Dacryocystosclerotherapy

Dacryocystosclerotherapy as an alternative to dacryocystectomy

Purpose: The aim of this study was to perform a histopathological assessment of the efficacy of sclerosing agents in dacryocystosclerotherapy (DCST) and to evaluate its role as an alternative to dacryocystectomy (DCT) in a specific group of patients. Methods: Thirteen lacrimal drainage systems of 10 patients with primary acquired nasolacrimal duct obstruction (PANDO) were studied. All patients were awaiting a DCT, indications being repeated attacks of dacryocystitis with severe systemic or ocular co-morbidities and/or refusal for a dacryocystorhinostomy. Fluorescent labelled sodium tetradecyl sulphate (SDS) or bleomycin were used as sclerosing agents for a DCST taking specific precautions. All patients underwent a DCT after 4 weeks and histopathological evaluation was performed to assess the changes and extent of DCST. Results: There were nine females and one male, and all patients were above the age of 60 years. Of the 13 lacrimal systems studied, the mean duration of PANDO was 1.3 years. All the patients had associated systemic and/or ocular co-morbidities. SDS and bleomycin were used in 6 and 7 lacrimal systems, respectively. The mean doses used for SDS and bleomycin were 0.26 and 0.31 cc, respectively. The post-injection phase was uneventful except for one patient who had a moderate inflammation, which resolved with low dose oral steroids. Histopathological features were more marked in the SDS group and included loss of epithelium, luminal closure, gross fibrosis across the lacrimal sac wall, congestion and hyalinization of blood vessels, and multiple areas of haemorrhages in the sac wall. Conclusions: DCST is a safe and effective alternative to DCT in very carefully selected patients. Histopathology demonstrates SDS to be more effective as compared to bleomycin.

Dacryocystectomy: goals, indications, techniques and complications

Dacryocystectomy is a well-established oculo plastics procedure that refers to a complete surgical extirpation of the lacrimal sac. It was first described by Woolhouse in 1724 and was the standard of care before the advent of dacryocystorhinostomy for management of dacryocystitis and lacrimal fistulas. Although it is a seldom performed procedure worldwide, it still has its place in the surgical armamentarium for certain specific indications like malignant lacrimal sac tumors. It is almost always performed through an external skin incision except in certain exceptional circumstances where endoscopic dacryocystectomy may be needed. This article discusses the indications, goals, techniques, and complications of a dacryocystectomy.

Ethanolamine Oleate Sclerotherapy Versus Simple Cyst Aspiration in the Management of Orbitopalpebral Cyst Associated With Congenital Microphthalmos

PURPOSE

To evaluate the efficacy of ethanolamine oleate (EO) sclerotherapy in the management of orbitopalpebral cysts associated with congenital microphthalmos, and compare it with simple cyst aspiration.

METHODS

Retrospective, interventional comparative case series of 12 orbitopalpebral cysts of 8 patients associated with congenital microphthalmos. Five cysts were treated with simple aspiration and 7 cysts with EO sclerotherapy. Cyst resolution was the main outcome measure.

RESULTS

Five cysts underwent aspiration alone at a median age of 12 weeks. One (20%; 95% CI, 0%-55.1%) of these 5 showed complete resolution. Seven cysts (6 patients) underwent aspiration combined with EO sclerotherapy at a median age of 30 weeks (3 had recurred following prior cyst aspiration). Postsclerotherapy, 6 eyes (85.7%; 95% CI, 59.8%-100%) showed complete cyst resolution (p = 0.072, Fisher exact test). The mean follow-up was 8.8 months (range, 3-23 months). In the EO group, 1 cyst (14.3%) required repeat sclerotherapy and another cyst showed partial resolution at 6 weeks. The number needed to treat with sclerotherapy to prevent 1 recurrence was 2 (1-5, 95% CI). No procedure-related complications were noted.

CONCLUSIONS

Simple aspiration of orbitopalpebral cyst is associated with a high recurrence rate and should be reserved for early prognostication of visual potential in the microphthalmic eye. Minimally invasive EO sclerotherapy provides a rapid, effective, and uncomplicated treatment modality for definitive therapy, and should be preferred in cases with no visual prognosis in the microphthalmic eye demonstrating adequate bony orbital expansion.

Ethanolamine oleate sclerotherapy in the management of orbito-palpebral cyst associated with congenital microphthalmos

PURPOSE

To report a novel, nonsurgical method of management of orbito-palpebral cyst associated with congenital microphthalmos.

DESIGN

Interventional case series.

METHODS

Two patients with orbito-palpebral cyst were included. Case 1 had bilateral orbito-palpebral cyst, whereas case 2 was unilateral. Transcutaneous cyst aspiration in both cases revealed a severely microphthalmic eye with no visual potential. Ethanolamine oleate sclerotherapy was performed immediately after cyst aspiration in both patients.

RESULTS

Complete resolution of the orbito-palpebral cysts was noted within 6 weeks, and the custom prosthesis was well retained.

CONCLUSIONS

Ethanolamine oleate sclerotherapy may be an effective minimal intervention treatment option for cosmetic rehabilitation of patients with orbito-palpebral cyst associated with congenital microphthalmos with no visual potential.