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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] [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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Xiao W, Wang B, Wang X, Zhang G, Zhao Y, Zhang Z, Li L, Qu C. Two-electron oxidized polyphenol chemistry-inspired superhydrophilic drug-carrying coatings for the construction of multifunctional nasolacrimal duct stents. J Mater Chem B 2024; 12:2877-2893. [PMID: 38426303 DOI: 10.1039/d3tb02668j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Nasolacrimal duct obstruction due to infection, inflammation, or excessive fibroblast proliferation may result in persistent tearing, intraocular inflammation, or even blindness. In this study, surface engineering techniques are applied to nasolacrimal duct stents for the first time. Based on the functioning of marine mussels, "one-pot" and "stepwise" methods were employed to construct a novel multifunctional superhydrophilic PDA/RAP coating using dopamine and rapamycin. Micron-sized rapamycin crystals combined with nano-sized polydopamine particles form a micro-nano topographical structure. Therefore, acting synergistically with in situ-generated hydrophilic groups (amino, carboxyl, and phenolic hydroxyl), they impart excellent and long-lasting superhydrophilicity to the nasolacrimal duct stent. The PDA/RAP coating effectively maintained the stability of the initial microenvironment during stent implantation by inhibiting the onset of acute inflammation and infection during the early stages of implantation. Meanwhile, the rapamycin crystals, supported by the superhydrophilic platform, exhibited a sustained-release capability that helped them to better exert their anti-inflammatory, antibacterial, and anti-fibroblast proliferative properties, ensuring conducive conditions for the rapid repair of nasolacrimal duct epithelial cells, verified by a series of experiments. In conclusion, the PDA/RAP hydrophilic coating has anti-inflammatory, antifibrotic, antibacterial, and antithrombotic properties, offering a new strategy to address restenosis following clinical nasolacrimal duct stent implantation.
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Affiliation(s)
- Wenzhe Xiao
- Eye School of Chengdu University of TCM, Chengdu 610075, China
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Binjian Wang
- Eye School of Chengdu University of TCM, Chengdu 610075, China
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Xuemei Wang
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Guanghong Zhang
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yihao Zhao
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Zezhen Zhang
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Linhua Li
- Kidney Research Laboratory, Department of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - Chao Qu
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
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Bian Y, Han X, Li S, Yu B. The Effects of Silicone Tube Intubation During Endoscopic Dacryocystorhinostomy in Patients With Acute Dacryocystitis With Acquired Skin Fistulization. J Craniofac Surg 2023; 35:00001665-990000000-01245. [PMID: 37994855 PMCID: PMC10880931 DOI: 10.1097/scs.0000000000009910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE This study aimed to determine the silicone tube intubation requirement for endoscopic dacryocystorhinostomy (En-DCR) in patients with acute dacryocystitis (AD) with acquired skin fistulization. METHODS Between September 2012 and October 2020, patients with AD and acquired skin fistulization undergoing En-DCR at the Eye Hospital of Wenzhou Medical University were randomized into treatment groups in which silicone tube intubation was carried out or not (groups A and B, respectively). All patients with skin fistulae present for 1+ months at En-DCR underwent fistulectomy. Operative success was assessed at 12 months post En-DCR in both treatment groups. Multiple logistic analyses were performed to assess for influencing factors on surgical success. RESULTS This study evaluated 94 patients for whom complete postoperative data were available, including 45 in group A and 44 in group B. Overall, 15 patients underwent fistulectomy and En-DCR simultaneously (8 from group A; 7 from group B ). At 12-month follow-up, anatomic and functional success rates were higher for patients in group A (93.3%, 86.7%) relative to those in group B (77.3%, 68.2%) (P<0.05). Intranasal ostium obstruction caused lacrimal passage reconstruction failure in group A. In contrast, intranasal ostium and canalicular obstruction caused it in patients in group B. No significant variations in operation success rates across groups were seen when group B cases with canalicular obstruction were eliminated from the analyses (P=0.070, >0.05). Multiple logistic regression analysis showed operative success was significantly influenced by fistulectomy (OR: 1.641, P<0.05) and intubation (OR: -1.559, P<0.05). CONCLUSION These findings imply that in patients with AD with skin fistulization undergoing En-DCR, intraoperative intubation is linked with a lower incidence of canalicular obstruction and positive outcomes. Accordingly, intraoperative intubation should be performed when operating on patients with AD with skin fistulization.
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Affiliation(s)
- Yang Bian
- Department of Ophthalmology, The First People’s Hospital of Changzhou, Changzhou, Jiangsu
| | - Xuemei Han
- Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou
| | - Shuting Li
- Department of Ophthalmology, The First People’s Hospital of Changzhou, Changzhou, Jiangsu
| | - Bo Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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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] [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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Remor BDC, Balsalobre L, Bison SHDVF, Nogueira MHSDP, Meurer ATDO, Bastos DC, Stamm AC. Relationship of the anterior ethmoid sinus to the lacrimal sac: a computed tomography study. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S108-S111. [PMID: 35331654 PMCID: PMC9801027 DOI: 10.1016/j.bjorl.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To analyze the anatomical relationship between the lacrimal sac and the agger nasi cell on Computed Tomography (CT); to correlate the right and left sides on each scan. METHODS CT scans of adult patients were reviewed for pneumatization of the agger nasi and its relationship to the lacrimal sac. The degree of agreement between the right and left sides was also evaluated. RESULTS A total of 130 CT scans were examined. An agger nasi cell was found medial to the lacrimal sac in 59.23% of scans. On 86.15% of scans, pneumatization was similar on both sides. CONCLUSION The agger nasi air cell is located medial to the lacrimal sac in more than half of individuals. The right and left sides exhibit the same pneumatization pattern in approximately 80% of cases. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Beatriz de Costa Remor
- Hospital Edmundo Vasconcelos, Centro de Otorrinolaringologia e Fonoaudiologia, São Paulo, SP, Brazil,Corresponding author.
| | - Leonardo Balsalobre
- Hospital Edmundo Vasconcelos, Centro de Otorrinolaringologia e Fonoaudiologia, São Paulo, SP, Brazil
| | | | | | | | | | - Aldo Cassol Stamm
- Hospital Edmundo Vasconcelos, Centro de Otorrinolaringologia e Fonoaudiologia, São Paulo, SP, Brazil
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Yu B, Xia Y, Sun JY, Ye Q, Tu YH, Zhou GM, Wu WC. Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation. Int J Ophthalmol 2021; 14:844-848. [PMID: 34150538 DOI: 10.18240/ijo.2021.06.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To establish the necessity of silicone tube intubation in acute dacryocystitis (AD) patients undergoing endonasal endoscopic dacryocystorhinostomy (En-DCR). METHODS Patients presenting with unilateral AD were randomly assigned to two treatment groups. En-DCR procedures were performed following lacrimal abscess formation, with the operation being performed with silicone intubation for patients in group B but not group A. Functional success was defined by an absence of additional AD episodes, no epiphora, and ostium patency as established via endoscopic evaluation or fluorescein irrigation. Operative success rates and demographic variables were compared between treatment groups. RESULTS In total, 66 patients were analyzed in the present study (33 per group), with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B, respectively. All patients exhibited complete resolution of acute inflammation. Upon follow-up, granulation tissue was detected around the ostium at higher rates in group B (9/22, 40.9%) relative to group A (4/27, 14.8%). At the 12-month follow-up time point, patients in group A exhibited higher success rates (25/27, 92.6%) relative to patients in group B (20/22, 90.9%), but this difference was not significant. Cases of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ostium. CONCLUSION Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation, cost, and operative duration, these data do not support the routine silicone intubation of AD patients following En-DCR surgery.
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Affiliation(s)
- Bo Yu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yu Xia
- Department of Ophthalmology, Eye Hospital of Jinan, Jinan 250000, Shandong Province, China
| | - Jia-Ying Sun
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Qian Ye
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yun-Hai Tu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Guang-Ming Zhou
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Wen-Can Wu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Sung JY, Kim JM, Hwang JY, Kim KN, Kim J, Lee SB. Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis. J Clin Med 2021; 10:jcm10102161. [PMID: 34067623 PMCID: PMC8155898 DOI: 10.3390/jcm10102161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery. Methods: A retrospective review of medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and an age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were the surgical outcomes at the final follow-up examination. The secondary outcome measure was the clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing the outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days). Results: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery, respectively. In the subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stays, and the duration of antibiotic treatments were significantly shorter after very early EnDCR (all ps < 0.05), whereas the surgical outcomes were not different between the two groups (p = 1.000). Conclusions: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR performed within 3 days leads to faster recovery and shortens the course of antibiotic treatment.
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Affiliation(s)
- Jae Yun Sung
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong 30099, Korea;
| | - Ju Mi Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon 35015, Korea; (J.M.K.); (J.Y.H.); (K.N.K.); (J.K.)
| | - Jae Yul Hwang
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon 35015, Korea; (J.M.K.); (J.Y.H.); (K.N.K.); (J.K.)
| | - Kyoung Nam Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon 35015, Korea; (J.M.K.); (J.Y.H.); (K.N.K.); (J.K.)
| | - Jaeyoung Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon 35015, Korea; (J.M.K.); (J.Y.H.); (K.N.K.); (J.K.)
| | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon 35015, Korea; (J.M.K.); (J.Y.H.); (K.N.K.); (J.K.)
- Correspondence: ; Tel.: +82-42-280-7604; Fax: +82-42-255-3745
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Ali MJ, Mishra DK, Bothra N. Lacrimal Fossa Bony Changes in Chronic Primary Acquired Nasolacrimal Duct Obstruction and Acute Dacryocystitis. Curr Eye Res 2021; 46:1132-1136. [PMID: 33583297 DOI: 10.1080/02713683.2021.1891254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aims to assess the bony lacrimal fossa changes in chronic cases of primary acquired nasolacrimal duct obstruction versus acute dacryocystitis. METHODS A prospective study was performed on 25 bony lacrimal fossae of 25 eyes of 15 patients who underwent endoscopic dacryocystorhinostomy at a tertiary care Dacryology service over a period of 6 months. Ten patients with chronic PANDO (> 1 year) with bilateral involvement and five patients of unilateral acute dacryocystitis were recruited in the study. None of the patients had a history of trauma or previous surgeries or nasal disease in the past. The bone samples from the frontal process of the maxilla and the lacrimal bone were obtained during the osteotomy and subjected to routine histopathological examination. Special stains used were von Kossa, Masson trichrome, periodic acid Schiff, and Alcian blue. Immunohistochemistry was performed using CD68 antibodies. Patient demographics, clinical presentation, duration of the disease, and bony changes were analyzed in different patient subsets. RESULTS The mean disease duration in the chronic PANDO subset was 3.1 years, whereas acute dacryocystitis was 6.8 days. There was no correlation between the bony changes and the laterality in the chronic subset. Periosteal thickness and fibrosis were universal in the chronic group but not in the acute dacryocystitis. There were also differences in the number of osteocytes per sq mm, osteoblast, osteoclast, bony remodeling, bony canals structure, and intrastromal fibrosis between the subsets. These changes within the chronic group increased with the duration of the disease. Interestingly, there was no evidence of any bony inflammation across the subsets in all the samples studied. CONCLUSION Characteristic bony changes can be demonstrated in patients with chronic PANDO but not in acute dacryocystitis. The lack of bony inflammatory infiltrates may provide clues in understanding the peri-sac disease pathogenesis in acute dacryocystitis.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Dilip Kumar Mishra
- Ophthalmic Pathology Laboratory, L.V.Prasad Eye Institute, Hyderabad, India
| | - Nandini Bothra
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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Marqués-Fernández V, De Las Heras Flórez P, Galindo-Ferreiro A. Dacriocistorrinostomía externa, conjuntivo-dacriocistorrinostomía y cirugía de la vía lagrimal en el meato inferior. REVISTA ORL 2020. [DOI: 10.14201/orl.24154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: Realizar una revisión sobre la dacriocistorrinostomía externa (DCR-ext), sondaje de la vía lagrimal y conjuntivodacriocistorrinostomía(CDCR) empleadas ante la obstrucción de la vía lagrimal.
Material y métodos : Revisión bibliográfica sobre técnicas quirúrgicas mencionadas.
Discusión: La obstrucción de la vía lagrimal puede dividirse según su localización en proximales y distales. Ante obstrucciones distales, la DCR ext es la técnica gold standard con porcentajes de éxito superiores al 95%, y la CDCR en caso de obstrucciones proximales.El sondaje de la vía lagrimal es la primera indicación quirúrgica en obstrucción congénita.
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10
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Cohen O, Amos I, Halperin D, Bavnik Y, Milstein A, Shoshani Y, Leiba H, Warman M. Five- and 10-Year Outcomes for Primary Endoscopic Dacryocystorhinostomy: Failure Rate and Risk Factors. Laryngoscope 2020; 131:10-16. [PMID: 32011002 DOI: 10.1002/lary.28528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/30/2019] [Accepted: 01/06/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Endoscopic dacryocystorhinostomy (eDCR) is the preferred approach for nasolacrimal duct obstruction, yet quality data on long-term outcomes is lacking. STUDY DESIGN A retrospective study in a single, academic institution. OBJECTIVE To assess the 5- and 10-year success rates of eDCR, and its associated risks. PATIENTS AND METHODS All eDCRs conducted at Kaplan Medical Center between the years 2002-2017 were included. For long-term follow-up analysis, two subgroups with a minimum of documented 5- and 10-year follow-up after surgery were defined. Surgical success was defined by both anatomical (observed patent lacrimal flow) and functional (symptomatic relief) success. Data was collected from the hospital's electronic medical records and was completed by phone interviews. Pre-, intra-, and postoperative variables were collected and stratified by multivariate analysis. RESULTS After exclusions, 321, 168, and 65 patients were included for immediate, 5- and 10-year outcome analysis, respectively. Overall success rates were 92.5%, 86.3%, and 80%, respectively. The anatomical success rates were 93.8%, 89.9%, and 86.1%, respectively. Multivariate analysis revealed that older age (P < .001, P = .001) previous smoking (P = .043, P = .037), and postoperative complains of epiphora (even when a successful irrigation was observed, P < .001, P = .01) were all associated with eDCR failure 5 and 10 years following surgery. Male gender was also associated with eDCR failure (5 years, P = .045; 10 years, P = .063). CONCLUSIONS Despite decreased rates over time, eDCR is beneficial for the majority of patients also at 10 years following surgery. Older age, smoking, postoperative epiphora, and male gender are related to long-term failure and should be discussed with the patients before surgery. LEVEL OF EVIDENCE 3b Laryngoscope, 131:10-16, 2021.
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Affiliation(s)
- Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Itai Amos
- Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Yosef Bavnik
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Asher Milstein
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Yochai Shoshani
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Hana Leiba
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Meir Warman
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
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Wladis EJ, Khan H, Chen VH. Are systemic antibiotics required during and after dacryocystitis-related dacryocystorhinostomy? Orbit 2019; 39:413-414. [PMID: 31856629 DOI: 10.1080/01676830.2019.1704798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the outcomes of patients with and without a history of dacryocystitis that undergo dacryocystorhinostomy without systemic intra- and post-operative antibiotics. METHODS A retrospective review was performed to identify all cases of patients that received surgery under this paradigm and had at least three months of follow up care. Key demographic and outcome data were captured, and a statistical analysis was performed via a dedicated software package (Microsoft Excel, Redmond, WA). RESULTS For the study period, 83 patients without and 69 patients with a history of dacryocystitis were identified, and the two groups were not statistically significantly different in age, gender, or postoperative follow up duration (mean = 6.4 months for patients without and 6.3 months for those with dacryocystitis, respectively). No patient developed a postoperative infection or a recurrence of dacryocystitis during the follow up period. DISCUSSION While many surgeons routinely use systemic antibiotics in patients with a history of dacryocystitis who undergo dacryocystorhinostomy, these agents may not be necessary. As a result, patients may be able to avoid the complications and side effects inherent to systemic antibiotics. Large-scale, prospective studies will likely help to further clarify this issue.
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Affiliation(s)
- Edward J Wladis
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College , Albany, New York, USA.,Division of Otolaryngology, Department of Surgery, Albany Medical College , Albany, New York, USA
| | - Hirah Khan
- Lions Eye Institute, Department of Ophthalmology, Albany Medical College , Albany, New York, USA
| | - Valerie H Chen
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College , Albany, New York, USA
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Endoscopic dacryocystorhinostomy: reasons for failure. Eye (Lond) 2019; 34:948-953. [PMID: 31595028 DOI: 10.1038/s41433-019-0612-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/06/2019] [Accepted: 07/16/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Endoscopic dacryocystorhinostomy (DCR) is a widely performed and safe procedure for the treatment of nasolacrimal duct obstruction manifested as epiphora or dacryocystitis. Current success rates are above 90%. Data on causes for failure of the procedure are sparse. We investigated the influence of several preoperative parameters on surgery outcome and to establish that parameters are linked with failure. METHODS A retrospective analysis of the medical records of all consecutive patients who underwent endoscopic DCR in the Tel-Aviv Medical Center, a tertiary referral center, between January 2010 and August 2016 were retrospectively examined and data on the occurrence of surgical failure and reasons for failure were retrieved. RESULTS A total of 165 patients (183 eyes) were included. The overall success rate for the surgery was 94.7%. The parameters that correlated significantly with failure were coexisting diabetes mellitus (P = 0.037), allergy to medications (P = 0.034), and prior ocular surgery (P = 0.043). There was no correlation between the surgical failure rates and facial trauma, previous nasal or lacrimal surgery, or the usage of a stent. CONCLUSION Endoscopic DCR is a safe and effective surgical procedure. Diabetes mellitus, allergies, and previous ocular surgery may lead to surgical failure. Patients with these risk factors should be aware of increased failure rates.
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Chong KKL, Abdulla HAA, Ali MJ. An update on endoscopic mechanical and powered dacryocystorhinostomy in acute dacryocystitis and lacrimal abscess. Ann Anat 2019; 227:151408. [PMID: 31465822 DOI: 10.1016/j.aanat.2019.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To provide a brief review of the literature on the utility and outcomes of endoscopic dacryocystorhinostomy (DCR) in patients with acute dacryocystitis (ADC) and lacrimal abscess. METHODS The authors performed a PubMed search of all articles published in English on endoscopic powered or mechanical DCR performed during the stage of acute dacryocystitis. Data captured include demographics, clinical presentations, time interval to surgery, intraoperative challenges, post-operative course, complications and outcomes. Specific emphasis was laid on addressing the intra-operative challenges and post-operative outcomes. RESULTS Increased intra-operative bleeding is a common finding. The use of mitomycin C and silicone intubation are not uncommon and are not reported to have negative influence on the outcomes of surgery. The general consensus is to initiate antibiotics immediately or a day before surgery and continue them in the post-operative period. Symptomatic pain relief was achieved very early (immediate to <3 days) and complete resolution was usually achieved in a week's time. The overall anatomical success rates varied from 81.8 to 96.2% and functional success from 72.7 to 96.2%. Cicatricial closure of the ostium was a common cause of failure. CONCLUSION Primary endoscopic DCR appears to be an effective modality in the management of ADC and lacrimal abscess, and results in a rapid resolution of inflammation while achieving comparable surgical success with a traditional approach of conservative management with or without drainage and 2nd stage external DCR.
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Affiliation(s)
- Kelvin Kam-Lung Chong
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong.
| | | | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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14
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Affiliation(s)
- Akshay Gopinathan Nair
- Advanced Eye Hospital & Institute, Ophthalmic Plastic Surgery & Ocular Oncology Services, Navi Mumbai, India
- Ophthalmic Plastic Surgery & Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, India
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | | | | | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, India
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15
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Bothra N, Naik MN, Ali MJ. Outcomes in pediatric powered endoscopic dacryocystorhinostomy: a single-center experience. Orbit 2018; 38:107-111. [PMID: 29787339 DOI: 10.1080/01676830.2018.1477808] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE The purpose of the article is to report the outcomes of powered endoscopic dacryocystorhinostomy (PEnDCR) in pediatric patients. METHODS A single-center, single surgeon, retrospective, interventional, non-comparative case series was performed on all pediatric patients who underwent PEnDCR between July 2014 and July 2017. Patients with associated congenital anomalies like single punctum agenesis or lacrimal fistula were excluded. Surgery was performed as per standard protocols published earlier. Data collected include demographics, clinical presentations, past interventions, indications for the surgery, intraoperative and postoperative complications, postoperative ostium characteristics, and anatomical and functional success. RESULTS Ninety-one eyes of 83 children underwent PEnDCR during the study period. Mean age was 8.32 years and epiphora was the most common presentation (81%, 74/91). The most common indication for PEnDCR was persistent congenital nasolacrimal duct obstruction refractory to earlier interventions of probing or intubation. Postoperative ostium assessment at 4 weeks showed a well-healed ostium with a dynamic internal common opening in 86.8% of the eyes. Edge granulomas of the ostium were the most common abnormal finding in the postoperative period (9.8%, 9/91) and all except one could be managed conservatively. At 6 months follow-up, five eyes showed anatomical failure and additional two eyes showeXd functional failure. Two of anatomical failure group and one of functional failure underwent a second intervention. The final anatomical and functional success were noted in 96.7% (88/91) and 95.6% (87/91), respectively. CONCLUSIONS This study shows that PEnDCR is a safe surgery for pediatric populations with a high success rate of beyond 95%.
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Affiliation(s)
- Nandini Bothra
- a Govindram Seksaria Institute of Dacryology , L.V. Prasad Eye Institute , Hyderabad , India
| | - Milind N Naik
- a Govindram Seksaria Institute of Dacryology , L.V. Prasad Eye Institute , Hyderabad , India
| | - Mohammad Javed Ali
- a Govindram Seksaria Institute of Dacryology , L.V. Prasad Eye Institute , Hyderabad , India
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Kwok T, Ali MJ, Yuen H. Preferred practice patterns in endoscopic dacryocystorhinostomy among oculoplastic surgeons in Asia-Pacific region. Orbit 2017; 37:248-253. [PMID: 29039995 DOI: 10.1080/01676830.2017.1383480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study is to report the preferred practice patterns in endoscopic dacryocystorhinostomy (EnDCR) among oculoplastic surgeons practicing in the Asia-Pacific region. METHODS A detailed survey with 40 questions was electronically disseminated among oculoplastic surgeons practicing in Asia-Pacific region. The mailing list included targeted members of the Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery and nonmembers from the contact directories of the two senior authors. Data collected include demographics, training, surgical techniques, postoperative care, and outcomes. RESULTS The majority of surgeons performed a preoperative nasal endoscopy (76.2%, total respondents (n) = 122), and most preferred a general anesthesia for endoscopic DCRs (51.9%, n = 104). The majority of surgeons believed in preserving nasal mucosal and the lacrimal sac flaps and adjunctive endoscopic procedures were performed when required (58.4%, n = 101). Routine lacrimal sac wall biopsy for histopathology was not a preferred practice. The practice of routine silicone intubation was more common than the use of topical adjunctive. The majority of surgeons (52.6%, n = 97) took 31-60 minutes to complete a unilateral endoscopic DCR. Postoperative routine nasal douching and ostium cleaning were not widespread practices. The self-reported outcomes were good. CONCLUSION A significantly high percentage of oculoplastic surgeons from Asia-Pacific perform endoscopic DCR. Although the range of practice patterns is wide, there is increasing uniformity in surgical techniques with regard to endoscopic DCR as compared to the previous surveys.
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Affiliation(s)
- Tracy Kwok
- a Department of Ophthalmology, Chinese University of Hong Kong , Hong Kong
| | - Mohammad Javed Ali
- b Govindram Seksaria Institute of Dacryology , L.V.Prasad Eye Institute , Hyderabad , India
| | - Hunter Yuen
- a Department of Ophthalmology, Chinese University of Hong Kong , Hong Kong
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Lou Z. Multifactorial assessment is essential to maximize the likelihood of good outcomes after endoscopic dacryocystorhinostomy. Eur Arch Otorhinolaryngol 2017; 274:4261-4262. [DOI: 10.1007/s00405-017-4685-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
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Ali MJ, Singh S, Naik MN. Entire lacrimal sac within the ethmoid sinus: outcomes of powered endoscopic dacryocystorhinostomy. Clin Ophthalmol 2016; 10:1199-203. [PMID: 27462137 PMCID: PMC4940020 DOI: 10.2147/opth.s108634] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was to report the outcomes of powered endoscopic dacryocystorhinostomy (PEnDCR) in patients with lacrimal sac within the sinus. MATERIALS AND METHODS Retrospective analysis was performed on all patients who underwent PEnDCR and were intraoperatively documented to have complete lacrimal sac in sinus. Data collected included demographics, clinical presentations, associated lacrimal and nasal anomalies, intraoperative findings, intraoperative guidance, complications, postoperative ostium behavior, and anatomical and functional success. A minimum follow-up of 6 months postsurgery was considered for final analysis. RESULTS A total of 17 eyes of 15 patients underwent PEnDCR using standard protocols, but with additional intraoperative guidance where required and careful maneuvering in the ethmoid sinus. The mean age of the patients was 37.2 (range 17-60) years. Of the unilateral cases, 69% (nine of 13) showed left-side predisposition; 80% of patients showed regurgitation on pressure over the lacrimal sac area. Associated lacrimal and nasal anomalies were observed in 13.3% (two of 15) and 40% (six of 15), respectively. At a mean follow-up of 6.6 months, anatomical and functional success were observed in 93.3% (14 of 15). One patient showed failure secondary to cicatricial closure of the ostium. CONCLUSION An entire sac within an ethmoid sinus poses a surgical challenge. Good sinus-surgery training, thorough knowledge of endoscopic anatomy, careful maneuvering, and use of intraoperative navigation guidance result in good outcomes with PEnDCR.
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Affiliation(s)
| | - Swati Singh
- Institute of Dacryology, LV Prasad Eye Institute, Hyderabad, India
| | - Milind N Naik
- Institute of Dacryology, LV Prasad Eye Institute, Hyderabad, India
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