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Lai CC, Yang CJ, Lin CC, Chi YC. Balloon Dacryocystoplasty with Pushed Monocanalicular Intubation as a Primary Management for Primary Acquired Nasolacrimal Duct Obstruction. J Pers Med 2023; 13:jpm13030564. [PMID: 36983745 PMCID: PMC10058743 DOI: 10.3390/jpm13030564] [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: 12/31/2022] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Given the improvement in the instrument and techniques, novel surgical interventions emerged to avoid the osteotomy from the gold standard dacryocystorhinostomy (DCR) for treating primary acquired nasolacrimal duct obstruction (PANDO). This study's aim is to compare the surgical outcomes of antegrade balloon dacryocystoplasty (DCP) with pushed monocanalicular intubation (MCI) to balloon DCP alone in patients with complete PANDO. Adult patients with complete PANDO receiving balloon DCP followed by pushed MCI or balloon DCP alone from December 2014 to May 2019 were retrospectively reviewed. A total of 37 eyes of 29 patients were treated with balloon DCP with pushed MCI for 1 month, whereas 35 eyes of 28 patients were treated with balloon DCP alone. The success rates at 1 month, 3 months, and 6 months after operation were 89.2%, 73.0%, and 70.2%, respectively, in balloon DCP with MCI group, and 62.9%, 62.9%, and 60.0%, respectively, in the balloon DCP alone group. The balloon DCP with pushed MCI group had a better success rate but only reached statistical significance at 1 month postoperatively (p < 0.01). Subgroup analysis was performed based on age. The success rate in those under 65 in the combined balloon DCP with MCI group was significantly higher than in balloon DCP alone group (72.7% vs. 9.1%, p = 0.004), whereas there was no significant difference between those aged at least 65 in the combined group and the balloon DCP alone group (69.2% vs. 83.3%, p = 0.2). Conclusively, there was no significant difference in the success rate between antegrade balloon DCP with and without pushed MCI in general. Nevertheless, the former procedure was associated with significantly higher surgical success rate than the latter in younger patients.
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Affiliation(s)
- Chun-Chieh Lai
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Cheng-Ju Yang
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chia-Chen Lin
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yi-Chun Chi
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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2
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Poignet B, Sultanik P, Beaujeux P, Koch E, Benkhatar H. Primary balloon dacryoplasty for nasolacrimal duct obstruction in adults: a systematic review. Orbit 2021; 40:455-460. [PMID: 32912011 DOI: 10.1080/01676830.2020.1818264] [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: 07/19/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Introduction: Acquired nasolacrimal duct obstruction (NLDO) is a major cause of epiphora. Balloon dacryoplasty (BD) is a minimally invasive procedure effectively used for congenital NLDO which has also been used in adults, instead of dacryocystorhinostomy (DCR), the current gold standard technique. The main objectives were to assess the results of BD with and without silicone tube insertion (STI) in NLDO in adults.Materiel and Method: A systematic review of literature was conducted on PubMed, SCOPUS and Cochrane databases. The articles were scanned to identify all studies that evaluated the outcomes of primary BD for NLDO in adults. The mean success rates were calculated and compared using the multiple comparisons Sidak's T-testResults: Sixty-seven articles were identified but only 13 publications matched the inclusion criteria. For partial NLDO, BD had a mean, success rate of 73.29% (64.86% with STI) with a mean follow-up of 16 months. For complete NLDO, BD had a success rate of 36.67% (52.50% with STI) with a mean follow-up of 15.5 months. Altogether the success rate of BD was significantly higher for partial NLDO compared to complete stenosis (p = 0,002).Conclusion: BD is significantly more successful for partial NLDO, without significant additional benefit from subsequent STI. The main complication would be the high recurrence rate. BD is not effective for complete NLDO with very low success rates. However, BD could be proposed for partial NLDO, as it is a safe procedure, with minimal invasiveness in comparison to DCR. Further prospective and controlled studies are required to confirm these encouraging results.
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Affiliation(s)
- Barthélémy Poignet
- Centre Hospitalier de Versailles, Service d'Ophtalmologie, Le Chesnay, France
| | - Philippe Sultanik
- Faculté de Médicine Paris Descartes, Université Paris V, Paris, France
- Service d'hépato gastro entérologie, Assistance Publique-Hôpitaux De Paris, Paris, France
| | - Pauline Beaujeux
- Centre Hospitalier de Versailles, Service d'Ophtalmologie, Le Chesnay, France
| | - Edouard Koch
- Centre Hospitalier de Versailles, Service d'Ophtalmologie, Le Chesnay, France
| | - Hakim Benkhatar
- Centre Hospitalier de Versailles, Service d'ORL et Chirurgie Cervico-faciale, Le Chesnay, France
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Masoomian B, Eshraghi B, Latifi G, Esfandiari H. Efficacy of probing adjunctive with low-dose mitomycin-C irrigation for the treatment of epiphora in adults with nasolacrimal duct stenosis. Taiwan J Ophthalmol 2021; 11:287-291. [PMID: 34703745 PMCID: PMC8493988 DOI: 10.4103/tjo.tjo_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/06/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE: The purpose of the study was to investigate the efficacy of adjunctive low-dose mitomycin-C (MMC) during successful lacrimal duct probing in adults with nasolacrimal ducts (NLDs) stenosis. MATERIALS AND METHODS: This is a prospective case–control study on patients with NLD stenosis who were randomized into two groups. All patients underwent probing without or with an application of MMC. Former group received 0.2 mg/ml MMC irrigation for 5 min. The main outcome measures were objective evaluation of patency with irrigation, as well as patients' subjective assessment of improvement. RESULTS: There were 73 eyes in 58 consecutive patients; patient mean age ranged from 19 to 78 years (mean 44 years). Female included larger group of patients (63%) and mean duration of the symptoms was 26.1 months (range, 2–120 months). After mean follow-up of 11 months (range, 9–14 months), 23 (60%) of the 38 eyes in the MMC groups and 8 (22%) of the 35 eyes in control group had complete response and remained symptom free. This difference was statistically significant (P = 0.005). According to the patient's satisfaction, epiphora was partially improved in 6 (17%) eyes of control group and 4 (10%) eyes in MMC group. Application of MMC has a better outcome in patients with severe stenosis (P = 0.007); patients who had symptoms more than 12 months (P = 0.02) and patients with constant epiphora were compared with intermittent symptoms (P = 0.001). No complications were detected during patients follow-up. CONCLUSION: This study suggests acceptable long-term results for probing adjunctive with MMC irrigation for adults with NLD stenosis that can be recommended as a simple and effective procedure for these patients.
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Affiliation(s)
- Babak Masoomian
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Eshraghi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Golshan Latifi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Esfandiari
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Pan ZQ, Liu JJ, Jia XK, Lee JKS, Tu YH, Shi JL, Yu B, Wu ED, Wu WC. Endoscopic transnasal canaliculorhinostomy for refractory common canalicular obstruction with an unidentifiable lacrimal sac. Int J Ophthalmol 2020; 13:1238-1243. [PMID: 32821677 DOI: 10.18240/ijo.2020.08.09] [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: 07/24/2019] [Accepted: 02/12/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To describe the role of endoscopic transnasal canaliculorhinostomy (ETC) in refractory common canalicular obstruction (CCO) associated with an absent or unidentifiable lacrimal sac. METHODS The records of patients with refractory CCO who underwent ETC at the Eye Hospital of Wenzhou Medical University from October 2007 to December 2016 were retrospectively reviewed. RESULTS Fifty-six patients (56 eyes) with refractory CCO were recruited into the study. Eight patients were excluded due to the presence of a residual lacrimal sac or failure to complete the follow-up duration. The anatomic and functional success rates were both 85.4% (41/48) at a mean follow-up of 18.6mo. Five cases failed as a result of ostial synechia and two failed because of ostial obstruction by granulation. Postoperative complications included mild nasal bleeding in 5 cases, dried nasal feeling in 8 cases, and olfactory dysfunction in 4 cases. CONCLUSION Although being surgically challenging, ETC has comparable findings to its external approach counterpart or conjunctivodacryocystorhinostomy (CDCR) with Jones tube. And it may prove to be a novel alternate surgical technique for patients with refractory CCO without identifiable lacrimal sac.
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Affiliation(s)
- Zhao-Qi Pan
- The Mini-invasive Orbital & Oculoplastic Surgery Center, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jian-Ju Liu
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Xian-Ke Jia
- Department of Ophthalmology, the People's Hospital of Pingyang, Wenzhou 325400, Zhejiang Province, China
| | - Jason Kian Seng Lee
- Ophthalmology and Visual Sciences Department, Khoo Teck Puat Hospital, 999002, Singapore
| | - Yun-Hai Tu
- The Mini-invasive Orbital & Oculoplastic Surgery Center, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jie-Liang Shi
- The Mini-invasive Orbital & Oculoplastic Surgery Center, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Bo Yu
- The Mini-invasive Orbital & Oculoplastic Surgery Center, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - En-De Wu
- The Mini-invasive Orbital & Oculoplastic Surgery Center, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Wen-Can Wu
- The Mini-invasive Orbital & Oculoplastic Surgery Center, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Trimarchi M, Giordano Resti A, Vinciguerra A, Danè G, Bussi M. Dacryocystorhinostomy: Evolution of endoscopic techniques after 498 cases. Eur J Ophthalmol 2019; 30:998-1003. [DOI: 10.1177/1120672119854582] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Endoscopic dacryocystorhinostomy is a well-known surgical practice used to treat nasolacrimal duct obstruction and widely considered as a valid alternative to external approaches. Purpose: We present a retrospective case series of 498 endoscopic dacryocystorhinostomies on 401 patients, from July 2004 to May 2018, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. Methods: Of the 498 procedures, 426 were unilateral and 72 were bilateral dacryocystorhinostomy. All patients underwent routine preoperative workup including fluorescein test (Jones test 1–2), probing and irrigation of the lacrimal way, nasal endoscopy, and maxilla-facial computed tomography scan. Surgical technique was based on nasal endoscopic dacryocystorhinostomy followed by positioning of a Catalano’s silicone stent, which was left in place for about 3 months. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. Results: Anatomic success was achieved in 91.54% cases in primary dacryocystorhinostomy and in 89.36% after revision, whereas functional success was obtained in 90.4% in primary and 85.1% in secondary dacryocystorhinostomies. After a second revision of endoscopic dacryocystorhinostomy, anatomical success was achieved in 90.1% and functional success in 88.7% of procedures. Conclusion: Our results confirm that endoscopic dacryocystorhinostomy can be considered as a valid surgical approach to primary nasolacrimal duct obstruction and revision cases. The key aspects in achieving functional and anatomical results are meticulous surgical procedure and precise follow-up.
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Affiliation(s)
- Matteo Trimarchi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Ophthalmology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Vinciguerra
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Giulia Danè
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Mario Bussi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
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Sia PI, Curragh D, Howell S, Selva D. Interobserver agreement on interpretation of conventional dacryocystography and dacryoscintigraphy findings: A retrospective single-centre study. Clin Exp Ophthalmol 2019; 47:713-717. [PMID: 30866143 DOI: 10.1111/ceo.13502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/23/2019] [Accepted: 03/07/2019] [Indexed: 11/26/2022]
Abstract
IMPORTANCE This study assesses the interobserver agreement on dacryocystography (DCG) and dacryoscintigraphy (DSG) findings. BACKGROUND There are no standard grading criteria to guide the interpretation of conventional DCG and DSG findings and therefore there may be a degree of subjectivity. This study evaluates the level of interobserver agreement in the interpretation of DCG and DSG findings. DESIGN A retrospective observational study at the Royal Adelaide Hospital. PARTICIPANTS A total of 165 patients who presented with epiphora with 276 DCGs and 290 DSGs performed were included in this study. METHODS DCG and DSG images were obtained, anonymized, randomized and interpreted by three independent oculoplastic surgeons. Standard grading criteria were set for both DCG and DSG images. Data from all observers were analysed for interobserver agreement using Kappa (κ) statistics, generated using a variation of Cohen's kappa for multiple observers. MAIN OUTCOME MEASURES Level of interobserver agreement (κ values) in the grading of DCG and DSG findings. RESULTS There was an overall moderate interobserver agreement for DCG findings (κ = 0.55), with the highest agreement on interpreting canalicular obstruction (κ = 0.80), followed by proximal nasolacrimal duct obstruction (κ = 0.67) and normal patency (κ = 0.63). There was an overall fair interobserver agreement for DSG findings (κ = 0.36), with the best being moderate agreement (κ = 0.42-0.50) for interpreting pre-sac delay and post-sac proximal delay. CONCLUSIONS AND RELEVANCE DCG offers good reliability in interpreting patent and obstructed systems. On the other hand, DSG has poor agreement and highlights some of the limitations in the ability to guide epiphora management.
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Affiliation(s)
- Paul I Sia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - David Curragh
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Stuart Howell
- Data, Design and Statistics Service, Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Patella F, Panella S, Zannoni S, Jannone ML, Pesapane F, Angileri SA, Sbaraini S, Ierardi AM, Soldi S, Franceschelli G, Carrafiello G. The role of interventional radiology in the treatment of epiphora. Gland Surg 2018; 7:103-110. [PMID: 29770306 DOI: 10.21037/gs.2017.09.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epiphora is a relatively common ophthalmologic affection representing almost 5% of clinical consultations in ophthalmology and it consists in the complete or partial obstruction of nasolacrimal duct, leading to insufficient drainage of tears. The traditional treatment is represented by surgery namely, external dacryocystorhinostomy (DCR). Despite the high success rate DCR has many disadvantages and limitations since it requires general anesthesia, it may arise in a permanent facial scar and it is often affected by the reobstruction of the anastomotic tract by fibrotic scars and osteogenic activity. Fluoroscopically guided interventional procedures are a therapeutic alternative to surgery for lacrimal duct system obstructions that can consist either in balloon dacryocystoplasty or in nasolacrimal stent placement. In both cases, a pre-operative imaging characterization of the occlusion is needed for a correct treatment planning. In this review, we propose to highlight the role of interventional radiology in the treatment of epiphora and the role of computed tomography dacryocystography (CTD) in depiction and the pre-interventional planning.
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Affiliation(s)
| | - Silvia Panella
- Postgraduation School of Radiodiagnostic of Milan, Milan, Italy
| | | | | | | | - Salvatore Alessio Angileri
- Postgraduation School of Radiodiagnostic of Milan, Milan, Italy.,Diagnostic and Interventional Radiology Service, San Paolo Hospital, Milan, Italy
| | - Sara Sbaraini
- Postgraduation School of Radiodiagnostic of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Service, San Paolo Hospital, Milan, Italy
| | - Simone Soldi
- Diagnostic and Interventional Radiology Service, San Paolo Hospital, Milan, Italy
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Lee JH, Young SM, Kim YD, Woo KI, Yum JH. Canaliculorhinostomy-Indications and Surgical Results. Am J Ophthalmol 2017; 181:134-139. [PMID: 28705661 DOI: 10.1016/j.ajo.2017.06.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the surgical results of canaliculorhinostomy for patients with distal canalicular obstruction and lacking a structurally functional lacrimal sac who would otherwise require a conjunctivodacryocystorhinostomy (CDCR) with Jones tube placement. DESIGN Retrospective observational case series. METHODS Setting: Single tertiary institution. PERIOD November 1994 to June 2011. PATIENT POPULATION Sixteen patients with canalicular obstruction at or beyond 8 mm from the punctum, with an absent or unidentifiable lacrimal sac. INTERVENTION Patients underwent canaliculorhinostomy, whereby direct anastomosis of the canaliculi or common canaliculus to the nasal mucosa was performed. MAIN OUTCOME MEASURES Anatomic and functional success. RESULTS Our study comprised 16 patients with a mean age of 44.9 ± 21.9 years. Ten (62.5%) were female and 6 (37.5%) male. Mean duration of follow-up was 7.8 years. Causes of an absent or unidentifiable lacrimal sac included previous trauma (n = 8, 50.0%), previous dacryocystorhinostomy (n = 4, 25.0%), chronic dacryocystitis (n = 3, 18.8%), and previous dacryocystectomy (n = 1, 6.2%). Anastomoses between the upper and lower canaliculi and the nasal mucosa was performed in 6 patients, while that between the common canaliculus and nasal mucosa was performed in 10. Anatomic and functional success rates were 87.5% (n = 14) and 81.3% (n = 13), respectively. CONCLUSION Canaliculorhinostomy has reasonable success rates and provides an effective surgical alternative for a group of patients in whom CDCR with Jones tube placement would otherwise have been indicated.
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Affiliation(s)
- Jung Hye Lee
- Department of Ophthalmology, Hyemin Eye Hospital, Seoul, South Korea
| | | | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Şimşek İ, Yabaş Kızıloğlu Ö, Ziylan Ş. External Dacryocystorhinostomy for the Treatment of Functional Nasolacrimal Drainage Obstruction. Turk J Ophthalmol 2016; 45:208-212. [PMID: 27800234 PMCID: PMC5082243 DOI: 10.4274/tjo.24381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/14/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To determine the outcome and long-term efficacy of external dacryocystorhinostomy (ext-DCR) with or without bicanalicular silicon intubation in patients with functional nasolacrimal drainage obstruction (FNLDO). MATERIALS AND METHODS Patients with epiphora and patent lacrimal systems on nasolacrimal irrigation were prospectively enrolled in the study. Each patient was assessed with lacrimal scintigraphy to differentiate drainage abnormalities as presac (proximal) or postsac (distal) delays. All patients underwent ext-DCR; bicanalicular silicone intubation was performed only in presac delay cases. On follow-up examinations patients were asked to report their symptoms as none, mild, moderate or unchanged. Success was defined as lacrimal patency to irrigation and no or mild epiphora at the end of the follow-up period. RESULTS Twenty-six lacrimal systems of 23 patients were eligible for inclusion. There were 9 presac delay and 17 postsac delay cases. Average follow-up time was 72.85 weeks (47-88 weeks). A successful outcome was achieved in 76.9% of the operated lacrimal systems. Success rate was 55.5% among presac obstructions and 88.2% among postsac obstructions. CONCLUSION The long-term efficacy of ext-DCR in FNLDO patients is confirmed with our overall successful outcome of 76.9%. In preoperative assessment, lacrimal scintigraphy is helpful to determine the surgical approach and to predict the surgical outcome.
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Affiliation(s)
- İlke Şimşek
- Medicine Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Özge Yabaş Kızıloğlu
- Bahçeşehir University Faculty of Medicine, Göztepe Medical Park Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Şule Ziylan
- Yeditepe University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
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Ali MJ, Naik MN. Efficacy of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in treatment of acquired partial nasolacrimal duct obstruction in adults. Saudi J Ophthalmol 2014; 28:40-3. [PMID: 24526857 PMCID: PMC3923196 DOI: 10.1016/j.sjopt.2013.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM To report the outcomes of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in patients with acquired partial nasolacrimal duct obstructions in adults. METHODS Retrospective case series, included 21 eyes with partially obstructed nasolacrimal ducts of 12 patients. All the 21 ducts were initially probed and the probe confirmed with an endoscope in the inferior meatus. After confirming the presence of probe in the inferior meatus, a 3 mm balloon was used for dilating the distal and proximal portions of nasolacrimal duct, followed by stenting of ducts with Crawford tubes. Main outcome measures were anatomical patency of the passage and resolution of epiphora. RESULTS Of the 12 patients, 9 had bilateral and 3 had unilateral acquired partial nasolacrimal duct obstructions. All the patients underwent bicanalicular stenting under endoscopic guidance which were retained for a period of 12 weeks. A minimum follow up of 6 months following stent removal was considered for final analysis. 15 of the 21 ducts (71%) were freely patent on irrigation but 13 of the 21 reported improvement of epiphora. Two nasolacrimal ducts showed similar partial regurgitation and partial patency on syringing as before with no improvement of symptoms. Four nasolacrimal ducts were completely obstructed with complete regurgitation of fluid on syringing with worsening of the epiphora. Two eyes persisted with symptoms of epiphora despite patent nasolacrimal duct with grade 2 dye retention on dye disappearance test. CONCLUSIONS 3 mm balloon dacryoplasty is an alternative and safe way to manage partial nasolacrimal duct obstructions with an anatomical success in 71% and functional success in 62% of the patients. Further studies with a large sample size and longer follow-up are required to ascertain the long term benefits.
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Affiliation(s)
- Mohammad Javed Ali
- Dacryology Service, Ophthalmic Plastics Surgery, L.V. Prasad Eye Institute, Hyderabad 34, India
| | - Milind N Naik
- Dacryology Service, Ophthalmic Plastics Surgery, L.V. Prasad Eye Institute, Hyderabad 34, India
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Kumar S, Dulgach P, Kamal S, Goel R. Long-Term Success of Modified External Dacryocystorhinostomy for the Treatment of Distal Common Canalicular Block. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2013; 2:94-8. [PMID: 26108045 DOI: 10.1097/apo.0b013e31828b9ba6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Epiphora caused by common canalicular obstruction is difficult to manage. Distal common canalicular block caused by membranous obstruction near its junction with the lacrimal sac can be managed by modified dacryocystorhinostomy (DCR) consisting of internal membranectomy. We report our experience with this technique during long-term follow-up. DESIGN A prospective interventional case series was performed at a tertiary care center including 15 patients with a diagnosis of distal common canalicular obstruction. METHODS External DCR was performed, and after lacrimal sac opening, membranous obstruction at the distal end of the common canaliculus was identified and managed successfully in all cases. Mitomycin C was applied, and silicone intubation was done for 2 months. The main outcome measures were anatomical success (patent syringing) and functional success (complete relief of epiphora) at a minimum follow-up period of 1 year. RESULTS Fourteen (93%) cases were completely relieved of epiphora with patent lacrimal syringing at a mean follow-up of 15.4 months (P = 0.0001, McNemar test). The postoperative complications occurred in 4 cases and included nasal bleeding, lateral displacement of silicone tube at medial canthus, complete extrusion of silicone tube (at 4 weeks), and noticeable incisional scar. CONCLUSIONS Distal common canalicular obstruction can be successfully managed with DCR with internal membranectomy and silicone intubation with mitomycin C. It avoids excision of common canaliculus as compared with canaliculo-DCR. The procedure is safe and effective with minor complications.
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Affiliation(s)
- Sushil Kumar
- From the Guru Nanak Eye Center, Maulana Azad Medical College, New Delhi, India
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Everman KR, Czyz CN, Kalwerisky K, Hill RH, Foster JA, Cahill KV. Canalicular obstruction: a histopathologic case series. Can J Ophthalmol 2012; 47:500-3. [DOI: 10.1016/j.jcjo.2012.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 07/17/2012] [Accepted: 08/02/2012] [Indexed: 11/26/2022]
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Kashkouli MB, Pakdel F, Kiavash V. Assessment and management of proximal and incomplete symptomatic obstruction of the lacrimal drainage system. Middle East Afr J Ophthalmol 2012; 19:60-9. [PMID: 22346116 PMCID: PMC3277026 DOI: 10.4103/0974-9233.92117] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Epiphora is a common complaint of patients who present to an Ophthalmology Clinic. In many cases, epiphora is due to an obstruction in the lacrimal drainage system. However, a subgroup of symptomatic patients with epiphora has a patent lacrimal drainage system. Such cases are usually termed ‘functional obstruction’ and / or ‘stenosis of the lacrimal drainage system’. Various etiologies and diagnostic and therapeutic approaches have been described in literature, which implies the lack of a standardized approach. This article will review the evolving diagnostic and therapeutic approaches in literature, and in the end, propose a paradigm in approaching this group of patients.
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Affiliation(s)
- Mohsen Bahmani Kashkouli
- Eye Research Center, Rassoul Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Bibliography. Current world literature. Curr Opin Ophthalmol 2009; 20:417-22. [PMID: 19684489 DOI: 10.1097/icu.0b013e32833079c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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