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Yu Y, Zhou G, Li X, Wei J, Ke X, Wu L, Wu W, Yu B. Computed Tomography Signs of Sinonasal Inflammation in Patients with Acute Dacryocystitis. Am J Rhinol Allergy 2024; 38:333-338. [PMID: 39033418 DOI: 10.1177/19458924241262098] [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: 07/23/2024]
Abstract
BACKGROUND Nasal and paranasal sinus abnormalities may be related to nasolacrimal duct obstructive disease but are strongly debated. Data of acute disease stage are lacking. OBJECTIVE The purpose of this study was to determine if there are correlations between radiologic signs of sinus inflammation and acute dacryocystitis (AD). METHODS This cross-sectional controlled study was conducted at Wenzhou, Zhejiang Province, China from February 2021 to November 2023. Forty-four consecutive patients with AD and 50 consecutive patients with orbital tumors (the control group), who completed preoperative computed tomography scans, were enrolled to evaluate the extent of their inflammatory sinonasal disease by the modified Lund-Mackay score system. RESULTS The inflammation signs of the paranasal sinuses (total mean sinus scores, 95% CI [0.00, 2.00]; P < 0.001), namely the anterior ethmoid sinus(95% CI [0.00, 1.00]; P < 0.001), the posterior ethmoid sinus(95% CI [0.00, 0.00]; P = 0.003), the frontal sinus (95% CI [0.00, 0.00]; P = 0.02), and the ostiomeatal complex (P < 0.001) were more extensive in patients with AD when compared with the controls. The disease course was negatively correlated with the anterior ethmoid (P = 0.03) and frontal scores (P = 0.01). The symptom of eyelid swelling was positively correlated with the anterior ethmoid (P = 0.03), ostiomeatal complex (P = 0.004), and total sinus scores (P = 0.005). CONCLUSION Inflammatory sinus disease was found to be more frequent in patients with AD, which was gradually alleviated with the prolongation of the disease course. The mutual spread of inflammation particularly in the acute course may play an important role in lacrimal duct obstructive disease.
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Affiliation(s)
- Yueqi Yu
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Guangming Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xinyu Li
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
| | - Jinfei Wei
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyu Ke
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
| | - Linjuan Wu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
| | - Wencan Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bo Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Valcheva KP, Murgova SV. Primary acquired nasolacrimal duct obstruction - epidemiology, clinical signs and surgical treatment. Folia Med (Plovdiv) 2024; 66:466-474. [PMID: 39257266 DOI: 10.3897/folmed.66.e128419] [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: 05/27/2024] [Accepted: 07/30/2024] [Indexed: 09/12/2024] Open
Abstract
AIM The aim of this study was to discuss the epidemiological aspects, clinical picture and the mode of surgical treatment in patients with primary acquired nasolacrimal duct obstruction (PANDO).
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Kim D, Lew H. Clinical characteristics and cytological changes in mucinous obstruction diagnosed by dacryoendoscopy. Sci Rep 2024; 14:8891. [PMID: 38632478 PMCID: PMC11024180 DOI: 10.1038/s41598-024-59580-9] [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: 08/19/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
To analyze the clinical characteristics of mucinous obstruction diagnosed by dacryoendoscopy and compared the cytological changes with membranous obstruction using a modified liquid-based thin prep cytology method. A retrospective chart review was conducted on 53 eyes of 51 patients with mucus obstruction based on dacryoendoscopic findings from January 2022 to October 2022. Liquid-based thin-prep cytology was performed by irrigating the inside of the nasolacrimal drainage system with saline during dacryoendoscopy-guided silicone tube intubation. Pathological findings were analyzed through a comparison of mucinous obstruction with membranous obstruction as determined by dacryoendoscopic findings. The modified liquid-based thin prep cytology technique had a higher cytology detection rate across all cases. Mucinous obstruction exhibited a significantly higher number of successful canalicular irrigation test cases compared to membranous obstruction. In mucinous obstruction, epithelial squamous cells were more frequently detected in pre-sac obstruction, whereas columnar epithelial cells were predominant in post-sac obstruction. Inflammatory cells showed a stronger correlation with primary change and post-sac obstruction. Bacterial colonies were observed exclusively in cases of mucinous obstruction. The use of a modified liquid-based thin prep cytology method enables the examination of histopathological changes in the lacrimal passage in primary acquired nasolacrimal duct obstruction (PANDO), particularly in cases of mucinous obstruction, without the need for invasive biopsies. These findings enhance the understanding of the etiopathogenesis of mucinous obstruction, complementing knowledge of membranous obstruction in PANDO.
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Affiliation(s)
- Doah Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, #59 Yatap-Ro, Bundang-Gu, Seongnam, 13496, Republic of Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, #59 Yatap-Ro, Bundang-Gu, Seongnam, 13496, Republic of Korea.
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Liu Y, Jiang A, Nie S, Cao S, Wumaier A, Ding R, Kuerban M, Zhou R, Lin F, Yang H, Liang X, Huang D, Chen R. CT-Measured Angulation Between the Frontal Bone and Bony Nasolacrimal Duct: Variations in Obstructed and Healthy Lacrimal Ducts. Semin Ophthalmol 2024:1-8. [PMID: 38493299 DOI: 10.1080/08820538.2024.2330501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The aim of this study was to analyze the characteristics of CT-measured intersection angle (FB-BNLD) between the frontal bone and bony nasolacrimal duct and to provide suggestions for treating primary acquired nasolacrimal duct obstruction (PANDO) patients in West China. METHODS Three hundred and nine participants' CT were, respectively, evaluated with RadiAnt DICOM Viewer. We defined the FB-BNLD angle >0° as the anterior type and the FB-BNLD angle ≤0° as the posterior type. RESULTS The mean FB-BNLD was -2.52° (95% CI, -3.16° to -1.88°) across all participants, of whom 37.2% were of the anterior type and 62.8% of the posterior type. Approximately 65.0% of the female patients had a posterior FB-BNLD type, and 54.2% of the male patients had an anterior FB-BNLD type (p = .002). Posterior FB-BNLD was the dominant type in the PANDO and control groups (p = .011), and the angle of FB-BNLD was statistically different in both groups (PANDO group, -2.54° to -0.71°; control group, -4.42° to -2.67°; p < .001). Among the male participants, the type of FB-BNLD differed between the two groups (p = .036), with differences in the angle of FB-BNLD (PANDO group, 0.59° to 5.13°; control group, -4.08° to 1.89°; p = .034). There was no difference in the type of FB-BNLD in female participants between the two groups (p = .051). CONCLUSION The present study revealed individual differences in the type of FB-BNLD, with anterior-type majority in males and posterior-type dominance in females. Evaluating the FB-BNLD type on CT can provide a fast method for knowing the nasolacrimal duct condition during planning for lacrimal manipulation.
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Affiliation(s)
- Yong Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Aixin Jiang
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Shihuai Nie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shujuan Cao
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Aizezi Wumaier
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Ruxin Ding
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Mayila Kuerban
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Renbing Zhou
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Fangzeng Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xuanwei Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Danping Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
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Ali MJ. Alterations of lacrimal sac vasculature in lacrimal disorders: Chromo endoscopic assessment with changes in effective spectral response. J Fr Ophtalmol 2024; 47:104133. [PMID: 38696863 DOI: 10.1016/j.jfo.2024.104133] [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: 08/13/2023] [Revised: 09/29/2023] [Accepted: 10/22/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE To study the structural and dynamic alterations in the lacrimal sac vasculature of patients with congenital, primary, and secondary acquired nasolacrimal duct obstructions (CNLDO, PANDO, SANDO) and patients with acute dacryocystitis (AD) and failed dacryocystorhinostomy (DCR). METHODS A prospective study was performed on 65 consecutive lacrimal sacs following their complete exposure during endoscopic dacryocystorhinostomy. High magnification chromo endoscopy and changes in effective spectral response was achieved using the Storz professional image enhancement system (SPIES®). Structural characteristics studied include vascular arrangement, superficial and deep vessels, vessel calibers on cut section, abnormal branching, localized and generalized dilatations and pathologies like varices. Flow characteristics in different caliber vessels and their alterations were assessed in Spectra A mode of SPIES®. RESULTS Distinct vascular alterations were noted in several lacrimal disorders. Vascular dilatations differed between the fundus and the body segments of the lacrimal sac, except in cases of traumatic SANDO and prior failed DCRs. 23% (7/30) of PANDO sacs showed peri sac varices and severe tortuosity. The flow in the dilated vessels was either very slow or showed intermittent backflow. Moderate dilatation of peri sac venous plexus with distinct surface linear vessels was noted in CNLDO. The cut surface of the sac wall and luminal surface differentially demonstrated several vascular patterns like speckled, scattered, branched loops, and skip areas in various diseased states. CONCLUSION The present study found distinct alterations of lacrimal sac vasculature in several lacrimal drainage disorders and provides impetus to the vascular theory for pathogenesis of PANDO.
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Affiliation(s)
- M J Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Road No 2, Banjara Hills, 500034 Hyderabad, India.
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Zhang W, Huang H, Liu X, Zhang L, Li L, Ding Y, Xiao Y, Ali MJ, Sun H, Xiao C. scRNA-Seq: First Atlas and Cellular Landscape of Lacrimal Sac: Implications in Primary Acquired Nasolacrimal Duct Obstruction Pathogenesis. Invest Ophthalmol Vis Sci 2024; 65:38. [PMID: 38551583 PMCID: PMC10981439 DOI: 10.1167/iovs.65.3.38] [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: 10/28/2023] [Accepted: 03/10/2024] [Indexed: 04/01/2024] Open
Abstract
Purpose The aim of this study was to describe the transcriptional changes of individual cellular components in the lacrimal sac in patients with primary acquired nasolacrimal duct obstruction (PANDO) and attempt to construct the first lacrimal sac cellular atlas to elucidate the potential mechanisms that may drive the disease pathogenesis. Methods Lacrimal sac samples were obtained intra-operatively during the endoscopic dacryocystorhinostomy (EnDCR) procedure from five patients. Single-cell RNA sequencing was performed to analyze each individual cell population including epithelial and immune cells during the early inflammatory and late inflammatory phases of the disease. Results Eleven cell types were identified among 25,791 cells. T cells and B cells were the cell populations with the greatest variation in cell numbers between the two phases and were involved in immune response and epithelium migration-related pathways. The present study showed that epithelial cells highly expressed the genes of senescence-associated secretory phenotype (SASP) and were involved in influencing the inflammation, neutrophil chemotaxis, and migration during the late inflammatory stage. Enhanced activity of CXCLs-CXCRs between the epithelial cells and neutrophils was noted by the cell-cell communication analysis and is suspected to play a role in inflammation by recruiting more neutrophils. Conclusions The study presents a comprehensive single-cell landscape of the lacrimal sac cells in different phases of PANDO. The contribution of T cells, B cells, and epithelial cells to the inflammatory response, and construction of the intercellular signaling networks between the cells within the lacrimal sac has further enhanced the present understanding of the PANDO pathogenesis.
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Affiliation(s)
- Wenyue Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Huan Huang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Xueru Liu
- Ophthalmic Center, Xinjiang 474 Hospital, Urumqi, Xinjiang, China
| | - Leilei Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Lunhao Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yi Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yichuan Xiao
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Hao Sun
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Caiwen Xiao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Wang G, Jin H, Sheng Y, Ji F, Liu Y, Han L, Wang X, Chen X, Ding H, Liu J, Fu Q. Higher incidence of meibomian gland dysfunction in postmenopausal women with primary acquired nasolacrimal duct obstruction. Int Ophthalmol 2024; 44:70. [PMID: 38349418 PMCID: PMC10864414 DOI: 10.1007/s10792-024-03041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE This study aimed to investigate the incidence of meibomian gland dysfunction (MGD) in postmenopausal women with primary acquired nasolacrimal duct obstruction (PANDO) and enables ophthalmologists to pay attention to ocular surface damage before surgery. METHODS 165 postmenopausal women with PANDO and 115 postmenopausal women with a normal lacrimal drainage system were enrolled in this prospective study. Based on the results of lacrimal duct irrigation and age, the participants were further subdivided. The incidence of different severities of MGD in different groups was calculated and analyzed by the chi-squared test. RESULTS The incidence of MGD in the PANDO group was 81.21%, and in the control group, it was 46.96%, which was significantly higher in the presence of PANDO (p < 0.001). The incidence of severe MGD in the complete and incomplete PANDO groups was higher than that in the control group (all p < 0.05), and no significant differences were observed between the complete and incomplete PANDO groups. The incidence of moderate MGD was significantly higher in the complete PANDO group than in the control group (p < 0.001). When age was considered an independent variable, the results revealed a significant value for patients aged < 70 years (p < 0.001). CONCLUSIONS Our study revealed a prodominantly high incidence of MGD in postmenopausal women with PANDO, especially in a complete PANDO or aged < 70 years. Ophthalmologists need to pay close attention to MGD in postmenopausal women with PANDO.
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Affiliation(s)
- Guoping Wang
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
| | - Haili Jin
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China.
| | - Yonghong Sheng
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
| | - Feng Ji
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
| | - Yin Liu
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
| | - Linfeng Han
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
| | - Xiaohu Wang
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
| | - Xianjie Chen
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
| | - He Ding
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
| | - Jing Liu
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
| | - Qingqing Fu
- Department of Ophthalmology, Wuhu Eye Hospital, Wuhu, 241002, Anhui Province, China
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Zhang W, Li L, Zhang L, Ding Y, Liu X, Ali MJ, Xiao C. Evaluation of primary acquired nasolacrimal duct obstruction: Comparison of CT-DCG and dacryoendoscopy in accurately localizing the lacrimal drainage obstructions. Eur J Ophthalmol 2024:11206721241230581. [PMID: 38327083 DOI: 10.1177/11206721241230581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To correlate and evaluate the power and limitations of CT-DCG in determining the level and type of lacrimal duct obstruction in comparison to dacryoendoscopy in patients clinically suspected to be having partial or complete primary acquired nasolacrimal duct obstruction (PANDO). METHODS A retrospective chart review was performed on 1232 lacrimal drainage systems of 957 patients who suffered from primary acquired nasolacrimal duct obstruction (PANDO) at Shanghai Ninth People's Hospital. Patients were examined with CT-DCG and correlated with dacryoendoscopy and the findings of clinical examination. RESULTS Of the studied patients, 173 were men and 784 were women with an age range of 18-93 years. Of the 1232 lacrimal pathways, good CT-DCG images could be obtained in 980 cases and dacryoendoscopy in 957 cases. Of these complete obstructions were noted in 81% (794/980), and partial obstructions were identified in 19% (186/980) with CT-DCG. CT-DCG and dacryoendoscopy showed 68.4% agreement for the type of the obstruction and 63% for the level of the obstruction. The majority of the obstructions occurred at the sac-duct junction (62.5%) followed by the upper half of the nasolacrimal duct (27.5%). There was a significant difference in the correlation of the obstruction type with age group and with the duration of symptoms. As the duration of symptoms increased, the proportion of complete lacrimal duct obstructions as shown on CT-DCG images increased and the proportion of incomplete obstruction decreased (p = 0.015). CONCLUSIONS The junction of lacrimal sac and nasolacrimal duct was the most common obstruction site. Age and the duration of symptoms influenced the type of obstruction noted. The degree and level of agreement between the investigations was moderate. A combination of CT-DCG and Dacryoendoscopy could together identify the location more accurately.
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Affiliation(s)
- Wenyue Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Lunhao Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Leilei Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yi Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xueru Liu
- Ophthalmic Center, Xinjiang 474 Hospital, Urumqi, Xinjiang 830011, China
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Caiwen Xiao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Ali MJ. Fungal microbiome (mycobiome) and virome of the lacrimal sac in patients with PANDO: the lacriome paper 5. Br J Ophthalmol 2024; 108:317-322. [PMID: 36270766 DOI: 10.1136/bjo-2022-322433] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To study the fungal microbiome (mycobiome) and the virome of the lacrimal sacs in patients with primary acquired nasolacrimal duct obstruction (PANDO). METHODS A prospective study was performed on 10 consecutive samples of the lacrimal sac contents obtained from patients with PANDO. The samples were obtained from the lacrimal sacs under endoscopy guidance and immediately transported on ice to the laboratory. Following DNA extraction and library preparation, a whole shotgun metagenome sequencing was performed on the Illumina platform (NOVASEQ 6000). The fungal internal transcript spacer analysis was performed using the PIPITS v2.7 . The viral taxonomy profiling was performed using Kraken2 against the virus database. RESULTS The taxonomic hit distribution across the lacrimal sac samples showed rich fungal diversity (4 phyla, 12 classed, 21 families and 26 genera). The major phyla were Ascomycota and Basidiomycota, and the key genera identified were Alternaria, Hyphopichia, Malassezia, Aspergillus and Epicoccum. The virome analysis identified 13 phyla, 15 classes and 27 families. The viruses were commonly from the families Poxviridae, Retroviridae, Siphoviridae and Myoviridae, Poxviridae being the most prevalent family. The BeAn 58058 virus, a member of the Poxviridae family, was the most abundant in all the samples. CONCLUSION The present study is the first whole metagenome sequencing exclusively of the fungal microbiome and virome from the lacrimal sacs of patients with PANDO. The lacrimal sacs harbour diverse fungal and viral communities with distinct ecosystem dynamics. Further studies of their functions and interactions with the hosts would provide valuable insights.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Hyderabad, India
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10
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Atkova EL, Yartsev VD, Ekaterinchev MA. [Anatomical structure and morphometric parameters of the distal segment of the lacrimal drainage system]. Vestn Oftalmol 2024; 140:143-149. [PMID: 38739144 DOI: 10.17116/oftalma2024140022143] [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: 05/14/2024]
Abstract
The article analyzes the literature data concerning the anatomical structure of the tear ducts with a focus on morphometric studies of individual structures. It is noted that, despite the high information content of cadaveric studies, most of the information to date has been obtained with the use of intravital radiation visualization methods. It is shown that the lacrimal drainage system has age, gender, and racial characteristics. Most studies focus on features of the bone nasolacrimal canal, while there is a relative shortage of research devoted to soft-tissue nasolacrimal duct. The analysis showed that most of the studies are devoted to particular morphometric indicators, which makes it difficult to obtain a complete objective picture of the size of the tear duct. Information about its volume can be found only in a couple of studies. The numerical values of the obtained data vary, which can be explained by a different approach to the selection of research subjects, sample sizes, anatomical criteria and the calculation method of morphometric parameters. There are only a few studies on morphometric parameters of the nasolacrimal duct in healthy humans, which is extremely important for determining the pathogenesis of disorders of the patency of the lacrimal drainage system.
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Affiliation(s)
- E L Atkova
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - V D Yartsev
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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Ali MJ. Nasolacrimal Duct Coronary Stent Recanalization (NCR): First Cadaver Experience and Its Potential as an Alternative to DCR. Ophthalmic Plast Reconstr Surg 2023; 39:558-562. [PMID: 36877544 PMCID: PMC10624404 DOI: 10.1097/iop.0000000000002381] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To investigate the feasibility of implanting a drug-eluting cobalt-chromium alloy coronary stent in the nasolacrimal ducts (NLDs) of human cadavers. METHODS The pilot study was carried out in 5 NLDs of 4 adult human cadavers. Sirolimus-eluting coronary stents of 2 mm in width and lengths of 8 and 12 mm, which were mounted on balloon catheters, were used. Following dilatation of the NLDs, the balloon catheters were introduced into the NLDs under direct endoscopy guidance. The stents were delivered following dilatation of the balloon to 12 ATMs and secured in a locked (spring out) position. The balloon is then deflated and securely extubated. The dacryoendoscopy confirmed the stent position. The lacrimal system was then dissected to assess several key parameters like the uniformity of the NLD expansion, anatomical interactions of the NLD mucosa with the stent rings and struts, integrity of the soft and bony NLD, stent movement on mechanical push and pull, and ease of manual removal. RESULTS The cobalt-chromium alloy coronary stents could be delivered with ease and secured in the cadaveric NLDs. Its position was confirmed by a dacryoendoscopy and later by the direct NLD dissection. The NLD was uniformly dilated 360° with a wide and uniform lumen. NLD mucosa was noted to be uniformly distributed in spaces between the stent rings without influencing the expanded lumen. Following the lacrimal sac's dissection, the NLD stent showed significant resistance to downward movement but could be easily retrieved with forceps. The 12-mm stents could reach the near total length of the NLD with good luminal expansion. The integrity of the bony and soft-tissue NLD was maintained. The learning curve is shallow if the surgeon is adept with the techniques of balloon dacryoplasty. CONCLUSION Drug-eluting cobalt-chromium alloy coronary stents can be precisely deployed and secured within the human NLDs. The study is the first of its kind to demonstrate the technique of NLD coronary stent recanalization in human cadavers. It is a step forward in the journey to evaluate their use in patients with primary acquired NLD obstructions and other NLD disorders.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Hyderabad, India
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Ali MJ. Etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO). Prog Retin Eye Res 2023; 96:101193. [PMID: 37394093 DOI: 10.1016/j.preteyeres.2023.101193] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/04/2023]
Abstract
Primary acquired nasolacrimal duct obstruction, or PANDO, is a common adult lacrimal drainage disorder. The current treatment modality of dacryocystorhinostomy to bypass the obstructed nasolacrimal duct has excellent outcomes. However, the understanding of the disease etiopathogenesis needs to be revisited. There are not many studies that specifically assessed any hypothesis or ones that convincingly put forth the presumed or confirmed interpretations regarding the PANDO pathogenesis or the mechanisms or pathways involved therein. Histopathological evidence points to recurrent inflammation of the nasolacrimal duct, subsequent fibrosis, and the resultant obstruction. The disease etiopathogenesis is considered multifactorial. Several implicated suspects include anatomical narrowing of the bony nasolacrimal duct, vascular factors, local hormonal imbalance, microbial influence, nasal abnormalities, autonomic dysregulation, surfactants, lysosomal dysfunction, gastroesophageal reflux, tear proteins, and deranged local host defenses. The present work reviewed the literature on the etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO) to gain insights into the present state of the understanding and the high-value translational implications of precisely decoding the disease etiology.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India.
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13
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Chen R, Yu X, Xie L, Hu Y, Jiang A, Wumaier A, Meng Z, Li J, Shen Y, Chen M, Li S, Huang D, Liang X. Microbial distributions in the conjunctiva and lacrimal sacs of patients with chronic dacryocystitis in a tertiary hospital. Int Ophthalmol 2023:10.1007/s10792-023-02743-w. [PMID: 37338773 DOI: 10.1007/s10792-023-02743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/06/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND The aim was to clarify the distributions of bacteria in the conjunctival sac and lacrimal sac in patients with chronic dacryocystitis. METHODS In total, 297 (322 eyes) chronic dacryocystitis patients who underwent nasal endoscopic dacryocystorhinostomy (EN-DCR) were included. Conjunctival sac secretions from the affected eye were collected preoperatively, and lacrimal sac retention fluid from the affected side in the same patient was collected intraoperatively. Bacterial culture and drug sensitivity testing were performed to determine bacterial distributions. RESULTS In total, 127 bacterial isolates (49 species) were detected in 123 eyes in the conjunctival group, with a positivity rate of 38.2% (123/322); 85 bacterial isolates (30 species) were detected in 85 eyes in the lacrimal sac group, with a positivity rate of 26.4% (85/322). The positivity rates were significantly different (P = 0.001) between two groups. The gram-negative bacilli proportion in the lacrimal sac group (36/85, 42.4%) was significantly higher than that in the conjunctival sac group (37/127, 29.2%) ( P = 0.047). Positive conjunctival sac secretion culture (123/322) was significantly associated with increased ocular secretion (281/322, 87.3%) (P = 0.002). Among the culture-positive bacteria in the conjunctival sac group and the lacrimal sac group, 30/127, 23.6% and 43/127, 26.7% and 21/85, 24.7% and 20/85, 23.5% were resistant to levofloxacin and tobramycin, respectively. CONCLUSIONS This study illustrated differences in bacterial distributions between conjunctival sac secretions and retained lacrimal sac fluid in chronic dacryocystitis patients, with a higher proportion of gram-negative bacilli in lacrimal sac secretions. The ocular surface flora in chronic dacryocystitis patients is partially resistant to levofloxacin and tobramycin, which need to be considered by ophthalmologists.
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Affiliation(s)
- Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China.
| | - Xinyue Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Lingling Xie
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, The First People's Hospital of Kashi Prefecture, Kashi, 844000, China
| | - Yu Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Aixin Jiang
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, The First People's Hospital of Kashi Prefecture, Kashi, 844000, China
| | - Aizezi Wumaier
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, The First People's Hospital of Kashi Prefecture, Kashi, 844000, China
| | - Ziwei Meng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Yongqing Shen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Meiqing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Shuiling Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Danping Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Xuanwei Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 South Xianlie Road, Guangzhou, 510060, China.
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Yartsev VD, Atkova EL, Ekaterinchev MA. Topographic and anatomical features of the nasolacrimal duct obstruction due to radioiodine treatment. Int Ophthalmol 2023:10.1007/s10792-023-02746-7. [PMID: 37199817 DOI: 10.1007/s10792-023-02746-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE To investigate the topographic and anatomical features of secondary acquired nasolacrimal duct obstruction (SALDO) due to radioiodine therapy. METHODS Dacryocystography-computed tomography (DCG-CT) scans of the nasolacrimal ducts in 64 cases with SALDO due to radioiodine therapy and in 69 cases with primary acquired nasolacrimal duct obstruction (PANDO) were studied. The anatomical site of obstruction was located, and morphometric characteristics of the nasolacrimal ducts were calculated: volume, length, and average sectional area. The statistical analysis was performed using the t-criterion, ROC analysis, and the odds ratio (OR). RESULTS The mean nasolacrimal section area was 10.7 ± 0.8 mm2 in patients with PANDO and 13.2 ± 0.9 mm2 in patients with SALDO due to radioiodine therapy (p = 0.039); the AUC value in ROC analysis for this parameter was 0.607 (p = 0.037). The development of "proximal" obstruction including lacrimal canaliculi obstruction and obstruction at the site of the lacrimal sac was 4.076 times more likely (CI: 1.967-8.443) in patients with PANDO than in patients with SALDO due to radioactive iodine exposure. CONCLUSIONS By comparing CT scans of the nasolacrimal ducts, we observed that in SALDO obstruction due to radioactive iodine therapy is predominantly "distal," while in PANDO it is more often "proximal." The development of obstruction within SALDO is followed by more pronounced suprastenotic ectasia.
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Affiliation(s)
- Vasily D Yartsev
- Lacrimal Pathology Department, Krasnov Research Institute of Eye Diseases, Rossolimo St., 11A, Moscow, Russia, 119021.
| | - Eugenia L Atkova
- Lacrimal Pathology Department, Krasnov Research Institute of Eye Diseases, Rossolimo St., 11A, Moscow, Russia, 119021
| | - Maxim A Ekaterinchev
- Lacrimal Pathology Department, Krasnov Research Institute of Eye Diseases, Rossolimo St., 11A, Moscow, Russia, 119021
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Zimmermann JA, Esser EL, Merté RL, Danzer MF, Rosenberger F, Brücher VC, Eter N, Alnawaiseh M, Blumberg AF, Lahme L, Mihailovic N. Nasolacrimal intubation in transcanalicular endoscopic dacryoplasty: a long-term follow-up study. Sci Rep 2023; 13:7521. [PMID: 37160950 PMCID: PMC10170144 DOI: 10.1038/s41598-023-34351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
Nowadays, transcanalicular endoscopic dacryoplasty represents the majority of lacrimal duct surgery procedures performed in adults in specialised centers. However, there are still hardly any data available regarding the intra- and postoperative care, particularly regarding the duration of silicone tube intubation (STI). Our aim was to evaluate the relation between tube duration and recurrence of symptoms in patients who underwent transcanalicular microdrill dacryoplasty (MDP) in a long-term setting. Medical records of 576 adult patients after MDP were retrospectively reviewed. A total of 256 eyes of 191 patients could be included. The median follow-up time was 7.83 [7.08; 9.25] years. In 57.0% of the cases there was still full resolution of symptoms at the time of the survey. The median duration of the STI was 6 [3.00; 6:00] months. When distinguishing between a tube duration < 3 months and ≥ 3 months there was a significant difference in the long-term success rate (< 3 months: 38%; ≥ 3 months: 61%; p = 0.011). In conclusion, an early removal of the STI (< 3 months) after transcanalicular MDP seems to be associated with a higher incidence of recurrence of symptoms. This should be considered in the intra- and postoperative care of patients following this minimally invasive first-step procedure.
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Affiliation(s)
- Julian Alexander Zimmermann
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Eliane Luisa Esser
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Ralph-Laurent Merté
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Moritz Fabian Danzer
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Friederike Rosenberger
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Viktoria C Brücher
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Maged Alnawaiseh
- Department of Ophthalmology, Klinikum Bielefeld Gem. GmbH, Bielefeld, Germany
| | - Alina Friederike Blumberg
- Department of Ophthalmology, Klinikum Fulda gAG, University of Marburg, Campus Fulda, Fulda, Germany
| | - Larissa Lahme
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Natasa Mihailovic
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany.
- Department of Ophthalmology, Klinikum Bielefeld Gem. GmbH, Bielefeld, Germany.
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Jin H, Zhang H. Changes in the meibomian glands in postmenopausal women with primary acquired nasolacrimal duct obstruction: a prospective study. BMC Ophthalmol 2023; 23:48. [PMID: 36726065 PMCID: PMC9890874 DOI: 10.1186/s12886-023-02799-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/30/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Primary acquired nasolacrimal duct obstruction (PANDO) is frequently encountered in perimenopausal women, causing tear flow stagnation and resulting in a variety of ocular discomfort symptoms. However, little is known about the alterations in the meibomian gland in postmenopausal women with PANDO. Hence, this study investigated the changes in the meibomian gland and ocular surface in postmenopausal women with PANDO. METHODS This prospective study included 60 eyes of 60 postmenopausal women with PANDO (PANDO group) and 30 eyes of 30 postmenopausal women without PANDO (control group). The PANDO group was further subdivided into incomplete and complete PANDO groups, based on the degree of nasolacrimal duct obstruction. The patients' symptoms were evaluated using the ocular surface disease index questionnaire. The meibomian gland and ocular surface were assessed using the Keratograph 5 M. Other ophthalmologic examinations included the tear break-up time, corneal fluorescein staining, meibomian gland expression, and Schirmer I test. The correlations between the degree of nasolacrimal duct obstruction and other metrics were analyzed. RESULTS The loss ratio of the upper eyelid was greater in the incomplete PANDO group than in the control group (p = 0.023). Meibomian gland distortion of the upper eyelid was more severe in the control group than in the complete PANDO group (p = 0.022). The non-invasive tear meniscus height was greater, whereas the intensity of corneal fluorescein staining was lower in the PANDO group than in the control group (all p < 0.05). The degree of nasolacrimal duct obstruction was positively associated with the non-invasive tear meniscus height and ocular surface disease index scores (p < 0.001 and p < 0.001, respectively). Corneal fluorescein staining and meibomian gland distortion of the upper eyelid were negatively correlated with the degree of nasolacrimal duct obstruction (p = 0.01 and p = 0.007, respectively). CONCLUSION Postmenopausal women with PANDO exhibit significant morphological changes in the meibomian gland. More attention should be paid to meibomian gland loss in postmenopausal women with incomplete PANDO, as it is crucial for identifying meibomian gland impairments in patients with PANDO.
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Affiliation(s)
- Haili Jin
- grid.265021.20000 0000 9792 1228Department of Ophthalmology, Tianjin Medical University, NO. 22, Qixiangtai Road, Tianjin, 300052 China ,grid.440648.a0000 0001 0477 188XDepartment of Ophthalmology, Wuhu Eye Hospital, Anhui University of Science & Technology, 378 Santan Road, Yijiang District, Wuhu, 241002, Anhui China
| | - Hong Zhang
- grid.265021.20000 0000 9792 1228Department of Ophthalmology, Tianjin Medical University, NO. 22, Qixiangtai Road, Tianjin, 300052 China ,grid.265021.20000 0000 9792 1228Department of Ophthalmology, Sino-Singapore Eco-City Hospital of Tianjin Medical University, NO. 3333, Hechang Road, Sino-Singapore Eco-City, Binhai New Area, Tianjin, 3000467 China
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Atkova EL, Yartsev VD, Krakhovetskiy NN. [Disorders of lacrimal drainage: the way from theory to practice]. Vestn Oftalmol 2023; 139:71-80. [PMID: 37144372 DOI: 10.17116/oftalma202313903271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The article summarizes the results of research conducted over the past decade concerning the current problems of dacryology, analyzes the improvements made to the methods of diagnostics used in disorders of lacrimal passages on the basis of modern imaging and functional studies, describes the techniques aimed at improving the clinical effectiveness of the intervention, as well as drug and non-drug methods of intraoperative prevention of excessive scarring in the area of the artificial ostium. The article also analyzes the experience of using balloon dacryoplasty in relapses of tear duct obstruction after dacryocystorhinostomy, and presents the modern minimally invasive surgical techniques, including nasolacrimal duct intubation, as well as balloon dacryoplasty and endoscopic plastic surgery of the ostium of the nasolacrimal duct. Additionally, the work lists the fundamental and applied tasks of dacryology and outlines promising directions of its development.
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Affiliation(s)
- E L Atkova
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - V D Yartsev
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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Ali MJ. Metagenomics of the lacrimal sac in primary acquired nasolacrimal duct obstruction: the Lacriome paper 1. Br J Ophthalmol 2023; 107:147-150. [PMID: 34261660 DOI: 10.1136/bjophthalmol-2021-319677] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/28/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The purpose is to study the metagenomics of the microbes isolated from the lacrimal sac of patients with primary acquired nasolacrimal duct obstruction (PANDO). METHODS A prospective study was performed on ten consecutive lacrimal sac samples obtained for the metagenomic analysis from the patients with PANDO, who underwent endoscopic dacryocystorhinostomy at a tertiary care Dacryology service. The samples were collected intraoperatively soon after a full-length lacrimal sac marsupialisation and immediately transported on ice to the laboratory. Following DNA extraction and library preparation, a whole shotgun metagenome sequencing was performed on the Illumina platform. The downstream processing and bioinformatics of the samples were performed using multiple software packaged in the SqueezeMeta pipeline and MG-RAST pipeline. RESULTS The taxonomic hit distribution across the samples showed that bacteria were the most common isolates (mean-97.56%), followed by viruses (mean-0.29%), archaea (0.04%) and others. The five major phyla identified across the samples of PANDO were proteobacteria, Bacteroidetes, Fusobacteria, Actinobacteria and Firmicutes. The prevalent organisms include Acinetobacter johnsonii, Porphyromonas catoniae, Cutibacterium acnes, Pseudomonas alcaliphila, Escherichia coli, Haemophilus influenzae, Enhydrobacter aerosaccus, Fusobacterium nucleatum, Moraxella osloensis, Butyricimonas virosa and Variovorax paradoxus, among few others. The alpha diversity of the ten sample datasets ranged from 60 to 175 species. CONCLUSION This is the first whole metagenome sequencing of the lacrimal sac contents from PANDO patients. Lacrimal sacs harbour diverse microbial communities, including bacteria, viruses, and archaea. Further Lacriome studies may provide clues for a better understanding of the disease aetiopathogenesis.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Hyderabad, Telangana, India
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19
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Atkova EL, Astrakhanstev AF, Subbot AM, Yartsev VD. [Dynamic pathomorphological characteristics of the nasolacrimal duct in its stenosis]. Arkh Patol 2023; 85:22-28. [PMID: 37814846 DOI: 10.17116/patol20238505122] [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: 10/11/2023]
Abstract
OBJECTIVE Pathological description of the process of stenosis of the nasolacrimal duct at its various stages. MATERIAL AND METHODS The material for the study was obtained from the wall of the nasolacrimal duct during surgery in 50 patients whose condition was attributed to the 1st, 2nd or 3rd clinical stage of dacryostenosis. The material was fixed in formalin and sent for pathohistological and immunohistochemical (IHC) studies. RESULTS In the 1st stage, the integrity of the epithelium of the nasolacrimal duct was preserved, the density of goblet cells was reduced. Seromucinous glands were single in the lamina propria in the area of stenosis. Diffuse lymphoid-plasmacytic infiltration was observed along the periphery of the terminal sections of the glands and in the subepithelial zone. The infiltrate includes CD68+ tissue macrophages and CD20+ and CD3+ lymphocytes, with a predominance of B-lymphocytes over T-lymphocytes. In the 2nd stage, changes in the epithelial layer in the stenosis zone were detected. In the IHC study, only individual leukocytes were observed in these zones, and T cells were found mainly in the subepithelial zone, B cells - deeper, monocytes - evenly in all layers. In the adjacent zones, the picture of the infiltrate corresponded to the 1st stage. In the 3rd stage, fragments of the nasolacrimal duct wall were represented by dense fibrous connective tissue with pronounced atrophic changes, areas of squamous metaplasia or proliferation of the basal layer, goblet cells were not detected. There was no infiltrate in the area of stenosis during IHC study. In the cellular elements of the infiltrate in areas adjacent to the stenosis zone, CD20+ and CD3+ lymphocytes were present in equal proportions, the arrangement in layers corresponded to that of the 2nd stage. CONCLUSION The results of the study showed that dacryostenosis is a progressive pathological process associated with the progredient development of chronic productive inflammation in the lacrimal ducts.
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Affiliation(s)
- E L Atkova
- M.M. Krasnov Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - A F Astrakhanstev
- D.I. Mastbaum Bureau of Forensic Medical Examination, Ryazan, Russia
| | - A M Subbot
- M.M. Krasnov Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - V D Yartsev
- M.M. Krasnov Scientific Research Institute of Eye Diseases, Moscow, Russia
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Su PY, Wang JK, Chang SW. Computed Tomography Morphology of Affected versus Unaffected Sides in Patients with Unilateral Primary Acquired Nasolacrimal Duct Obstruction. J Clin Med 2023; 12:jcm12010340. [PMID: 36615139 PMCID: PMC9821633 DOI: 10.3390/jcm12010340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This study aimed to describe the anatomical details of the bony nasolacrimal duct (BNLD) and adjacent nasal structures by analyzing computed tomography (CT) images, and to investigate their effects on the development of primary acquired nasolacrimal duct obstruction (PANDO). METHODS A total of 50 patients with unilateral PANDO who underwent dacryocystorhinostomy, with a mean age of 57.96 years, were included. The preoperative CT images were reviewed to measure the anteroposterior and transverse diameters of the BNLD at the entrance and exit levels, as well as the minimum transverse diameter along the tract. The sagittal CT images were analyzed to classify the shape of the bony canals into columnar, funnel, flare, and hourglass. The associated paranasal abnormalities, including nasal septum deviation (NSD), sinusitis, angle between the bony inferior turbinate and medial wall of the maxillary sinus, and mucosal thickness of the inferior turbinate, were investigated. RESULTS Fifty CT images were analyzed, and all parameters measured on both sides of the BNLD were not significantly different between the PANDO and non-PANDO sides, except for the minimum transverse diameter, which was significantly smaller on the PANDO side (p = 0.002). Columnar-shaped BNLD was the most common on both sides. No significant difference was observed in the incidence of paranasal abnormalities between sides; however, deviation of the septum toward the non-PANDO side was more common (67.9%). CONCLUSIONS A small minimum transverse diameter of the BNLD may be a risk factor for PANDO. The association between nasal abnormalities and PANDO was not remarkable.
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Affiliation(s)
- Pei-Yuan Su
- Ophthalmology Department, Far-Eastern Memorial Hospital, New Taipei City 220, Taiwan
- School of Medicine, Fu-Jen Catholic, New Taipei City 242062, Taiwan
- Correspondence: ; Tel.: +886-2-89667000 (ext. 1349)
| | - Jia-Kang Wang
- Ophthalmology Department, Far-Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Shu-Wen Chang
- Ophthalmology Department, Far-Eastern Memorial Hospital, New Taipei City 220, Taiwan
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Zhao Y, Tian M, Luo B, Liang W, Wu H, Wang Q, Zhang J. Quantitative analysis of both lacrimal glands in unilateral primary acquired nasolacrimal duct obstruction, based on three-dimensional fast spin echo-Cube-Flex. Eur J Radiol 2022; 156:110517. [PMID: 36108476 DOI: 10.1016/j.ejrad.2022.110517] [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: 05/17/2022] [Revised: 08/17/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate whether unilateral primary acquired nasolacrimal duct obstruction (PANDO) changes the volume and water fraction of both lacrimal glands, using three-dimensional fast spin echo (3D-FSE)-Cube-Flex images, and to identify whether the lacrimal gland is a target organ in this disease. METHODS 3D-FSE-Cube-Flex images of both lacrimal glands in 25 healthy volunteers and 31 patients with unilateral PANDO were retrospectively reviewed. The differences in volume and water content in the lacrimal glands between the controls, non-PANDO side, and PANDO side groups were examined. Moreover, the associations between magnetic resonance imaging (MRI) parameters and disease duration were assessed with correlation analysis. RESULTS The lacrimal gland volumes were not significantly different between the PANDO and non-PANDO side groups, compared to the control group (P = 0.484). However, the gland volumes tended to be increased bilaterally in patients with PANDO. In contrast, the gland water fractions in the PANDO and non-PANDO side groups were significantly higher than those in the control group (P = 0.009 and P = 0.014, respectively), and similar between the non-PANDO and PANDO side groups (P = 0.897). No correlation was found between the disease duration and the gland MRI parameters (volume and water fraction). CONCLUSIONS Both lacrimal glands are affected by unilateral PANDO. A change in the water fraction of these glands appears to precede the change in volume and may be a sensitive early indicator.
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Affiliation(s)
- Yali Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Tian
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ban Luo
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiqiang Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyu Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuxia Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Jing Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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22
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Vinciguerra A, Resti AG, Rampi A, Bussi M, Bandello F, Trimarchi M. Endoscopic and external dacryocystorhinostomy: A therapeutic proposal for distal acquired lacrimal obstructions. Eur J Ophthalmol 2022; 33:1287-1293. [PMID: 36254409 PMCID: PMC10152216 DOI: 10.1177/11206721221132746] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endoscopic (END-DCR) and external dacryocystorhinostomies (EXT-DCR) are nowadays considered the gold standard techniques for non-oncologic distal acquired lacrimal disorders (DALO). However, no unanimous consensus has been achieved on which of these surgeries is the most suitable to the individual patient. Herein, we review the available literature of the last 30 years with the aim of defining a simple and reproduceable treatment algorithm to treat DALO. A search of PubMed, EMBASE, Scopus and Cochrane databases was last performed in December 2021 to examine evidence regarding the role of END-DCR and EXT-DCR in primary and revision surgeries. If considered primary surgeries, END-DCR should be preferred in case of intranasal comorbidities, given the possibility to directly visualize and treat potential intranasal pathologies. Conversely, EXT-DCR should be chosen in case of need/preference for local anesthesia, given the major historical experience and wider surgical field that helps to resolve intra-operatory complications (e.g., bleeding) in an uncollaborative patient. In the absence of the abovementioned conditions, the decision of one or other approach should be discussed with the patient. In recurrent cases, END-DCR should be considered the treatment of choice given the major likelihood to visualize the causes of primary failure and directly resolve it. In conclusion, END-DCR should be considered the treatment of choice in revision cases or in primary ones associated with intranasal pathologies, whereas EXT-DCR should be chosen if local anesthesia is needed. In the absence of these scenarios, it is still open to debate which of these two approaches should be used.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck Department, Ophthalmology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Rampi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck Department, Ophthalmology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
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23
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Tıskaoğlu NS, Yazıcı A. Tear instability in the fellow eye of unilateral nasolacrimal obstruction and resolution with dacryocystorhinostomy. Orbit 2022:1-7. [PMID: 36069079 DOI: 10.1080/01676830.2022.2119261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine the effect of unilateral primary acquired nasolacrimal obstruction (PANDO) on ocular surface parameters in PANDOeyes and fellow eyes and changes in these parameters after dacryocystorhinostomy. METHODS Tear osmolarity, tear break-up time (TBUT), Schirmer's test, Meibomian gland score, and Lissamine Green staining of PANDO eyes and fellow eyes were measured preoperatively and postoperatively at Day 15, 1 month, and 3 months. Lacrimal irrigation and epiphora symptomatology were evaluated at all follow-up visits, and patients who did not meet surgical success criteria were excluded from the study. RESULTS Twenty-nine patients who underwent successful dacryocystorhinostomy surgery were included in the study. Preoperative and postoperative Day 15 Schirmer (p = .019, p = .001) and TBUT (p = .039, p = .043) were significantly lower in the fellow eye compared to PANDO eyes. The differences observed between PANDO eyes and fellow eyes in all other parameters were not significant (p > .05). Preoperatively PANDO eye parameters were normal, whereas TBUT (7.59 ± 5.39 s) and tear osmolarity (308.59 ± 17.32 mOsm/L) values of the fellow eye may be indicative of tear film instability. TBUT and tear osmolarity of the fellow eye showed significant improvement 3 months postoperatively compared to preoperative values (p = .010; p = .027 respectively). CONCLUSION Schirmer and TBUT values of the fellow eye were significantly lower than PANDO eyes preoperatively, one month after surgery there was no significant difference. TBUT and tear osmolarity of the fellow eyes may be indicative of tear instability preoperatively with improvement 3 months after dacryocystorhinostomy.
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Affiliation(s)
- Nesime Setge Tıskaoğlu
- Department of Ophthalmology, Dr. Ersin Arslan Research and Education Hospital, Gaziantep, Turkey
| | - Alper Yazıcı
- Department of Ophthalmology, Batı Göz Hospital, Izmir, Turkey
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24
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Tıskaoğlu NS, Yazıcı A. Reduced tear break-up time in the fellow eye of patients with unilateral primary acquired nasolacrimal duct obstruction. Int Ophthalmol 2022; 43:965-971. [PMID: 36053478 DOI: 10.1007/s10792-022-02498-w] [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: 02/26/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To measure tear osmolarity, Schirmer I test and tear break-up time (TBUT) values in the obstructed and non-obstructed fellow eye of unilateral primary acquired nasolacrimal duct obstruction (PANDO) patients and compare them with healthy controls. METHODS In this prospective noninterventional study, the tear osmolarity, Schirmer I test, and TBUT values from unilateral PANDO eyes, fellow eyes, and control eyes of all subjects were measured. RESULTS The study included 114 eyes of 30 PANDO patients as well as 27 healthy controls. There was a significant difference between TBUT and Schirmer values of fellow eyes and PANDO eyes (p = 0,035; p = 0,001). There was no significant difference in any of the ocular surface parameters between PANDO eyes and control eyes (p > 0.05). When fellow eyes were compared to control eyes, there was a significant difference in TBUT (p = 0.046). CONCLUSIONS Decreased TBUT was exhibited by the fellow eye of unilateral PANDO patients, compared to the PANDO side and controls. Compensatory changes in PANDO eyes due to a decrease in the tear secretion reflex may lead to tear dysfunction of the fellow eye. Clinicians should assess tear stability in the fellow eye of PANDO patients as this could be leading to added symptomatic complaints.
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Affiliation(s)
- Nesime Setge Tıskaoğlu
- Ophthalmology Department, Dr. Ersin Arslan's Research and Education Hospital, Gaziantep, Turkey. .,Ophthalmology Department, İzmir Torbalı State Hospital, İzmir, Turkey.
| | - Alper Yazıcı
- Ophthalmology Department, Dr. Ersin Arslan's Research and Education Hospital, Gaziantep, Turkey.,Ophthalmology Department, İzmir Torbalı State Hospital, İzmir, Turkey
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25
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Shahryari S, Hanafi MG, Kamankesh R, Mahdianrad A, Moghadam ARE. Computed tomographic assessment of the lacrimal sac fossa in southwest population of Iran. Anat Cell Biol 2022; 55:277-283. [PMID: 35942868 PMCID: PMC9519764 DOI: 10.5115/acb.22.001] [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: 01/02/2022] [Revised: 04/15/2022] [Accepted: 05/11/2022] [Indexed: 11/27/2022] Open
Abstract
To determine the morphology of the lacrimal sac fossa and bony nasolacrimal duct using computed tomography for obtaining detailed anatomical understanding of the drainage system and utilizing these measurements in planning for dacryocystorhinostomy (DCR) and nasolacrimal duct (NLD) obstruction in normal southwest (SW) population of Iran. One-hundred-sixty-five cases referred for the diagnosis of neuro-ophthalmic conditions were retrospectively studied. Measurements of lacrimal sac fossa were taken on three anatomical sections (upper, middle, and lower planes) utilizing a digital caliper/protractor instrument. Lacrimal thickness and two measurements of maxillary bone thickness were taken at each plane—namely, the “midpoint thickness” and the “maximum thickness.” The anterior extent of the nasal mucosa and NLD width was also evaluated. The mean maximum thickness of the maxillary bone at the three anatomical planes of the lacrimal sac fossa was 4.07 mm, 4.78 mm, and 5.60 mm, respectively. The midpoint thickness of the maxillary bone at each plane was 2.38 mm, 1.99 mm, and 1.68 mm, respectively, in both sexs. The lacrimal bone thickness at each level was 0.76 mm, 0.69 mm, and 0.67 mm, respectively. The proportion of the lacrimal sac fossa comprising the lacrimal bone at lower plane was 43.57% and showed a positive correlation with age (P=0.01). The mean anteroposterior bony nasolacrimal diameter was 5.94 mm with no significant difference between patient sex and age. According to the results, its indicate that performing an osteotomy during DCR could be easier in the Iranian SW population compared to other ethnics.
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Affiliation(s)
- Samad Shahryari
- Department of Radiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Ghasem Hanafi
- Department of Radiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Rouhangiz Kamankesh
- Department of Radiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Atefeh Mahdianrad
- Department of Ophthalmology, Faculty of Medicine, Infectious Ophthalmic Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Reza Eftekhari Moghadam
- Department of Anatomical Sciences, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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26
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Changes in Tears Monocyte Chemoattractant Protein-1 Level After External Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction. J Craniofac Surg 2022; 33:e776-e779. [PMID: 35882040 DOI: 10.1097/scs.0000000000008723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND The authors aimed to define tears monocyte chemoattractant protein-1 (MCP-1) changes after external dacryocystorhinostomy surgery. MATERIALS AND METHODS Tears samples were collected with a Schirmer strip and stored in Eppendorf tubes at -80°C. At the end of the study, the papers were cut into small pieces and incubated with phosphate-buffered saline solution. Monocyte chemoattractant protein-1 levels were determined by using an enzyme-linked immunosorbent assays kit. RESULTS The MCP-1 levels were 498.66±101.35, 576.40±149.78, 422.53±85.94, and 436.96±81.38 ng/L before surgery, in the first week, the first, and third months after surgery, respectively. Its level significantly increased in the first week compared with the preoperative level ( P <0.001). There was a prominent decrease in the postoperative first month ( P <0.001). In the third postoperative month, the mean MCP-1 level was not significantly increased compared with the postoperative first month ( P =0.196). CONCLUSION The tears MCP-1 level was significantly decreased after external dacryocystorhinostomy surgery.
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27
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Yang MK, Sa HS, Kim N, Kim JH, Choung H, Khwarg SI. Bony nasolacrimal duct size and outcomes of nasolacrimal silicone intubation for incomplete primary acquired nasolacrimal duct obstruction. PLoS One 2022; 17:e0266040. [PMID: 35344555 PMCID: PMC8959155 DOI: 10.1371/journal.pone.0266040] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the association between the bony nasolacrimal duct (NLD) size and outcomes of nasolacrimal silicone intubation for incomplete primary acquired nasolacrimal duct obstruction (PANDO). Methods Patients who underwent silicone intubation for incomplete PANDO and had undergone facial computed tomography (CT) were included. Surgical success was judged by both epiphora improvement and normalized tear meniscus height (TMH; < 300 μm) on anterior segment optical coherence tomography at 3 months after tube removal. The area, major axis diameter, and minor axis diameter of the elliptic bony NLD sections were measured in 1.0 mm-thick axial CT images. These bony NLD sizes were analyzed for associations with surgical success and TMH normalization. Results Eighty-one eyes of 48 patients were investigated. The smallest area and the smallest minor axis diameter were significantly larger in the success group (49 eyes), compared with those in the failure group (median smallest minor axis diameter: 4.7 mm vs. 3.8 mm, P = 0.008, Mann–Whitney U test). There was also a tendency for the TMH normalization rate to significantly increase as the smallest area and the smallest minor axis diameter increased (P = 0.028 and 0.037, respectively, Fisher’s 2 × 4 tests). Under multivariable logistic regression analysis using generalized estimating equation, a larger smallest minor axis diameter was associated with success of the nasolacrimal silicone intubation (odds ratio: 2.481, 95% confidence interval: 1.143–5.384). Conclusion Surgical success of the nasolacrimal silicone intubation in incomplete PANDO is associated with a larger smallest minor axis diameter of the bony NLD. This finding will help understand the pathophysiology of surgical failure after nasolacrimal silicone intubation.
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Affiliation(s)
- Min Kyu Yang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- * E-mail:
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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28
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Yartsev VD, Atkova EL, Rozmanov EO, Yartseva ND. Rhinological Status of Patients with Nasolacrimal Duct Obstruction. Int Arch Otorhinolaryngol 2021; 26:e434-e439. [PMID: 35846831 PMCID: PMC9282945 DOI: 10.1055/s-0041-1730018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/14/2021] [Indexed: 10/31/2022] Open
Abstract
Abstract
Introduction Studying the state of the nasal cavity and its sinuses and the morphometric parameters of the inferior nasal conchae, as well as a comparative analysis of obtained values in patients with primary (PANDO) and secondary acquired nasolacrimal duct obstruction (SALDO), is relevant.
Objective To study the rhinological status of patients with PANDO) and SALDO).
Methods The present study was based on the results of computed tomography (CT) dacryocystography in patients with PANDO (n = 45) and SALDO due to exposure to radioactive iodine (n = 14). The control group included CT images of paranasal sinuses in patients with no pathology (n = 49). Rhinological status according to the Newman and Lund-Mackay scales and volume of the inferior nasal conchae were assessed. Statistical processing included nonparametric statistics methods; χ2 Pearson test; and the Spearman rank correlation method.
Results The difference in values of the Newman and Lund-Mackay scales for the tested groups was significant. A significant difference in scores by the Newman scale was revealed when comparing the results of patients with SALDO and PANDO. Comparing the scores by the Lund-Mackay scale, a significant difference was found between the results of patients with SALDO and PANDO and between the results of patients with PANDO and the control group.
Conclusion It was demonstrated that the rhinological status of patients with PANDO was worse than that of patients with SALDO and of subjects in the control group. No connection was found between the volume of the inferior nasal conchae and the development of lacrimal duct obstruction.
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Affiliation(s)
| | | | | | - Nina D. Yartseva
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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29
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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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30
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Ali MJ. Functional metagenomic profile of the lacrimal sac microbial communities in primary acquired nasolacrimal duct obstruction: The Lacriome paper 2. Eur J Ophthalmol 2021; 32:2059-2066. [PMID: 34816752 DOI: 10.1177/11206721211064015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To study the functional metagenomic profile of the microbes isolated from the lacrimal sac of patients with primary acquired nasolacrimal duct obstruction. METHODS A prospective study was performed on 10 consecutive lacrimal sac samples obtained for the metagenomic analysis from patients with primary acquired nasolacrimal duct obstruction ( who underwent endoscopic dacryocystorhinostomy at a tertiary care Dacryology service. The samples were collected intraoperatively soon after a full-length lacrimal sac marsupialization and immediately transported on ice to the laboratory. Following DNA extraction and library preparation, a whole shotgun metagenome sequencing was performed on the Illumina NOVASEQ 6000TM platform. The downstream processing and bioinformatics of the samples were performed using multiple software packaged in SqueezeMetaTM pipeline and functional analysis using the MG-RASTTM pipeline. RESULTS The microbial gene mapping and protein prediction demonstrated proteins with known functions to range from 66.41% to 84.03% across the samples. The functional category distribution of Kyoto Encyclopedia of Genes and Genomes ortholog (level 1 data) showed metabolism to be the most commonly involved function followed by environmental information processes, genetic information processes and cellular processes. The functional subsystem profiling demonstrated genes associated with carbohydrate, protein and RNA metabolism, Amino acids and their derivatives, cofactors and prosthetic groups and factors involved in cell structure regulation and cell cycle control. CONCLUSION This is the first functional metagenomic profile of the lacrimal sac microbiota from patients with primary acquired nasolacrimal duct obstruction. Functional analysis has provided newer insights into the ecosystem dynamics and strategies of microbial communities inhabiting the lacrimal sac. Further Lacriome studies may provide clues for better understanding of the disease etiopathogenesis.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, 28592L.V. Prasad Eye Institute, Hyderabad, India
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31
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Lin Z, Kamath N, Malik A. High-resolution computed tomography assessment of bony nasolacrimal parameters: variations due to age, sex, and facial features. Orbit 2021; 40:364-369. [PMID: 32669001 DOI: 10.1080/01676830.2020.1793374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To compare nasolacrimal duct anatomy between gender, age, and facial features, and explore correlations between bony parameters. METHODS A retrospective case series of patients of four races who had high-resolution computed tomography (CT) between 2004 and 2019 covering the full length of their nasolacrimal ducts in two hospitals in Essex, England. Only normal ducts were included; patients with tearing or radiological abnormalities were excluded. Measurements were taken of the nasolacrimal duct and surrounding anatomy based on measurements found in the existing literature. RESULTS More females (n = 114) than males (n = 40) were included. Mean age was slightly older for females (45.7 years) compared to males (42.5). Males have taller noses and wider faces. Nasolacrimal duct calibre correlated positively with age, male gender, and facial width, and negatively with nasal height. There was a tendency for nasolacrimal ducts to be longer in males. CONCLUSION The bony nasolacrimal duct is smaller in younger female patients. Having a taller nose and narrower upper face is also correlated with a smaller calibre duct. Acquired nasolacrimal duct obstruction in patients without these demographics or facial features may be more likely due to secondary causes.
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Affiliation(s)
- Zhiheng Lin
- Ophthalmology Department, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
- Radiology Department, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Namita Kamath
- Ophthalmology Department, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Adeela Malik
- Radiology Department, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
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32
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Vinciguerra A, Nonis A, Giordano Resti A, Ali MJ, Bussi M, Trimarchi M. Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases. Eur J Ophthalmol 2021; 32:66-74. [PMID: 34318721 DOI: 10.1177/11206721211035616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Distal acquired lacrimal obstruction is a common adulthood pathology whose primary treatment is represented by EXT-DCR and END-DCR. When considering their influencing factors, the role of the type of anaesthesia applied during these surgeries has a major role. The aim of this study is to systematically analyse the influence of general and local/regional anaesthesia on the final success rates of EXT-DCR and END-DCR. Primary EXT-DCR and END-DCR articles published later than 2000 with at least 50 single clinician procedures were selected. Exclusion criteria included acute dacryocystitis, tumours, studies focussing on revision surgeries, surgeries with adjunctive procedures, not clearly demarcated surgeons, mixed cohort study of acquired and congenital disorders. This systematic review was conducted in accordance with MOOSE guidelines; where feasible, a meta-analysis of the collected results was conducted. As a result, 11,445 articles were selected of which 2741 were examined after screening, and 16 included after full text review (0.6% of the initial papers). Among all papers included, the number of EXT-DCR was not enough to provide a solid analysis of the effect of anaesthesia; conversely, a significant difference of success rate was noted between local anaesthesia + sedation (85.1%, IC 77.8%-90.4%), and general anaesthesia (90.8%, IC 88.8%-92.4%) in END-DCR (p = 0.048). In conclusion, END-DCR performed with general anaesthesia should be considered as the solution of choice; however, local anaesthesia, eventually associated with a sedation, can be used as an alternative in selected cases. No meaningful conclusions could be drawn for EXT-DCR, due to the lack of data.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Nonis
- CUSSB, University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck Department, Ophthalmologic Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies. Eur Arch Otorhinolaryngol 2021; 279:1929-1935. [PMID: 34251520 PMCID: PMC8273032 DOI: 10.1007/s00405-021-06975-3] [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: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Purpose Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction. Methods At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test. Results Among 14 patients included and after a mean follow-up of 19.5 months (range 13–51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported. Conclusion Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.
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Nagendran ST, Ali MJ, Dogru M, Malhotra R. Complications and Adverse Effects of Periocular Aesthetic Treatments. Surv Ophthalmol 2021; 67:741-757. [PMID: 33933438 DOI: 10.1016/j.survophthal.2021.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
The popularity and variety of temporary and permanent periocular aesthetic treatments has increased over the past decade. Patients frequently present to eye clinics with ocular complications and side effects following these treatments, their severity ranging from ocular irritation from dry eyes to visual loss from vascular occlusion. A careful, thorough history is essential, as many patients may not associate aesthetic procedures with ocular complications, and some may be embarrassed to disclose this information. All ophthalmologists should understand the potential ocular sequelae of these treatments and be able to initiate treatment in sight-threatening cases. Wesummarises the current literature on ophthalmic complications of the most common periocular aesthetic treatments.
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Affiliation(s)
- Sonali T Nagendran
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, United Kingdom
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Murat Dogru
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, United Kingdom.
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The Microbiome of the Nasolacrimal System and Its Role in Nasolacrimal Duct Obstruction. Ophthalmic Plast Reconstr Surg 2021; 36:80-85. [PMID: 31809480 DOI: 10.1097/iop.0000000000001473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Acquired nasolacrimal duct obstruction (NLDO) is a common problem leading to epiphora, the pathophysiology of which remains unclear. Culture-based studies have found Staphylococcal species to be the most prevalent organisms, reported in 47% to 73% of patients with NLDO. Recently, culture-independent molecular methods of have allowed more comprehensive detailing of local microbiota. This study aims to evaluate the sinonasal and lacrimal microbiome of patients undergoing dacryocystorhinostomy for NLDO using 16S-amplicon sequencing. METHODS Guarded intraoperative swabs were taken from the middle meatus (MM), inferior meatus, and the opened lacrimal sac of 14 NLDO patients undergoing dacryocystorhinostomy and from the inferior meatus and MM on the contralateral unaffected side. MM swabs from 12 control patients were compared with NLDO patients. RESULTS Comparing microbiota at lacrimal sac to MM and inferior meatus sites reveals that the lacrimal sac microbiome is dominated by Staphylococci (36.3%) and Corynebacterium (35.8%). No significant genus differential abundance between the 3 sites, and between the ipsilateral and contralateral sinonasal swabs, and no convincing evidence of reduced alpha diversity in all comparisons. There was a statistically significant lower relative abundance of Corynebacterium (37.6% vs. 65.1%; p = 0.035) in the MM of NLDO patients compared with controls. CONCLUSIONS The lacrimal sac microbiome in acquired NLDO is similar to the sinonasal microbiome. The relative abundance of Corynebacterium was reduced compared with controls. These findings suggest that an altered sinonasal microbiome may be associated with NLDO, either as a consequence or a risk factor, and merits future research.The authors have demonstrated a decreased relative abundance of Corynebacterium at the middle meatus of patients with ipsilateral nasolacrimal duct obstruction (NLDO), compared with controls, and that the lacrimal sac microbiome is similar to the sinonasal microbiome. An altered microbial state may, therefore, be associated with NLDO, either as a consequence or a risk factor, and merits future research.
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Alam M, Singh P, Amitava A, Ali M. Self-regurgitation on pressure over lacrimal sac in cases of primary-acquired nasolacrimal duct obstruction: Correlation with physician examination and patients' perceptions. Saudi J Ophthalmol 2021; 35:217-219. [PMID: 35601852 PMCID: PMC9116091 DOI: 10.4103/sjopt.sjopt_87_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To analyze the correlation between patient-reported regurgitation on pressure over lacrimal sac (ROPLAS) with the physician's examination in diagnosing primary-acquired nasolacrimal duct obstruction (PANDO). METHODS: A cross-sectional study was done over 5 months (March–July 2018). All cases diagnosed as PANDO were included in the study. The maneuver of pressing over the lacrimal sac area and noticing the egress of mucoid or clear fluid from the surrounding area by the patient was termed as self-ROPLAS. A specific patient history of performance of this maneuver was compared with a clinician-performed ROPLAS and subsequent objective lacrimal drainage evaluation. The various reasons for performing self-ROPLAS by the patients were documented. RESULTS: A total of 134 patients were included in the study, out of which 59 (44.02%) were males and 75 (55.9%) were females. History of self-ROPLAS was present in 64 (47.8%) of the patients, whereas the physician examination revealed ROPLAS to be positive in 92 (68.6%) of the patients. All patients (100%) with a positive history of self-ROPLAS had nasolacrimal duct obstruction on subsequent examination. The most common reason for performing self-ROPLAS was for emptying the discharge from the medial canthal region to reduce the painless swelling. CONCLUSION: Self-ROPLAS is highly suggestive of an obstructed nasolacrimal duct and can be used as a screening tool by the primary physician to triage the patients toward ophthalmic plastic clinics or consult.
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Alkatan H, Alhammad F, Edward D, Y. Maktabi A, Khandekar R, Galindo-Ferreiro A, Al-Sheikh O. The association of cosmetic-related lacrimal sac black deposits with primary-acquired nasolacrimal duct obstruction and dry eye disease. Saudi J Ophthalmol 2021. [DOI: 10.4103/sjopt.sjop_122_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lin Z, Kamath N, Malik A. Morphometric differences in normal bony nasolacrimal anatomy: comparison between four ethnic groups. Surg Radiol Anat 2020; 43:179-185. [PMID: 33184673 DOI: 10.1007/s00276-020-02614-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare bony nasolacrimal duct anatomy between ethnic groups. METHODS A retrospective observational study of patients of four ethnic groups who had high-resolution CTs between 2004 and 2019 covering the full length of their nasolacrimal ducts in two hospitals in Essex, England. Only normal ducts were included; patients with tearing or radiological abnormalities were excluded. Measurements were taken of the nasolacrimal duct and surrounding anatomy based on measurements found in the existing literature. RESULTS More females (n = 114) than males (n = 40) were included. South Asian (Indian subcontinent), Afro-Caribbean and European groups were equivocal demographically (n = 25-29, mean age 40-45); however, the Oriental group was fewer in number (n = 13) and slightly older (mean age 51). South Asian and European ducts had no significant differences. Afro-Caribbean ducts were wider and shorter than European. Afro-Caribbean faces are wider and their noses flatter and wider than European. Oriental ducts were wider and longer than European, but Europeans have taller noses. CONCLUSION The results from our Oriental group fits with the published data in Orientals. The bony nasolacrimal duct is greater in calibre (inner diameter) if the patient is of Afro-Caribbean or Oriental origin compared to European or South Asian. Acquired nasolacrimal duct obstruction in Afro-Caribbean or Oriental patients may be more likely due to secondary causes.
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Affiliation(s)
- Zhiheng Lin
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK.
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK.
| | - Namita Kamath
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Adeela Malik
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
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Bielecki P, Gindzienska-Sieskiewicz E, Reszeć J, Piszczatowski B, Rogowski M, Kowal-Bielecka O, Kowal K, Sieskiewicz A. Expression of LIGHT/TNFSF14 and Its Receptors, HVEM and LTβR, Correlates with the Severity of Fibrosis in Lacrimal Sacs from Patients with Lacrimal Duct Obstruction. Ophthalmol Ther 2020; 10:63-74. [PMID: 33188486 PMCID: PMC7665092 DOI: 10.1007/s40123-020-00320-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/31/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Fibrosis is one of the factors contributing to the development of primary acquired lacrimal duct obstruction (LDO). LIGHT (homologous to lymphotoxins, exhibiting inducible expression and competing with herpes simplex virus glycoprotein D for herpes virus entry mediator [HVEM]), a receptor expressed by T lymphocytes, has recently emerged as a new regulator of connective tissue remodeling and fibrotic response. The purpose of this study was to evaluate the role of LIGHT in the pathogenesis of LDO through: (1) assessment of expression of LIGHT and its two receptors, HVEM and LTβR (lymphotoxin β receptor), and (2) investigation of potential relationships between expression of LIGHT and its receptors and clinical and histopathologic features. Methods Lacrimal sacs of 30 patients undergoing endoscopic dacryocystorhinostomy because of LDO were assessed intraoperatively and histopathologically with respect to inflammation and fibrosis. Expression of LIGHT, HVEM and LTβR was assessed by immunohistochemistry using specific antibodies and evaluated semiquantitatively using a four-grade scoring system. Results All investigated molecules, LIGHT/TNFSF14, HVEM and LTβR, were expressed in biopsies from all patients. The most prominent expression was seen within inflammatory infiltrates. Expression of LIGH, HVEM and LTβR correlated significantly with the intensity of fibrosis and duration of the disease. In multivariate analysis only LIGHT showed a significant relationship with fibrosis (β coefficient = 0.759, p = 0.02). There was no significant correlation between expression of any molecule and other demographic or clinical features. Conclusion We assume that LIGHT along with its receptors may be a factor contributing to fibrosis and synechiae formation in the lacrimal sac. This assumption needs to be proven in a future study in a group of patients who fail to improve after the first operation.
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Affiliation(s)
- Pawel Bielecki
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | | | - Joanna Reszeć
- Department of Medical Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | | | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
- Department of Experimental Allergology and Immunology, Medical University of Bialystok, Bialystok, Poland
| | - Andrzej Sieskiewicz
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
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Dikici O, Ulutaş HG. Relationship Between Primary Acquired Nasolacrimal Duct Obstruction, Paranasal Abnormalities and Nasal Septal Deviation. J Craniofac Surg 2020; 31:782-786. [PMID: 31895849 DOI: 10.1097/scs.0000000000006108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the relationship between nasal septal deviation and paranasal abnormalities in the etiology of primary acquired nasolacrimal duct obstruction (PANDO). METHODS A total of 37 (8 men, 29 women) patients (48 eyes with PANDO) between the ages 20 and 77 years (mean age, 52.8 ± 13.1 years) were included in the study. In the axial sections of paranasal sinus computed tomography, the transverse diameters at the most upper part and the most distal part of the nasolacrimal canal were separately measured. In addition, the relationships between PANDO and nasal septal deviation, inferior turbinate hypertrophy, agger nasi cells, paradoxical middle turbinate, concha bullosa, and the angle between the bony inferior turbinate and medial wall of the maxillary sinus were investigated. RESULTS A statistically significant relationship was found between PANDO and the axial location of septal deviation classification, axial angle of septal deviation classification, paradoxical middle turbinate, angle between the bony inferior turbinate and medial wall of the maxillary sinus and inferior meatus measure. CONCLUSION The authors concluded that the location and angle of the nasal septal deviation in the axial plane, width of the angle between the bony inferior turbinate and medial wall of the maxillary sinus, inferior meatus measure, and paradoxical middle turbinate may be effective factors in the etiology of PANDO.
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Affiliation(s)
| | - Hafize Gökben Ulutaş
- Department of Ophthalmology, Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Ali MJ, Ponnaganti S, Barla K, Varma DR, Bothra N. Color Doppler Imaging Features of the Lacrimal Sac in Health and Diseased States. Curr Eye Res 2020; 46:758-761. [PMID: 32886568 DOI: 10.1080/02713683.2020.1820527] [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] [Indexed: 01/03/2023]
Abstract
PURPOSE The objective of this study is to present Color Doppler imaging (CDI) features of the lacrimal sac in normal and diseased states. METHODS Prospective study was performed on 20 lacrimal sacs of 20 eyes of 10 patients who underwent Color Doppler imaging at a tertiary care Dacryology service over a period of 6 months. All the patients were subjected to Duplex doppler scanning of the lacrimal sacs. Of the 20 lacrimal drainage systems studied, 8 were normal, 8 had primary acquired nasolacrimal duct obstruction (PANDO) and 4 were that of acute dacryocystitis (AcDac). Patient demographics, clinical presentation, duration of the disease and Color Doppler vascular characteristics like peri-sac vascular flow, peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI), arterial spectral waveforms and sac dimensions and wall thickness were analyzed. RESULTS The vascular flow around the lacrimal sac was increased with higher flow velocities in PANDO as compared to normal and grossly enhanced in AcDac. Flow disturbances were also quite discernible in AcDac. The mean PSV and EDV were 9 & 3.87 cm/sec, 13.07 & 4.63 cm/sec and 18 & 8.5 cm/sec in normal, PANDO and AcDac, respectively. The mean vascular resistivity index increased in patients with PANDO (0.67) and decreased in AcDac (0.53) as compared to the normal (0.57). The arterial spectral waveforms in PANDO and AcDac showed low pulsatility, but the systolic peaks were sharper with more continuous forward flow through diastole in AcDac. This reflects vascular dilatation and reduced resistance to flow in AcDac. CONCLUSION Characteristic Color Doppler flow parameters can be demonstrated in patients with PANDO and acute dacryocystitis. Color Doppler techniques have the potential to enhance the understanding of lacrimal drainage pathophysiology.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | | | - Kiran Barla
- Department of Neuroradiology, Citi Neuro Centre, Hyderabad, India
| | - D Ravi Varma
- Department of Neuroradiology, Citi Neuro Centre, Hyderabad, India
| | - Nandini Bothra
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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Lee S, Lee UY, Yang SW, Lee WJ, Kim DH, Youn KH, Kim YS. 3D morphological classification of the nasolacrimal duct: Anatomical study for planning treatment of tear drainage obstruction. Clin Anat 2020; 34:624-633. [PMID: 32889737 DOI: 10.1002/ca.23678] [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: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study is to analyze and classify morphological features of the nasolacrimal duct (NLD) through 3D reconstruction to help understand the causes and treatment of NLD obstruction. METHODS In this study, we included 63 males and 55 females who underwent autopsy without NLD obstruction with ages ranging from 20 to 78 years. The NLD was defined from the lacrimal fossa to the opening of the BNLD to the inferior meatus, and all continuous CT images showing the NLD were selected. Segmentation was performed semi-automatically, and the reconstruction and measurement of NLD was performed using the Mimics program. RESULTS Overall NLD length, bony nasolacrimal duct (BNLD) length, anteroposterior and transverse diameters at the entrance to the BNLD, anteroposterior and transverse smallest diameters of the BNLD, BNLD volume, and lacrimal sac BNLD angle were significantly higher in males than females (p < .05). BNLD direction in the coronal plane was slightly more likely to be inward. The most common type in both sexes was cylinder type (42.0%), males were more likely to have lower-thicker types (34.1%), and females more likely to have upper-thicker types (22.7%). CONCLUSION There were sex differences in NLD measurements, and females had significantly smaller NLDs. These results may partially explain the increased prevalence of primary acquired NLD obstruction in females. The BNLD tends toward the midline, and inclines posteriorly.
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Affiliation(s)
- Sohyun Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - U-Young Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Suk-Woo Yang
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea
| | - Won-Joon Lee
- Department of Forensic Medicine Investigation, National Forensic Service Seoul Institute, Seoul, South Korea
| | - Dong-Ho Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwan Hyun Youn
- Division in Biomedical Art, Incheon Catholic University Graduate School, Incheon, South Korea
| | - Yi-Suk Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Vinciguerra A, Nonis A, Giordano Resti A, Bussi M, Trimarchi M. Best treatments available for distal acquired lacrimal obstruction: A systematic review and meta‐analysis. Clin Otolaryngol 2020; 45:545-557. [DOI: 10.1111/coa.13551] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Alessandro Nonis
- CUSSB University Centre for Statistics in the Biomedical Sciences San Raffaele Hospital Vita‐Salute University Milano Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department Ophthalmologic unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Mario Bussi
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Matteo Trimarchi
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
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Altered Surfactant Protein Expression in Primary Acquired Nasolacrimal Duct Obstruction. Ophthalmic Plast Reconstr Surg 2020; 35:553-557. [PMID: 30882588 DOI: 10.1097/iop.0000000000001372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the presence and distribution patterns of 6 surfactant proteins in lacrimal drainage tissues of patients with primary acquired nasolacrimal duct (NLD) obstruction. METHODS The presence and distribution of surfactant proteins (SP)-G and SP-H was first assessed in normal cadaveric lacrimal systems. The study was then performed in 10 samples of lacrimal sac and the respective NLDs obtained from patients suffering from primary acquired NLD obstruction who underwent either a dacryocystorhinostomy or a dacryocystectomy. The lacrimal sac samples were further divided into fundus and body, soon after their removal. Immunohistochemical labeling was performed for assessing the presence and distribution of SPs: SP-A, SP-B, SP-C, SP-D, SP-G/SFTA2, and SP-H/SFTA3. The results were then scored as positive or negative and the distribution pattern, if any, within the lacrimal sac and NLDs was assessed. Human lung tissues were used as controls. RESULTS SP-H was demonstrated in the lining epithelia of the normal lacrimal drainage systems, whereas SP-G was uniformly negative. Immunohistochemical labeling revealed wide variations in the staining patterns of different SPs in different regions of the lacrimal sac and the NLD. SP-D and SP-G revealed uniformly negative immunoreactivity. Variable staining patterns were also noted between the superficial and basal layers of the lining epithelia. However, the goblet cells and intraepithelial mucous glands did not express any of the SPs. CONCLUSIONS This study provides a proof of principle for the presence of SP-H and absence of SP-G in the normal lacrimal drainage systems. In cases of primary acquired nasolacrimal duct obstruction, there were alterations or loss of SP expression in the lining epithelia of the lacrimal sac and NLDs, reflecting their possible role in the etiopathogenesis of primary acquired nasolacrimal duct obstruction.In cases of primary-acquired nasolacrimal duct obstruction, the expression of multiple surfactant proteins was either deranged or lost in the lining epithelium of the lacrimal sac and nasolacrimal ducts.
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Vaidya A, Ohmichi Y, Naito M, Nakano T, Kakizaki H, Takahashi Y. Positional relationship between medial canthal tendon and common canalicular orifice: A cadaveric study. Ann Anat 2019; 227:151432. [PMID: 31639441 DOI: 10.1016/j.aanat.2019.151432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine the positional relationship between the medial canthal tendon (MCT) and the common canalicular orifice (CCO) in cadavers. METHODS This experimental anatomical study was conducted using 75 orbits from 48 embalmed Japanese cadavers fixed in 10% buffered formalin (24 orbits from 17 males and 51 orbits from 31 females; 38 right and 37 left; mean age at time of death, 84.1±9.2 years). The vertical width of the MCT on the level of the medial orbital rim and the angle between the MCT and axial plane were measured. In addition, the vertical distance from the CCO to the lower edge of the MCT was measured. Positive values of the distance were indicated when the CCO was located below the lower edge of the MCT. RESULTS The vertical distance from the CCO to the lower edge of the MCT was -1.43±1.31mm. Only 13 orbits (17.3%) showed the CCO located on the same level (2 orbits, 2.7%) or below the lower edge of the MCT (11 orbits, 14.7%), while the CCO was located above the lower edge of the MCT in 62 orbits (82.7%). In multiple regression analyses, both the MCT width and angle between the MCT and axial plane were not correlated with the distance (P>0.050). CONCLUSIONS As the CCO was mostly found to be located above the inferior margin of the MCT, the creation of the bony window up to the MCT's inferior margin is not sufficient in external dacryocystorhinostomy to completely expose the CCO.
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Affiliation(s)
- Aric Vaidya
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
| | - Yusuke Ohmichi
- Department of Anatomy, Aichi Medical University, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
| | - Takashi Nakano
- Department of Anatomy, Aichi Medical University, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan.
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Ali MJ, Patnaik S, Kelkar N, Ali MH, Kaur I. Alteration of Tear Cytokine Expressions in Primary Acquired Nasolacrimal Duct Obstruction – Potential Insights into the Etiopathogenesis. Curr Eye Res 2019; 45:435-439. [DOI: 10.1080/02713683.2019.1665186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Satish Patnaik
- Prof. Brien Holden Eye Research Center, L.V. Prasad Eye Institute, Hyderabad, India
| | - Natasha Kelkar
- Prof. Brien Holden Eye Research Center, L.V. Prasad Eye Institute, Hyderabad, India
| | - Mohammad Hasnat Ali
- Prof. Brien Holden Eye Research Center, L.V. Prasad Eye Institute, Hyderabad, India
| | - Inderjeet Kaur
- Prof. Brien Holden Eye Research Center, L.V. Prasad Eye Institute, Hyderabad, India
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Ali MJ, Rehorek SJ, Paulsen F. A major review on disorders of the animal lacrimal drainage systems: Evolutionary perspectives and comparisons with humans. Ann Anat 2019; 224:102-112. [DOI: 10.1016/j.aanat.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/12/2023]
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Ali MJ, Paulsen F. Prolactin and Prolactin-inducible protein (PIP) in the pathogenesis of primary acquired nasolacrimal duct obstruction (PANDO). Med Hypotheses 2019; 125:137-138. [DOI: 10.1016/j.mehy.2019.02.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/15/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
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Ali MJ, Paulsen F. Ultrastructure of the lacrimal drainage system in health and disease: A major review. Ann Anat 2019; 224:1-7. [PMID: 30862471 DOI: 10.1016/j.aanat.2019.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To provide a systematic review of the literature on the ultrastructural findings of the lacrimal drainage system in healthy state and in few of the disorders studied so far. METHODS The authors performed a PubMed search of all articles published with reference to electron microscopic features of the lacrimal drainage pathways. Data captured include demographics, study techniques, scanning or transmission electron microscopic features, presumed or confirmed interpretations and their implications. Specific emphasis was laid on addressing the lacunae and potential directions for future research. RESULTS Ultrastructural studies have led to better understanding of the lacrimal drainage anatomy-physiology correlations. Cellular interactions between fibroblasts and lymphocytes could form a basis for pathogenesis of punctal stenosis. Ultrastructural characterization of peri-lacrimal cavernous bodies and changes in primary acquired nasolacrimal duct obstruction (PANDO) led to them being partly implicated in its etiopathogenesis. Electron microscopic characterization of the dacryolith core promises insights into their evolution. Ultrastructural tissue effects of mitomycin-C during a DCR surgery has provided potential evidence of its role in cases with high-risk of failure. Lacrimal stent biofilms are common but their clinical implications are currently uncertain. CONCLUSION Ultrastructural exploration of lacrimal drainage system so far has been limited and sparsely explored. The list of unexplored areas is exhaustive. There is a need for the lacrimal Clinician-Scientist to make themselves familiar with techniques and interpretation of electron microscopy to advance the ultrastructural frontier of this science.
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Affiliation(s)
- Mohammad Javed Ali
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Germany; Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India.
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Germany
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