun C. Early Endonasal Dacryocystorhinostomy for Acute Dacryocystitis: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2024; 38:185-191. [PMID: 38444220 DOI: 10.1177/19458924241237009] [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] [Indexed: 03/07/2024]
Abstract
OBJECTIVE The aim of this meta-analysis is to compare the outcomes of early endonasal dacryocystorhinostomy (DCR) with delayed DCR in the treatment of acute dacryocystitis (AD). METHODS A comprehensive electronic search of PubMed, Embase, Web of Science, and the Cochrane Library databases was conducted up to November 11, 2023. Data synthesis was performed using Review Manager 5.4, and forest plots were generated for each outcome measure. Potential publication bias was assessed using funnel plots and Egger's test. RESULTS Six studies involving 288 patients were included in the meta-analysis. Overall, the success rate of early endonasal DCR was comparable to that in the delayed DCR group (odds ratio [OR] = 1.52, 95% confidence interval [CI]: 0.81-2.85, P = .19). Furthermore, in comparison with the delayed DCR group, early endonasal DCR significantly reduced the time for medial canthus swelling resolution (mean differences [MD] = -4.92, 95% CI: -5.46 to 4-.37, P < .00001) and complete resolution of symptoms (MD = -17.70, 95% CI: -23.88 to -11.52, P < .00001). CONCLUSION Primary early endonasal DCR seems to be a promising and favorable approach for managing AD with comparable efficacy and faster relief of symptoms compared to conventional delayed DCR.
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Affiliation(s)
- Jia Li
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jihong Wang
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Changling Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
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Sonesson A, Baumgarten M, Bhongir R, Engelsberg K. Is a bacterial biofilm in the lacrimal sac the cause of chronic refractory dacryocystitis? - A pilot study. Orbit 2024; 43:217-221. [PMID: 37885304 DOI: 10.1080/01676830.2023.2269580] [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: 07/14/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE A pilot study to identify bacterial biofilm in the lacrimal sacs of patients with chronic dacryocystitis, and in patients with epiphora but without discharge, using scanning electron microscopy. METHODS Five patients: two with nasolacrimal duct obstruction without dacryocystitis, and three with dacryocystitis refractory to antibiotics, underwent external dacryocystorhinostomy. One control patient without infection was included. Bacterial cultures were obtained from the lumen of the lacrimal sac to analyze possible bacterial growth, including antibiotic resistance. Biopsies were taken from all lacrimal sacs and prepared for light and scanning electron microscopy. RESULTS Scanning electron microscopy of all the lacrimal sac samples revealed structures consistent with bacterial communities and adjacent extracellular material, indicating biofilm formation. This was most prominent in one of the patients with chronic dacryocystitis. Bacteria were found not only on the luminal surface of the sac, but also within the tissue of the sac. Bacterial growth was identified in samples from two patients with chronic dacryocystitis, whereas samples from the other three patients showed no bacterial growth. CONCLUSION Lack of patency of the lacrimal duct predisposes to bacterial growth, even in patients with no clinically confirmed infection of the lacrimal sac. The finding of a biofilm in patients with chronic dacryocystitis explains the lack of efficiency of antibiotic treatment at the concentrations used in clinical practice.
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Affiliation(s)
- Andreas Sonesson
- Division of Dermatology and Venereology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Maria Baumgarten
- Division of Infection Medicine, Department of Clinical Sciences Lund, Skane University Hospital, Sweden
| | - Ravi Bhongir
- Division of Infection Medicine, Department of Clinical Sciences Lund, Skane University Hospital, Sweden
| | - Karl Engelsberg
- Ophthalmology Clinic, Department of Clinical Sciences Lund, Skane University Hospital, Sweden
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Boal NS, Chiou CA, Sadlak N, Sarmiento VA, Lefebvre DR, Distefano AG. Antibiotic utilization in endoscopic dacryocystorhinostomy: a multi-institutional study and review of the literature. Orbit 2024; 43:183-189. [PMID: 37395439 DOI: 10.1080/01676830.2023.2227705] [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: 02/12/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Utilization of antibiotics for endoscopic dacryocystorhinostomy (endo-DCR) is largely dependent on individual surgeon preference. This study aimed to investigate prescribing practices of pre-, peri-, and postoperative antibiotics and effects on postoperative infection rates in patients who underwent endo-DCR. METHODS A retrospective chart review of institutional data at two academic centers of endo-DCR cases from 2015-2020 was performed. Postoperative infection rates for patients who received pre-, peri-, and postoperative antibiotics, individually or in combination, and those who did not, were compared via odds ratio and ANOVA linear regression. RESULTS 331 endo-DCR cases were included; 22 cases (6.6%) had a postoperative infection. There was no significant difference in the infection rates between patients without an active preoperative dacryocystitis who received different permutations of peri- and postoperative antibiotics. Patients who received preoperative antibiotics within two weeks of surgery for preexisting acute dacryocystitis, but did not receive peri- or postoperative antibiotics, had a higher rate of postoperative infections (p = 008). CONCLUSIONS Our data suggest antibiotics may be beneficial only when patients have a recent or active dacryocystitis prior to surgery. Otherwise, our data do not support the routine use of antibiotic prophylaxis in endo-DCR.
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Affiliation(s)
- Nina S Boal
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Carolina A Chiou
- Division of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Sadlak
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - V Adrian Sarmiento
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Daniel R Lefebvre
- Division of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Division of Ophthalmology, Surgical Service, Boston Veterans Affairs HealthCare System, Boston, Massachusetts, USA
- Dedham Ophthalmic Consultants and Surgeons / Lexington Eye Associates, Dedham, Massachusetts, USA
| | - Alberto G Distefano
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Gupta A, Saini P, Bothra N, Ali MJ. Acute dacryocystitis: changing practice pattern over the last three decades at a tertiary care setup. Graefes Arch Clin Exp Ophthalmol 2024; 262:1289-1293. [PMID: 37924496 DOI: 10.1007/s00417-023-06300-0] [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: 05/11/2023] [Revised: 09/15/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
AIM To compare the demographics, clinical features, and changes in the management pattern of acute dacryocystitis at a tertiary care eye institute. METHODS A retrospective review was performed of electronic medical records of all patients diagnosed with acute dacryocystitis from January 2013 to January 2023. Data retrieved include demographics, history, presenting symptoms, duration of symptoms, surgical interventions, associated systemic conditions, management, complications, and outcomes. A successful anatomical outcome was defined as patency on lacrimal irrigation, and a successful functional outcome was defined as the resolution of infection and epiphora. The data parameters obtained were compared with the historical published data of the earlier two decades from the same Institute. RESULTS A total of 363 eyes of 349 patients were enrolled in this retrospective study. The median age was 45 years (range: 19-94 years). There were 216 (62%) females and 133 (38%) males. Surgery was performed in 320 (88%) patients. Needle aspiration or incision and drainage were performed in 102(32%) patients with lacrimal abscesses. Of the 320 patients, an endoscopic DCR was performed in 138 (43%) patients and an external DCR in 182 (57%). Of the 320 patients who underwent DCR surgery, 308 (96%) demonstrated anatomical and functional success at 1-year follow-up. CONCLUSION There is a changing trend towards endoscopic DCR being incorporated as the primary procedure for managing acute dacryocystitis with the advantages of quicker resolution and reduced morbidity. There is a trend for choosing needle aspiration over the traditional incision and drainage in the initial management of lacrimal abscess.
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Affiliation(s)
- Adit Gupta
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India
- Department of Orbit and Oculoplasty, Shantilal Shanghvi Eye Institute, Mumbai, India
| | - Pragya Saini
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India
| | - Nandini Bothra
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India.
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Liu S, Zhang H, Zhang YR, Chen LJ, Yu XY. The efficacy of endoscopic dacryocystorhinostomy in the treatment of dacryocystitis: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37312. [PMID: 38489695 PMCID: PMC10939585 DOI: 10.1097/md.0000000000037312] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND This article aimed to discuss the efficacy and safety of endoscopic dacryocystorhinostomy (EDCR) versus external dacryocystorhinostomy (EX-DCR) for the treatment of dacryocystitis by meta-analysis. METHODS All randomized controlled trials that met the inclusion and exclusion criteria were collected by searching the following databases: PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang, from the establishment of the database to June 2023. Meta-analysis was performed using Stata 17.0 software and review manager 5.4 software. In the collected trials, the observation group was treated with EDCR, whereas the control group was treated with EX-DCR. RESULTS A total of 10 studies involving 969 patients were included in this analysis. There was a similar surgical success rate in the treatment of dacryocystitis between the 2 groups (RR = 1.021, 95% CI [0. 803, 1.297], P = 0. 865). However, compared with the control group, patients in the observation group had a higher total effective rate of treatment (RR = 1. 195, 95% CI [1. 063, 1.343], P = .003), and shorter operative time (WMD = -23.640, 95% CI [-35.533, -11.747], P < .001), and less intraoperative blood loss (WMD = -50.797, 95% CI [-80.339, -21.255], P = .001), shorter length of hospital stays (WMD = -4.570, 95% CI [-5.992, -3.148], P < .001), and lower incidence of adverse events (RR = 0.295, 95% CI [0.173, 0.504], P < .001). CONCLUSION EDCR is an effective and safe surgical procedure for the treatment of dacryocystitis and can be used as an alternative to EX-DCR.
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Affiliation(s)
- Shui Liu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Ophthalmology, Zhongshan Torch Development Zone People’s Hospital, Zhongshan, Guangdong, China
| | - Huang Zhang
- Department of Ophthalmology, Zhongshan Torch Development Zone People’s Hospital, Zhongshan, Guangdong, China
| | - Yue-Rui Zhang
- Department of Ophthalmology, Zhongshan Torch Development Zone People’s Hospital, Zhongshan, Guangdong, China
| | - Li-Jun Chen
- Department of Ophthalmology, Zhongshan Torch Development Zone People’s Hospital, Zhongshan, Guangdong, China
| | - Xiao-Yi Yu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Ma Y, Wang Z, Zhou G, Wang Y, Dong B, Wu W, Yu B. Comparison of the surgical outcomes of endoscopic dacryocystorhinostomy in chronic dacryocystitis with or without previous bicanalicular silicone tube intubation. Am J Otolaryngol 2024; 45:104200. [PMID: 38113779 DOI: 10.1016/j.amjoto.2023.104200] [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: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
AIMS To compare the outcomes of endoscopic dacryocystorhinostomy (En-DCR) in chronic dacryocystitis (CD) with or without previous bicanalicular silicone tube intubation (BSTI), and investigate whether previous BSTI influenced postoperative outcomes. METHODS We conducted a retrospective review of medical records of CD patients (group A) who had previously undergone BSTI for nasolacrimal duct stenosis and an age- and sex-matched control group of CD patients (group B) without previous intubation receiving En-DCR from November 2017 to January 2022. Sixty-one patients (61 eyes) were included in group A and age- and sex-matched 122 patients (122 eyes) in group B. Dacryocystic parameters were measured by computed tomography-dacryocystography and surgical findings were recorded during surgeries. The surgical success rates of the two groups were compared at 12 months post-operation. RESULTS The mean horizontal, sagittal, and vertical lengths were 6.06 ± 1.24, 6.03 ± 1.44, and 8.05 ± 2.00 mm, respectively, in group A and 6.33 ± 1.25, 6.26 ± 1.19, and 10.40 ± 2.45 mm, respectively, in group B. There were no differences in the horizontal or sagittal parameters between the two groups. The vertical parameter in group A was significantly lower than that in group B. Scar formation in the sac was observed in 54 patients in group A but was absent in group B. At 12 months postoperatively, the anatomical and functional success rates were 88.52 % and 85.25 %, respectively, in group A and 92.62 % and 89.34 %, respectively, in group B, with no difference between the two groups. CONCLUSION Previous BSTI reduced dacryocyst vertical parameter and caused dacryocyst scar formation but did not affect postoperative En-DCR efficacy.
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Affiliation(s)
- Yingjie Ma
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Zhuowei Wang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Guangming Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Yanan Wang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Bin Dong
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Wencan Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Bo Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
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Li M, Li W, Sha Q, Yu L, Wang X. Analysis of the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis. Medicine (Baltimore) 2024; 103:e36934. [PMID: 38241549 PMCID: PMC10798723 DOI: 10.1097/md.0000000000036934] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
To estimate the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis. The clinical data of 105 subjects with chronic dacryocystitis enrolled into our hospital were analyzed retrospectively. The subjects were distinguished into nasal endoscopic group (endoscopic dacryocystorhinostomy; i.e., 51 cases) according to their surgical methods and external-route group (external-route dacryocystorhinostomy; i.e., 54 cases). The therapeutic effect, lacrimal gland secretion function, tear film stability, degree of epiphora, lacrimal passage patency, complications, and recurrence rate were contrasted between the 2 groups. The nasal endoscopic group exhibited a higher effective remedy rate (98.04%) compared with the external-route group (83.33%). Three months postoperation, both groups showed improvements in lacrimal gland secretion function and tear film stability, with the nasal endoscopic group demonstrating more significant enhancement in lacrimal gland secretion function than the external-route group. Six months postoperation, a reduction in the degree of epiphora was observed in both groups, with the nasal endoscopic group displaying a more pronounced decrease in epiphora severity and a higher lacrimal passage patency rate than the external-route group. Furthermore, the nasal endoscopic group experienced lower incidences of postoperative complications and recurrence rates. Endoscopic dacryocystorhinostomy is safe and effective in the remedy of chronic dacryocystitis.
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Affiliation(s)
- Mingzhe Li
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Wenping Li
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Qian Sha
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Liuying Yu
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Xuefei Wang
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
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Heichel J, Dettmer W, Paulsen F, Ali MJ, Schmidt-Pokrzywniak A, Viestenz A, Hammer T, Struck HG. Transcutaneous (External) Dacryocystorhinostomy with Reconstruction of the Ductus nasolacrimalis. Klin Monbl Augenheilkd 2024; 241:30-38. [PMID: 37967816 DOI: 10.1055/a-2158-5422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
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.
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Affiliation(s)
- Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
| | - Wiebke Dettmer
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
| | - Friedrich Paulsen
- Institut für Funktionelle und Klinische Anatomie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | | | - Andrea Schmidt-Pokrzywniak
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Arne Viestenz
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
| | - Thomas Hammer
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
| | - Hans-Gert Struck
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
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Mathewson PA, Athwal S, Hyer JN, Ezra DG. The Whitnall Barrier: A Technique for the Management of Lacrimal Gland Prolapse. Plast Reconstr Surg 2024; 153:216-220. [PMID: 37075289 DOI: 10.1097/prs.0000000000010563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND The Whitnall barrier procedure, a modified Beer and Kompatscher surgical technique to reposition the lacrimal gland, is presented alongside a case series of patients demonstrating excellent aesthetic and functional outcomes. METHODS The Whitnall barrier procedure is illustrated procedurally and accompanied by a case series of 20 consecutive patients treated in a single institution by a single surgical team between December of 2016 and February of 2020. Lid contour and function were assessed postoperatively, as was patient satisfaction. RESULTS Thirty-seven eyes of 20 patients were included. All patients were women, with an average age of 50 years. Fourteen patients underwent surgery for cosmesis, four had inactive thyroid eye disease, and two had lacrimal gland enlargement secondary to dacryoadenitis. The degree of lacrimal gland prolapse was described as mild in two eyes and moderate in 35 eyes. All patients had one or more additional surgical procedures. Mean follow-up duration was 11 months, with complete resolution of lacrimal gland prolapse in 34 eyes. The patient who did not have complete resolution had dacryoadenitis and required ongoing immunosuppressive therapy. Two patients were discharged on topical lubricants: one with thyroid eye disease and one cosmetic patient who underwent upper and lower lid blepharoplasties at the same time. There were no intraoperative complications and no incidences of infection, dehiscence, or damage to the lacrimal gland ductules. CONCLUSIONS The Whitnall barrier technique is a safe and effective surgical procedure to restore the anatomic location of the lacrimal gland. It provides excellent aesthetic and functional outcomes.
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Affiliation(s)
- Priscilla A Mathewson
- From the Adnexal Department, Moorfields Eye Hospital National Health Service Foundation Trust
| | - Sarju Athwal
- Maidstone and Tunbridge Wells National Health Service Trust
| | - Jonathan N Hyer
- From the Adnexal Department, Moorfields Eye Hospital National Health Service Foundation Trust
| | - Daniel G Ezra
- From the Adnexal Department, Moorfields Eye Hospital National Health Service Foundation Trust
- University College London Institute of Ophthalmology and Moorfields Eye Hospital National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology
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10
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Wang M, Ma Y, Tu Y, Wu W, Yu B. A prospective study comparing mini-invasive and conventional canaliculotomy of punctum-sparing canaliculotomy for primary canaliculitis treatment. Eye (Lond) 2023; 37:2289-2293. [PMID: 36473974 PMCID: PMC10366210 DOI: 10.1038/s41433-022-02333-7] [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: 04/11/2022] [Revised: 10/17/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare outcomes of mini-invasive canaliculotomy with those of conventional canaliculotomy conducted using the punctum-sparing approach for the treatment of primary canaliculitis. METHODS A prospective, comparative, and interventional case series study was conducted on 118 individuals with unilateral inferior primary canaliculitis. These patients were randomly divided into two groups, each with 59 cases. Group A underwent mini-invasive canaliculotomy (minor incision ~3 mm), whereas group B received conventional canaliculotomy (long incision ~6-8 mm). Punctum-sparing and canaliculus-reconstructing procedure was used to treat all patients. Both groups had silicone tube intubations and were retained in the lacrimal passages for one month. Both groups' surgical success rates and postoperative complications were measured at the last follow-up of 12 months after surgery. RESULTS A total of 108 patients were finally included in the study, 53 in group A and 55 in group B. There were 79 females and 29 males with a median age of 57 ± 13.4 years. The anatomical success rates for groups A and B were 96.2% and 92.7% (P = 0.679), respectively. Functional success rate was accomplished by considerably more patients in group A (50/53, 94.3%) compared to group B (45/55, 81.8%) (P = 0.046). No recurrences were seen during follow-up visits in any of the participants. CONCLUSIONS The two procedures employed in this study to treat primary canaliculitis achieves excellent clinical effects with no incidence of recurrence. The mini-invasive canaliculotomy is worthy to be recommended for its higher functional success rate with mini-invasion of canaliculus and intact lacrimal punctum.
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Affiliation(s)
- Mingling Wang
- Department of Ophthalmology, Baoan Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Yingjie Ma
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yunhai Tu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wencan Wu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Bo Yu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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11
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Goel R, Sagar C, Gupta SN, Shah S, Agarwal A, Golhait P, Kumar S, Akash R. Outcome of transcanalicular laser dacryocystorhinostomy with endonasal augmentation in acute versus post-acute dacryocystitis. Eye (Lond) 2023; 37:1225-1230. [PMID: 35590102 PMCID: PMC10101941 DOI: 10.1038/s41433-022-02104-4] [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: 03/17/2022] [Revised: 03/29/2022] [Accepted: 05/10/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To study the outcomes of transcanalicular laser dacryocystorhinostomy (TCL-DCR) with endonasal augmentation in acute versus post-acute dacryocystitis and compare it with external DCR in post-acute settings. METHODS A prospective, randomised study was conducted in 90 adult cases of Acute dacryocystitis. All the patients were started on systemic antibiotics and a 4 mm × 4 mm osteotomy was created using TCL-DCR. The osteotomy was enlarged to 8 mm × 8 mm by endonasal augmentation at the same sitting in group 1, after 10 days in group 2 and after 10 days with external DCR in group 3. The cases were assessed for symptomatic relief and complications. Success was defined as functional and anatomical patency at 36 months. RESULTS The mean age was 45.33 ± 15.06 years and the male: female ratio was 1:2. The presenting complaints were painful swelling (100%), epiphora or discharge (88.8%), fistula (33%) and fever (6%). The average number of acute episodes was 2.96. The intra-group pain reduction from day 1 to day 4, was significant in all three groups (p = 0.000). Intra-operative (p = 0.015, χ2 = 8.37) and post-operative complications (p = 0.002, χ2 = 0.002) were higher in group. Anatomical success was achieved in all the three groups, however, the functional success in Group 3, Group 2 and Group 1 was 100%, 86.7% and 66.7% respectively (p = 0.002, χ2 = 12.86). CONCLUSIONS The creation of osteotomy using TCL-DCR provides early relief in symptoms. Single-stage surgery in inflamed tissues is associated with higher complication rates. External DCR in post-acute settings gives the best outcomes with minimal complications, endoscopic augmentation requires a close follow-up.
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Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), New Delhi, India.
| | - Charu Sagar
- Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), New Delhi, India
| | - Smriti Nagpal Gupta
- Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), New Delhi, India
| | - Shalin Shah
- Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), New Delhi, India
| | - Ayushi Agarwal
- Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), New Delhi, India
| | - Priyanka Golhait
- Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), New Delhi, India
| | - Sushil Kumar
- Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), New Delhi, India
| | - Raut Akash
- Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), New Delhi, India
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12
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Ozturker C, Kaynak P. Epiphora and Dacryocystitis After Transcanalicular Laser-assisted Dacryocystorhinostomy due to an Undiagnosed Dacryolith. Ophthalmic Plast Reconstr Surg 2022; 38:e59-e62. [PMID: 34873124 DOI: 10.1097/iop.0000000000002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 45-year-old female patient who had previously undergone endoscopic dacryocystorhinostomy (EN-DCR) at another surgical center was diagnosed with functional failure after DCR and underwent an uneventful transcanalicular laser-assisted DCR (TCL-DCR). After 5 months, the patient underwent endoscopic examination due to persistent epiphora and dacryocystitis attacks. Endonasal visualization revealed a large dacryolith that filled the ostium and sac and was removed en bloc mechanically with forceps. Carbonized material on the dacryolith's superior part indicated that it was perforated through-and-through by the laser beam during TCL-DCR. The patient's complaints were resolved completely following the removal of the dacryolith. The transcanalicular lacrimal procedures do not allow complete visualization of the contents of the lacrimal sac, and the laser beam can ablate even an undetected dacryolith and may result in unsuccessful DCR, although the surgical course may look completely uneventful.
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Affiliation(s)
- Can Ozturker
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pelin Kaynak
- Ophthalmic Plastic and Reconstructive Surgery Division, Rufus Eye Microsurgery Center, Istanbul, Turkey
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13
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Mechel E, Sheikh A, Rodgers R, Hymowitz M, Cocker R. Actinomyces ductular dacryoadenitis resulting in a lacrimal gland abscess. Orbit 2022; 41:105-107. [PMID: 34130588 DOI: 10.1080/01676830.2021.1939728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/12/2021] [Accepted: 06/02/2021] [Indexed: 06/12/2023]
Abstract
Lacrimal gland ductulitis is a rare infection of the lacrimal gland ductules. Individuals affected report a history of chronic mucopurulent conjunctivitis with "stringy" discharge. All patients are clinically noted to have an inflamed lacrimal gland ductule. Prior reports have suggested Actinomyces species as the "probable" etiology.We report the findings of a 42-year-old male found to have lacrimal gland ductulitis with a lacrimal gland abscess, confirmed by radiologic studies. Surgical drainage was necessitated and performed. Histopathologic analysis confirmed colonization by Actinomyces species, as well as the presence of sulfur granules. To our knowledge, this is the first report of Actinomyces lacrimal gland ductulitis resulting in a secondary lacrimal gland abscess.
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Affiliation(s)
- Elzbieta Mechel
- Department of Ophthalmology, Northwell Eye Institute, Great Neck, New York, USA
| | - Ahmed Sheikh
- Department of Ophthalmology, Will's Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Rand Rodgers
- Department of Ophthalmology, Northwell Eye Institute, Great Neck, New York, USA
| | - Maggie Hymowitz
- Department of Ophthalmology, Northwell Eye Institute, Great Neck, New York, USA
| | - Rubina Cocker
- Northwell Health Department of Pathology, Great Neck, New York, USA
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14
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Neerukonda VK, Stagner AM, Wolkow N. Lymphoma of the Lacrimal Sac: The Massachusetts Eye and Ear Experience With a Comparison to the Previously Reported Literature. Ophthalmic Plast Reconstr Surg 2022; 38:79-86. [PMID: 34269767 DOI: 10.1097/iop.0000000000001997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the frequency, clinical features, and histologic subtypes of biopsy proven lacrimal sac lymphomas, and to compare these results to the previously published literature. METHODS A retrospective chart review was performed at a single institution from 2004 to 2017. Pathology reports, operative notes, and patients' medical charts were reviewed. RESULTS Of 566 lacrimal sacs submitted for routine histopathologic evaluation, 16 cases of lymphoma were identified. All were low-grade, non-Hodgkin B-cell lymphomas, biopsied at an average age of 71 years. Thirteen patients (81.25%) had a pre-existing lymphoma diagnosis; the average interval between the diagnosis of systemic or nonocular adnexal lymphoma and lacrimal sac lymphoma was 7.9 years (range 2-26 years; median 5.5 years). Three cases of primary lacrimal sac lymphoma were identified. Histopathology showed 3 cases (18.75%) of follicular lymphoma, 3 (18.75%) of extranodal marginal zone lymphoma, and 10 (62.5%) of chronic lymphocytic leukemia/small lymphocytic lymphoma. Primary cases presented with epiphora and nasolacrimal duct obstruction, while secondary cases predominantly manifested as dacryocystitis. All lacrimal sac neoplasms were locally responsive (without local recurrence) to chemotherapy, radiation, or both. CONCLUSIONS Lacrimal sac lymphoma is uncommon but should be suspected among patients with known lymphoma who develop dacryocystitis. In this series, primary lacrimal sac lymphoma most often presented as a mass or nasolacrimal duct obstruction. Chronic lymphocytic leukemia/small lymphocytic lymphoma was the most commonly identified cause of secondary lacrimal sac lymphoma. Distinguishing primary from secondary lacrimal sac lymphomas is important, as the extent of disease and histopathologic subtypes differ, which may affect patient management.
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Affiliation(s)
| | | | - Natalie Wolkow
- David G. Cogan Laboratory of Ophthalmic Pathology
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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15
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Amjad MM, Jacobs SM, Callahan MA, Gonzalez ML, Tavakoli M. Small Cell Neuroendocrine Carcinoma Presenting as Recurrent Dacryocystitis: Case Report of a Rare Entity. Ophthalmic Plast Reconstr Surg 2022; 38:e2-e6. [PMID: 34431823 DOI: 10.1097/iop.0000000000002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An 84-year-old man presented with a localized, firm, tender mass over the right lacrimal sac. He had a history of acute dacryocystitis in the same eye 6 months before presentation, which resolved with antibiotics followed by uneventful dacryocystorhinostomy. At repeat presentation, the patient underwent orbital imaging and excisional biopsy of the lesion. Histologic studies revealed a small cell neuroendocrine carcinoma. The patient was subsequently treated with chemotherapy and radiation. Although there are rare reports of small cell neuroendocrine carcinoma originating in the sino-orbital-lacrimal region, this is the first report of tumor presentation with acute dacryocystitis in a patient with prior dacryocystorhinostomy.
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Affiliation(s)
- Muhammad M Amjad
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Sarah M Jacobs
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Michael A Callahan
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Manuel Lora Gonzalez
- Department of Pathology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, U.S.A
| | - Mehdi Tavakoli
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
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16
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Abstract
PURPOSE To analyze the clinical presentation, course, and management in a large cohort of pediatric acute dacryocystitis subjects and to examine whether hospitalization and urgent surgical intervention are indeed mandatory. METHODS A retrospective analysis of all pediatric subjects diagnosed with dacryocystitis at the Children's Hospital of Philadelphia over a 12-year period (2009-2020). RESULTS One-hundred sixty-nine pediatric acute dacryocystitis patients were included in this study. Management included admission in 117 cases (69%). Sixty-eight patients (40%) were treated medically with no surgical intervention, 75 cases (44%) required urgent surgical intervention, and 26 additional cases (15%) required surgery due to persistent tearing symptoms after medical management. The urgent procedures included most commonly: 1) endonasal examination and microdebridement of intranasal cysts in 26 cases (35%); 2) probing and irrigation without examination and microdebridement, with or without stent intubation, in 30 cases (40%); and 3) dacryocystorhinostomy (13 endonasal and 4 external) in 17 cases (23%). CONCLUSIONS Management of pediatric acute dacryocystitis should be tailored individually for each case. Hospital admission and early surgical intervention are not mandatory, as 31% of cases resolved without admission, and 56% without early surgical intervention. Although a specific age cutoff is not plausible, hospital admission for younger patients is more commonly advocated. When surgical intervention is indicated, endonasal examination and microdebridement of any associated intranasal cyst and probing with possible stenting are the initial procedures of choice. Dacryocystorhinostomy is reserved for more complex obstructions. Although pediatric acute dacryocystitis is an infection with serious potential problems, when managed appropriately, complications are rare.
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Affiliation(s)
- Daphna Prat
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katie Magoon
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Karen E Revere
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - James A Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - William R Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
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17
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Habib M, Saunders PJ, Rubinstein TJ. Stenotrophomonas maltophilia-Associated Dacryocystitis in Leukemia-Infiltrated Lacrimal Sacs: Case and Review of Literature. Ophthalmic Plast Reconstr Surg 2021; 37:e143-e145. [PMID: 33782323 DOI: 10.1097/iop.0000000000001925] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 91-year-old female with a history of chronic lymphocytic leukemia developed recurrent bouts of bilateral dacryocystitis. She underwent incision and drainage of the lacrimal sac with culture demonstrating the rare bacteria Stenotrophomonas maltophilia. She underwent subsequent dacryocystectomy with biopsy revealing bilateral involvement of chronic lymphocytic leukemia in the lacrimal sac. Stenotrophomonas maltophilia has been associated with immune suppression and is rarely seen in dacryocystitis. Local and/or systemic immune deregulation or suppression may play a role in lacrimal sac infection with this bacterium in some patients.
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Affiliation(s)
| | - Peter J Saunders
- Division of Ophthalmology, Albany Medical Center
- Department of Pathology, Albany Medical Center
| | - Tal J Rubinstein
- Division of Ophthalmology, Albany Medical Center
- Ophthalmic Plastic Surgery, Albany, New York, U.S.A
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18
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Saratziotis A, Zanotti C, Baldovin M, Emanuelli E. Ectopic lacrimal gland in the lacrimal sac mimicking tumour: literature review. BMJ Case Rep 2020; 13:13/7/e235187. [PMID: 32699057 DOI: 10.1136/bcr-2020-235187] [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] [Indexed: 11/03/2022] Open
Abstract
An 80-year-old man referred with repeated episode of dacryocystitis from the left lacrimal drainage system and palpable swelling. For many years, he has being presented with epiphora unilaterally with chronic dacryocystitis. Investigations with dye-test revealed subocclusion of the natural passage of the tears, and CT and MRI scans revealed solid mass in the lacrimal sac. The lacrimal sac was opened by endonasal endoscopic approach, the sacral mass was identified and completely removed. The histopathological examination showed lacrimal gland in ectopic position. Patient followed for 18 months with complete recovery of symptoms. In our differential diagnosis, the ectopic lacrimal gland is also identified, when a mass in the lacrimal sac and duct is present. Successful surgical excision required considerable multidisciplinary teamwork between ophtalmologist-ENT (Otolaryngologist) and radiologist. Endonasal endoscopic approach is perfectly safe with direct control and ensures a smooth postoperative recovery.
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Affiliation(s)
- Athanasios Saratziotis
- ENT Department of Otolaryngology, General University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Claudia Zanotti
- Otolaryngology and Otologic Surgery, University of Padova, Padova, Veneto, Italy
| | - Maria Baldovin
- Otolaryngology and Otologic Surgery, University of Padova, Padova, Veneto, Italy
| | - Enzo Emanuelli
- Otolaryngology and Otologic Surgery, University of Padova, Padova, Veneto, Italy
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19
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Chen X, Liu Y. Efficacy of nasal endoscopic dacryocystorhinostomy for chronic dacryocystitis: A systematic review protocol of randomized controlled trial. Medicine (Baltimore) 2019; 98:e14889. [PMID: 30896635 PMCID: PMC6708894 DOI: 10.1097/md.0000000000014889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aims to assess the efficacy and safety of nasal endoscopic dacryocystorhinostomy (NED) for patients with chronic dacryocystitis (CD). METHODS The following 7 electronic databases will be searched from inception to the present: Cochrane Library, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. In addition, the clinical trials registry and reference lists of included studies will also be searched. We will only include randomized controlled trials of NED for CD in this systematic review. Two review authors independently carry out the study selection, data extraction, and methodological quality assessment. Whenever it is possible, we will pool the data and conduct meta-analysis by using RevMan 5.3 software. RESULTS This study will evaluate the efficacy and safety of NED for patients with CD. The primary outcome includes success rate of ostial patency. The secondary outcomes consist of duration of surgery, quality of life, postoperative complications, and surgeon's comfort. CONCLUSION The findings of this study may summarize the latest evidence of NED for patients with CD. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019123664.
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Affiliation(s)
- Xiao Chen
- Department of Ophthalmology, Yangling Demonstration District Hospital, Yangling
| | - Yang Liu
- Department of Ophthalmology, Yan’an People's Hospital, Yan’an, China
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20
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Islam MR, Wadud SA, Akhanda AH, Rahman MS, Habibullah M, Kabir MS, Rahman MH, Motaleb MA, Islam MM, Haque M, Chowdhury FQ. Outcome of Transcanalicular Endolaser and External Dacryocystorhinostomy in Chronic Dacryocystitis. Mymensingh Med J 2018; 27:673-678. [PMID: 30487479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nasolacrimal duct obstruction due to chronic dacryocystitis is the most common cause of epiphora. Dacryocystorhinostomy (DCR) is the treatment of choice for chronic dacryocystitis. This can be carried out by external, endoscopic and endolaser surgical approach. Though external DCR is still a gold standard and most popular method, the latest procedure of less traumatic DCR is transcanalicular approach. The study was done to evaluate the outcome of Transcanalicular Endolaser DCR regarding epiphora and surgery related complications by measuring anatomical success rate (patency assessed by irrigation), functional success rate (symptom free) and complication rate and to compare with External DCR (Ext-DCR). This prospective interventional study was conducted from October 2011 to September 2012 in Ophthalmology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Total 62 patients included in the study as per inclusion and exclusion criteria of them 31 for TCEL-DCR and 31 for Ext-DCR. But during follow-up one patient was dropped from each group and finally outcome of 30 patients analyzed in each group. Mean age of the patients TCEL-DCR was 38.3±11.54 and of Ext-DCR was 38.4±14.01. In both groups females were the most sufferer (female: male = 1.5: 1). Functional and anatomical success rate of TCEL-DCR showed 93.3% and 83.3% after 3 months; 83.3% and 76.7% after 6 months respectively. Statistically non-significant difference was observed about success rate in comparison between groups. Per-operative complications were pain excessive bleeding. In TCEL-DCR pain complained 13.3% and excessive bleeding occurred in 3.3%. Where as in Ext-DCR pain complained 16.7% and excessive bleeding occurred in 20%; difference was statistically significant (p=0.001). Post-operative complications were bleeding and scar formation. Bleeding occurred in TCEL-DCR 6.67% and in Ext-DCR 10%. So, TCEL-DCR could be an alternative option for the treatment of chronic dacryocystitis especially for those patients who are conscious about scar formation and afraid about Ext-DCR technique.
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Affiliation(s)
- M R Islam
- Dr Muhammad Rafiqul Islam, Junior Consultant, Department of Ophthalmology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh
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21
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Abstract
RATIONALE Sporotrichosis is the most common subcutaneous mycosis. It is caused by the dimorphic fungus Sporothrix schenckii. Ocular sporotrichosis is uncommon and has been rarely reported. PATIENT CONCERNS We describe a 34-year-old female who presented with a nodule increasing in size near the medial angle of the left eye. Originally, she was misdiagnosed with a dacryocyst space-occupying lesion, and the lesion was removed by surgery. DIAGNOSES Findings of fungal structures in the histopathological examination contributed to the diagnosis of Sporothrix dacryocystitis. Further culture of conjunctival secretions and contact lens storage solution was positive for Sporothrix. INTERVENTIONS She was treated with oral itraconazole, 200 mg by mouth twice daily. OUTCOMES After 3 months of treatment with oral itraconazole, culture of the conjunctival secretions was negative. LESSONS It is of paramount importance to clinically suspect mycosis, even in unusual locations or in the absence of the typical epidemiological history.
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Affiliation(s)
- Lixia Sun
- Department of Ophthalmology, Yanbian University Affiliated Hospital, Yanbian University, Yanji
| | - Yaru Dong
- Department of Ophthalmology, Second Hospital of Jilin University, Jilin University, Changchun
| | - Xin Wang
- Department of Ophthalmology, Jiin Guowen Hospital, Gongzhuling
| | | | - Min Zhang
- Department of Pathology, Second Hospital of Jilin University, Jilin University, Changchun, Jilin, P.R. China
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22
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Orhan M, Onerci M, Dayanir V, Orhan D, Irkeç T, Irkeç M. Lacrimal Sac Dacryolith: A Study with Atomic Absorption Spectrophotometry and Scanning Electron Microscopy. Eur J Ophthalmol 2018; 6:478-80. [PMID: 8997597 DOI: 10.1177/112067219600600425] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dacryoliths are uncommon causes of partial or complete obstruction of the nasolacrimal drainage apparatus. We report our findings of a dacryolith that we studied by culture, light microscopy, atomic absorption spectrophotometry, and scanning electron microscopy. Although no fungi were recovered by culturing, hyphae-like structures were observed. No inorganic material was detected by atomic absorption spectrophotometry. Scanning electron microscopy of ultrastructure showed the stone was composed of lobes and lobules built on an amorphous core material.
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Affiliation(s)
- M Orhan
- Department of Ophthalmology, Hacettepe University, School of Medicine, Ankara, Turkey
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23
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Abstract
To evaluate the dacryocystectomy (DCT) outcomes for chronic dacryocystitis in an elderly population over 70 years old. A retrospective chart review was performed for patients over 70 years old who were diagnosed with chronic dacryocystitis and underwent DCT at the Botucatu School of Medicine, UNESP, Brazil, from 2007 to July 2014. Data were collected about patient demographics, age, gender, previous nasal, or ophthalmic diseases, symptoms related to the lacrimal drainage system preoperatively and postoperatively, signs of enlargement of the lacrimal sac (regurgitation of secretion), and histopathologic evaluation. The study sample was comprised of 17 patients with an average age of 76.5 ± 8.5 years. The major complaint for all patients was tearing and 17.6% patients had an additional complaint of discharge. Regurgitation of secretion with lacrimal sac expression was present in 76.5% of patients. Postoperatively, 76.5% of the patients reported improvement of the initial complaint, likely due to the total excision of the lacrimal sac which removed the focal site of chronic infection. Epiphora persisted in 23.5% of patients, of whom 11.7% underwent successful lacrimal stent intubation. DCT for chronic dacryocystitis should be considered a primary procedure in individuals over 70 years old. This procedure has a much lower risk to these patients who often have associated comorbidities.
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Affiliation(s)
- Mariana N Meireles
- a Department of Ophthalmology , Botucatu Medical School - UNESP , São Paulo , Brazil
| | - Magda Mh Viveiros
- a Department of Ophthalmology , Botucatu Medical School - UNESP , São Paulo , Brazil
| | - Roberta Lfs Meneghin
- a Department of Ophthalmology , Botucatu Medical School - UNESP , São Paulo , Brazil
| | - Alicia Galindo-Ferreiro
- b King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
- c Department of Ophthalmology , Complejo Asistencial de Palencia , Palencia , Spain
| | | | - Silvana A Schellini
- a Department of Ophthalmology , Botucatu Medical School - UNESP , São Paulo , Brazil
- b King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
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24
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Abstract
A 31-year-old woman presented with a prominent, yellowish conjunctival mass in the left temporal canthus that had persisted for 3 months despite previous puncture. Repeat incision and curettage produced an 8 mm long concretion. A histopathological examination revealed a dacryolith in the lacrimal duct. This pathology is very rare in this location but has to be considered as a differential diagnosis when patients present with prominence and discomfort in the area of the temporal canthus. The treatment of choice is resection of the dacryolith and irrigation of the lacrimal ducts with penicillin.
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Affiliation(s)
- C Holtmann
- Klinik für Augenheilkunde, Universitätsaugenklinik Düsseldorf, Universitätsklinikum der Heinrich Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - M Brachert
- Klinik für Augenheilkunde, Universitätsaugenklinik Düsseldorf, Universitätsklinikum der Heinrich Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - K Spaniol
- Klinik für Augenheilkunde, Universitätsaugenklinik Düsseldorf, Universitätsklinikum der Heinrich Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - M Roth
- Klinik für Augenheilkunde, Universitätsaugenklinik Düsseldorf, Universitätsklinikum der Heinrich Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - C Cacchi
- Institut für Pathologie, Universität Düsseldorf, Düsseldorf, Deutschland
| | - G Geerling
- Klinik für Augenheilkunde, Universitätsaugenklinik Düsseldorf, Universitätsklinikum der Heinrich Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
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25
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Demarco R, Strose A, Araújo M, Valera FCP, Moribe I, Anselmo-Lima WT. Endoscopic Revision of External Dacryocystorhinostomy. Otolaryngol Head Neck Surg 2016; 137:497-9. [PMID: 17765783 DOI: 10.1016/j.otohns.2007.03.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 03/13/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES: To observe the benefit of endoscopic surgery for the treatment of lacrimal duct obstruction in revisional surgeries after external dacryocystorhinostomy. STUDY DESIGN AND SETTING: Retrospective nonrandomized study. Eleven cases of recurrent lacrimal duct obstruction after external dacryocystorhinostomy were submitted to endoscopic dacryocystorhinostomy. RESULTS: The rate of success after revisional surgery was 90.9%. The major causes of failure of the external approach were the presence of granulation tissue, septal deviations and synechiae near the opening of the fistula, inadequate removal of the bony wall adjuvant the lacrimal sac, technical error in the localization of the lacrimal sac, and excessive perioperative bleeding that impaired the surgical field. CONCLUSION: Endoscopic dacryocystorhinostomy in revisional cases proved to be a safe technique of low morbidity, permitting effective resolution of the lacrimal obstructions. SIGNIFICANCE: Endoscopic surgery allows greater visibility of the lacrimal sac and its neighbor anatomic alterations and leads to better results.
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Affiliation(s)
- Ricardo Demarco
- Department of Ophthalmology, Otorhinolaryngology-Head and Neck Surgery, University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil-USP
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Hossain MI, Nahar L, Rashid MA. Re-DCR with Silicone Tube Intubation: An Effective Method of Management of Failed DCR. Mymensingh Med J 2015; 24:661-664. [PMID: 26620000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This prospective observational study was performed with twenty nine eyes of Twenty eight patients who were operated upon for chronic dacryocystitis eight months to two years six months before, presented with history of persistent watering and discharge. Number of male was 6(21%) and female was 22(79%). Re-DCR with silicone tube intubation was performed in all the patients. Post operative follow up for a period of 12-24 months revealed absence of symptoms in 28 eyes (97%) while 1(3%) eye persisted with watering and discharge despite uncomplicated surgical procedure. There are so many options for management of Failed DCR, among them Re-DCR with Silicone Tube Intubation is the most safe and less cost effective method.
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Affiliation(s)
- M I Hossain
- Dr Md Ismail Hossain, Assistant Professor, Department of Ophthalmology, Mymensingh Medical College, Mymensingh, Bangladesh
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Kurdi M, Allen L, Wehrli B, Chakrabarti S. Solitary fibrous tumour of the lacrimal sac presenting with recurrent dacryocystitis. Can J Ophthalmol 2015; 49:e108-10. [PMID: 25284109 DOI: 10.1016/j.jcjo.2014.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/23/2014] [Accepted: 05/26/2014] [Indexed: 11/19/2022]
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Başal Y, Güleç G, Ertuğrul B, Eryilmaz A, Günel C, Başak S. Changes in nasal flora one year after endoscopic dacryocystorhinostomy. B-ENT 2015; 11:129-134. [PMID: 26563013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
PURPOSE This study investigated changes in patient nasal and conjunctival flora one year after endoscopic dacryocystorhinostomy (EDSR). METHODS The prospective study included 20 patients that underwent EDSR due to chronic dacryocystitis. Conjunctival and nasal cultures were obtained one year after EDSR from both study and control groups. Patient characteristics, chronic illnesses, the severity and duration of complaints, culture results, and the stent removal time were recorded and analyzed. RESULTS In the study group, the most commonly isolated microorganism in the nasal cultures was coagulase-negative staphylococcus (n = 11), and the second most commonly isolated microorganism was Staphylococcus aureus (n = 7). A total of 11 (55%) of the nasal cultures in the study group showed the presence of multi-drug resistant (MDR) bacteria, as did 2 (10%) of the nasal cultures in the control group (p = 0.007). CONCLUSIONS One year after EDSR surgery with silicon stent placement, we detected changes in the nasal flora in the operated side compared with the non-operated side. Even though more than half of the nasal cultures in the study group were positive for MDR bacteria, these microorganisms did not cause attacks of dacryocystitis or affect surgical success.
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Jakobiec FA, Rashid A, Lane KA, Kazim M. Granulomatous dacryoadenitis in regional enteritis (crohn disease). Am J Ophthalmol 2014; 158:838-844.e1. [PMID: 25036879 DOI: 10.1016/j.ajo.2014.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the clinical and immunopathologic features of 2 patients with bilateral dacryoadenitis associated with regional enteritis. DESIGN Retrospective, clinicopathologic study. METHODS Clinical records, photographs, and imaging studies were reviewed and microscopic sections of lacrimal gland biopsy samples were critically re-evaluated. The microscopic slides were stained with hematoxylin and eosin, special stains for organisms, and a range of immunohistochemical biomarkers, including CD3, CD4, CD5, CD8, CD20, CD68, CD138, CD1a, and immunoglobulins Ig G, IgG4, and IgA. RESULTS Both patients were young women with a well-established diagnosis of regional enteritis. Histopathologic examination of biopsy samples disclosed moderate intraparenchymal fibrosis and lymphoplasmacytic infiltrates without lymphoid follicles. Small to medium intraparenchymal, noncaseating granulomas lacking multinucleated giant cells and, in 1 patient, CD68-positive and CD1a-negative palisading granulomas in widened interlobular fibrous septa were detected. Vasculitis and IgG4 plasma cells were not observed. Additional immunohistochemical studies revealed that CD8 T lymphocytes (suppressor or cytotoxic subset) predominated over CD4-positive T lymphocytes (helper cells) surrounding the necrobiotic foci and were intermixed with the CD68-positive histiocytes in the absence of CD20 B lymphocytes. Special stains for organisms demonstrated negative results. CONCLUSIONS Dacryoadenitis is the rarest form of ocular adnexal involvement in regional enteritis, which affects the orbit far more frequently than ulcerative colitis. It is a granulomatous process with the possibility of palisading necrobiotic foci. In contrast, ulcerative colitis causes an interstitial lymphocytic and nongranulomatous myositis. Sarcoidosis, Wegener granulomatosis, and pseudorheumatoid nodules must be ruled out. Treatment options entail a wide variety of agents with selection based on empirical considerations and tailored to the patient's symptoms.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Alia Rashid
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | | | - Michael Kazim
- Edward S. Harkness Eye Institute of the New York Hospital Presbyterian Medical Center, and Columbia University, New York, New York
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Li D, Ding J. [Whether external dacryocystorhinostomy will be abandoned]. Zhonghua Yan Ke Za Zhi 2014; 50:566-568. [PMID: 25385373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
External dacryocystorhinostomy (DCR) has long been considered as the gold standard treatment for nasolacrimal duct obstruction or chronic dacryocystitis. Recently, however, endoscopic endonasal DCR is becoming increasingly popular with the development of endoscopic surgery technique in naso-orbit related diseases. Endoscopic DCR has the advantages of avoiding an external incision scar and simultaneously handling with nasal conditions. Nevertheless, the new method also has some disadvantages, for example, the lower long-term success rate, the high technical requirement, long learning curves, expensive equipment and the high cost of surgery. The choice of the surgical approaches should be based on the patient's condition, experience of the surgeon and available resources. After nearly a century of proven, external DCR still has incomparable superiority and should receive widespread attention and application.
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Affiliation(s)
- Dongmei Li
- Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China.
| | - Jingwen Ding
- Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
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Mohamad S, Khan I, Shakeel M. Authors' response. Ann R Coll Surg Engl 2014; 96:173-4. [PMID: 24895763 PMCID: PMC4474263 DOI: 10.1308/rcsann.2014.173a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mostovych NK, Rabinowitz MR, Bilyk JR, Pribitkin EA. Endoscopic ultrasonic dacryocystorhinostomy for recurrent dacryocystitis following rhinoplasty. Aesthet Surg J 2014; 34:520-5. [PMID: 24658062 DOI: 10.1177/1090820x14526615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The lacrimal sac is the structure most vulnerable to injury when performing rhinoplastic osteotomies. When performed in a low lateral position or along the frontal process of the frontal-maxillary suture, osteotomies can potentially tear the medial canthal tendon and injure the underlying lacrimal sac, possibly resulting in dacryocystitis. In this case report, the authors discuss a case of dacryocystitis following primary rhinoplasty; this injury was repaired with endoscopic dacryocystorhinostomy (DCR) using a Sonopet ultrasonic bone aspirator (Stryker, Kalamazoo, Michigan) at a single institution. This method achieved nasolacrimal duct patency, and the patient continued to be symptom-free at an 18-month follow-up. This is the first reported case of recurrent dacryocystitis following rhinoplasty as treated by endoscopic DCR. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Nadia K Mostovych
- Dr Mostovych and Dr Rabinowitz are Residents and Dr Pribitkin is a Professor in the Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Wang B, Yu W, Ji J. [The treatment of recurrent traumatic dacryocystitis experience]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28:341-342. [PMID: 25185295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
PURPOSE To evaluate the success of lacrimal sac empyema incision and drainage followed by early external dacryocystorhinostomy. METHODS Interventional consecutive case series conducted in Farabi Eye Hospital between August 2007 and November 2010. Patients with acute dacyocystitis and lacrimal sac empyema underwent incision and drainage, followed by early (less than 4 weeks) external DCR. Data collection included patient demographics, past medical history, procedure technique, culture results, and formation of a persistent cutaneous fistula. RESULTS A total of 32 patients were included: 87.5% had a positive history of chronic epiphora before dacryocystitis. Of these 32 cases, 55.6% had positive culture. Staphylococcus aureus was the most common organism with 8 isolates (38%). The average number of days between empyema drainage and DCR was 11.44 days. All patients had complete resolution of dacryocystitis, with no recurrence during the follow-up period. Neither of 32 patients treated with early DCR after primary empyema drainage, developed a persistent lacrimal-cutaneous fistula. CONCLUSIONS Incision and drainage of the lacrimal sac empyema followed by early external dacryocystorhinostomy can be an appropriate treatment strategy for acute dacryocystitis.
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Affiliation(s)
- Bahram Eshraghi
- Department of Ophthalmology, Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
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Xu B, Qiu Y, Zhao H. [Twenty-three cases of recurrent dacryocystitis treated with modified silicone mold implantation]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 27:602-603. [PMID: 23987012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To observe the surgical therapeutic effects of dacryorhinocystotomy under nasal endoscope combined with the application of modified silicone mold implantation for postoperative recurrent dacryocystitis. METHOD The research method is to conduct the dacryorhinocystotomy under nasal endoscope to 23 cases(24 eyes) of recurrent dacryocystitis, in the process of which modified silicone mold is implanted under the nasal mucosa. RESULT During a follow-up of 6-12 months to the 23 cases (24 eyes), 18 eyes were cured, 6 eyes were getting setter and there was no recurrence. CONCLUSION It's concluded that the modified silicone mold implantation can avoid the recurrent atresia of the aperture created by the dacryorhinocystotomy, which proves that the combination with the modified silicone mold implantation in dacryorhinocystotomy is an effective treatment method of curing recurrent dacryocystitis.
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Affiliation(s)
- Bingxing Xu
- Department of Otolaryngology, the Ninth People's Hospital of Nanyang, Nanyang, 473065, China.
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Abstract
INTRODUCTION This study aimed to evaluate the short and long-term results of endoscopic dacryocystorhinostomy (DCR) with and without silicone stenting in chronic dacrocystorhinitis due to postsaccal blockage. METHODS The study involved a case series of consecutive 89 patients (128 eyes) who underwent endoscopic DCR. All patients were operated on by the senior author. The stent group comprised 63 eyes (44 patients), for which the DCR was performed between September 2002 and September 2005. The non-stent group with 65 eyes (45 patients) underwent the DCR between October 2005 and December 2006. The follow-up duration was up to 33 months after surgery. The statistical significance (p-value) was calculated using the chi-squared test. RESULTS The short-term success rate at six months' follow-up was 70% in the stent group and 97% in the non-stent group (p=0.0005) while the long-term success rate at 33 months was only 57% in stent group compared with 89% in the non-stent group (p=0.0003). CONCLUSIONS In this study, the non-stent group showed a higher success rate than the stent group on both short and long-term follow-up. Our study suggests that postoperative stents are not necessary for primary DCR and may be associated with a worse outcome.
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Yu G, Hu M, Liu W, Zhang CY, Cui YH, Fan YW, Cao WH, Lin Q, Cui J, Wu Q. [Congenital dacryocystocele: presentation and treatment]. Zhonghua Yan Ke Za Zhi 2013; 49:263-267. [PMID: 23866709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To report the presentation, complications, and treatment strategies for infants with congenital dacryocystocele. METHOD We performed a retrospective chart review of all patients presenting with dacryocystoceles to Beijing Children's Hospital between 2007 and 2011. RESULTS Thirty-one patients (33 eyes) were identified, presenting at a median age of 10 days of life. Twenty-four (72.72%) patients presented with cellulitis or dacryocystitis and required systemic antibiotics. Two (6.45%) patients presented with respiratory compromise. Resolution occurred with conservative treatment for 6 eyes, but 27 (81.82%) required surgical intervention. All 27 eyes received probing, and 20 (74.07%) were successful. The other 7 eyes required marsupialization of an intranasal cyst. CONCLUSIONS Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require surgical intervention. Referral in the early neonatal period can aid in timely intervention before complications such as infection occur.
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Affiliation(s)
- Gang Yu
- Department of Ophthalmology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
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Beloglazov VG, At'kova EL, Abdurakhmanov GA, Krakhovetskiĭ NN. [Prevention of ostial obstruction after microendoscopic endonasal dacryocystorhinostomy]. Vestn Oftalmol 2013; 129:20-23. [PMID: 23808175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ostial dilatator was created to prevent recurrence and improve efficacy of microendoscopic endonasal dacryocystorhinostomy. Proposed technique was for the first time used in 52 patients. Postoperative results were analyzed: recovery was achieved in 78% of cases, improvement - in 22%. In a control group (51 patients) we used conventional technique, recovery was achieved in 67% of patients and improvement in 28%, in 5% recurrence occurred. The use of ostial dilatator resulted in microendoscopic endonasal dacryocystorhinostomy efficacy improvement.
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Kou G. [Dacryocystorhinostomy and trumpet-shaped tube placement under nasal endoscopy for the treatment of chronic dacryocystitis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 27:94-95. [PMID: 23650711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Ari S, Cingu K, Şahin A, Özkök A, Çaça I. The outcomes of surgical treatment in fistulous dacryocystitis. Eur Rev Med Pharmacol Sci 2013; 17:243-246. [PMID: 23377815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to evaluate the outcomes of surgical management in fistulous dacryocystitis cases associated with nasolacrimal duct (NLD) obstruction. MATERIALS AND METHODS Twenty-two patients (14 female, 8 male) with fistulous dacryocystitis were included. The patients were divided into two groups as congenital (Group I) and acquired (Group II) groups. Fistula excision (FE) together with external dacryocystorhinostomy (DCR) and bicanalicular silicon tube (FCI Ophthalmics, Marshfield Hills, MA, USA) intubation (BSTI) were performed following medical therapy (Ofloxacin 0.3 % four times a day,intravenous cefazolin (50 mg/kg/day in children and 2 g/day in adults and gentamicin (5 mg/kg/day in children and 3 mg/kg/day in adults). The groups were compared with each other in terms of preoperative medical therapy duration, time of silicone tube extubation, follow-up time, and surgical outcomes. RESULTS Group I included five patients with acute dacryocystitis and seven patients with recurrent dacryocystitis following probing, whereas Group II was comprised of 8 acute dacryocystitis and two recurrent fistulous dacryocystitis. Mean length of preoperative medical therapy was 14.1±6.5 days for Group I and 11.9±2.5 days for Group II. Extubation of the silicone tube was performed after 4.5±1.2 months in Group I and after 4.6± 1.1 months in Group II. The patients were followed up for 13.5±4.8 months in Group I and 14.3±3.7 months in Group II. There was no significant difference between the two groups in length of preoperative medical therapy, time of extubation of the silicone tube, and follow-up time (p > 0.05). Postoperatively, patency of the nasolacrimal drainage system was verified by irrigation of the lacrimal ducts and use of fluorescein eye stain. In both groups, all patients underwent surgical treatment were treated successfully. CONCLUSIONS In fistulous dacryocystitis cases associated with the obstruction of NLD application of FE, external DCR treatment and BSTI appears as a valid surgical treatment option.
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Affiliation(s)
- S Ari
- Department of Ophthalmology, School of Medicine, Dicle University Diyarbakir, Turkey.
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Abstract
Dacryocystitis related to Stenotrophomonas maltophilia is rare. We describe a case of Strenotrophomonas maltophilia-related chronic dacryocystitis with associated coagulase-negative Staphylococcus. Following external dacryocystorhinostomy without intraoperative or postoperative antibiotics, her discharge and lacrimal sac fullness resolved.
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Affiliation(s)
- Douglas P Marx
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.
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Zhou J, Li B, Li Y. [Clinical analysis on endoscopic nasal dacryocystorhinostomy for recurrent dacryocystitis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 26:1142-1143. [PMID: 23477124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Hanada K, Miyokawa N, Sano A, Igarashi S, Yoshida A. [Fungal dacryocystitis with cacosmia after penetrating keratoplasty--taxonomy and identification of pathogenic fungi based on DNA sequence analysis]. Nippon Ganka Gakkai Zasshi 2012; 116:1144-1149. [PMID: 23379204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CASE A 76-year-old woman with a history of penetrating keratoplasty had cacosmia associated with dacryocystitis. Two species of yeast-like fungi were isolated from the contents of her lacrimal sac. Each cultured fungus had a unique, distinctive odor. Althogh treated with an oral antifungal agent and washing of the nasolacrimal duct, the cacosmia was not improved. The continuous dacryocystitis with cacosmia was treated by dacryocystectomy. Two yeast-like fungi were again isolated from the contents of the lacrimal sac. Pathological examination confirmed a diagnosis of fungal dacryocystitis based on the fungal hyphae observed on the excised lacrimal sac wall. The cacosmia promptly disappeared. The fungi isolated from the contents of lacrimal sac were identified by DNA sequencing as Wickerhamomyces anamalus (Pichia anomala-Candida pelliculosa) and Galactomyces geotrichum (Geotrichum candidum). CONCLUSION The cause of cacosmia in the present case was fungal dacryocystitis. Antibiotic eye drops and steroid eye drops for the treatment of penetrating keratoplasty can cause atypical fungal presentation in the inconsistently treated lacrimal system and can induce dacryocystitis. Careful usage and consideration is necessary in the long-term use of antibiotics and steroids following corneal transplantation.
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Affiliation(s)
- Kazuomi Hanada
- Department of Medicine and Engineering Combined Research Institute, Asahikawa Medical University, Hokkaido, Japan.
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Chen P, Zuo J, Mao Q. [Fifty two patients with chronic dacryocystitis treated by dacryocystorhinostomy under endoscope and T drainage tube inserting]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 26:664-665. [PMID: 23156814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Yoshida N, Kanazawa H, Shinnabe A, Iino Y. Powered endoscopic dacryocystorhinostomy with radiowave instruments: surgical outcome according to obstruction level. Eur Arch Otorhinolaryngol 2012; 270:579-84. [PMID: 22695876 DOI: 10.1007/s00405-012-2065-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 05/22/2012] [Indexed: 11/25/2022]
Abstract
Endoscopic endonasal dacryocystorhinostomy (EDCR) is an accepted alternative to external dacryocystorhinostomy (DCR) for relieving obstruction of the lacrimal drainage system. Powered and radiowave instruments are useful for the control of bleeding and for wide exposure of the lacrimal sac and canaliculus. In this study, we evaluated the surgical outcome of powered EDCR with radiowave instruments at five obstruction levels: (1) upper and/or lower canaliculi (obstruction was located less than 8 mm from puncta); (2) common canaliculus (obstruction was less than 10 mm from puncta); (3) lacrimal sac; (4) duct-sac junction; and (5) nasolacrimal duct. The overall success rate was 93.6 % (104/111), with 60.0 % (3/5) success for upper and lower canalicular stenosis, 85.0 % (17/20) for common canalicular stenosis, 92.0 % (23/25) for obstruction at the lacrimal sac, 100 % (41/41) for obstruction at the duct-sac junction, and 100 % (20/20) for nasolacrimal duct obstruction. EDCR resulted in a good overall surgical outcome for any obstruction of the lacrimal drainage pathway compared with external DCR. Powered EDCR using radiowave instruments is useful for not only obstruction of the lacrimal sac and duct-sac junction, but also for that of the upper/lower and common canaliculi.
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Affiliation(s)
- Naohiro Yoshida
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Saitama 330-8503, Japan.
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Prasannaraj T, Kumar BYP, Narasimhan I, Shivaprakash KV. Significance of adjunctive mitomycin C in endoscopic dacryocystorhinostomy. Am J Otolaryngol 2012; 33:47-50. [PMID: 21392851 DOI: 10.1016/j.amjoto.2011.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/16/2010] [Accepted: 01/24/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to observe the effect of intraoperative topical application of mitomycin C (MMC) on the results of endoscopic dacryocystorhinostomy. DESIGN This is a prospective, randomized, controlled, single-blind study. SETTINGS Hospitalized treatment was done in a tertiary medical college hospital and research center that deals with a predominantly rural population. PATIENTS Patients with primary acquired postsaccal obstruction causing chronic dacryocystitis were considered. METHODS A total of 38 patients were randomized into either a mitomycin group or a control group. Both of these groups were subjected to an identical surgical procedure, except that 0.2 mg/dL of MMC was used in the mitomycin group, whereas normal saline was used in the control group. The follow-up period was at least 6 months. An asymptomatic patient with a visible stoma at nasendoscopy and free flow of saline into the nose with lacrimal syringing after 6 months after surgery was used as criteria for defining a successful result. RESULTS The success rate was 82.3% when MMC was used and 85.7% among the controls (P > .05). Granulations, adhesions, and obliterative sclerosis occurred in a similar number of patients of both groups. However, granulations and adhesions did not have a bearing on the success rate in either group. CONCLUSION Mitomycin C did not appear to influence the occurrence of granulations, synechiae, or obliterative sclerosis, nor did it alter the success rate significantly.
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Affiliation(s)
- Thomas Prasannaraj
- Department of Otorhinolaryngology, R.L. Jalappa Hospital and Research Centre, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education, Tamaka, Kolar, India.
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Abstract
PURPOSE To analyze the clinical and microbiological characteristics and factors associated with the outcome of lacrimal canaliculitis. METHODS Thirty four patients (34 eyes) treated for lacrimal canaliculitis between January 2001 and December 2006 in a tertiary medical centre were retrospectively reviewed. Clinical and microbiological profiles, treatment outcome, and risk factors related to recurrence and concretions formation were evaluated. RESULTS There were 10 males and 24 females with a mean age of 64 years. The average time lapse to diagnosis was 18 months. Lower canaliculus (91%) was most commonly involved. Six patients (18%) had both upper and lower canaliculitis. Culture positive specimens were 21 of 25 (84%), with a mixed infection of 7 (28%). Streptococcus species (28%), Staphylococcus species (20%), and Actinomyces (16%) were the most commonly cultured organisms. Concretions were noted in nine patients (26%). All cultures of concretions were positive. No specific factor was found to be related to concretions formation. Canaliculotomy was performed in 25 patients (74%). Recurrence developed in seven patients (21%), with a mean time to recurrence of 24 months. Multivariate analysis demonstrated that male patients (p=0.038) and presence of concretions (p=0.001) were associated with higher recurrent rate. Both patients with Haemophilus influenzae isolate developed recurrence (100%). CONCLUSION Canaliculitis are often delayed diagnosed and prone to recur or persist. Male gender and concretions are important risk factors for recurrence. Surgical removal of all possible concretions is essential for cure.
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Affiliation(s)
- Shuai-Chun Lin
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
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Wu S, Zhu G, Xiao D, Cao J. [Modified intranasal endoscopic dacryocystorhinostomy in chronic dacryocystitis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011; 25:873-875. [PMID: 22242468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the technique and curative effect of modified intranasal endoscopic dacryocystorhinostomy (EDCR) for chronic dacryocystitis. METHOD Twenty-two patients (Twenty-three eyes)with chronic dacryocystitis, undergoing modified intranasal EDCR were retrospectively analyzed in this study. RESULT The follow-up period ranged from six months to ten months. Twenty eyes were cured successfully and two eyes had relieved symptoms. While one case failed. No serious complications were found. The total effective rate was 22/23 (95.7%). CONCLUSION The modified intranasal EDCR is an effective method to treat chronic dacryocystitis.
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Affiliation(s)
- Sihai Wu
- Department of Otorhinolaryngology, the Wuxi No. 2 People's Hospital, Wuxi, 214002, China.
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Zhou B, Han DM. [The rules and experiences of endoscopic surgery for common nose-eye related diseases]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011; 46:874-876. [PMID: 22321433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Smirnov G, Pirinen R, Tuomilehto H, Seppä J, Teräsvirta M, Uusitalo H, Nuutinen J, Kaarniranta K. Strong expression of HSP47 in metaplastic nasal mucosa may predict a poor outcome after primary endoscopic dacryocystorhinostomy: a prospective study. Acta Ophthalmol 2011; 89:e132-6. [PMID: 19785638 DOI: 10.1111/j.1755-3768.2009.01654.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Dacryocystorhinostomy (DCR) is an effective and safe procedure for patients with post-saccal obstruction of the nasolacrimal pathway. The aim of DCR is to relieve symptoms by creating a bypass between the lacrimal sac and the nasal cavity. The most common reason for failure is stenosis caused by a fibrotic process at the rhinostomy site. In this prospective study we assessed the expression of heat shock protein 47 (HSP47), a regulator of fibrosis, in the biopsies of nasal mucosa isolated from patients undergoing primary endoscopic DCR (EN-DCR). METHODS Thirty consecutive primary EN-DCR procedures in 30 patients were performed using the powered instrumentation technique. The nasal mucosa specimens over the rhinostomy site were collected for histological analysis at the beginning of the operation and the expression of HSP47 was evaluated by immunohistochemistry. The outcome of EN-DCR was estimated in follow-up visits at 1 week, 2 months and 6 months after surgery. RESULTS At the 6-month follow-up, the overall success rate after primary EN-DCR was 83%. A metaplastic change and strong expression of HSP47 in nasal mucosa were associated with EN-DCR failure (p = 0.009). CONCLUSIONS HSP47 may be regarded as a novel marker to predict impaired EN-DCR outcome.
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Affiliation(s)
- Grigori Smirnov
- Department of Otorhinolaryngology, Kuopio University Hospital, Finland.
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