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Chacko A, J.K. Y. Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy with or without Preservation of Nasal Mucosal Flap. Indian J Otolaryngol Head Neck Surg 2024; 76:894-898. [PMID: 38440443 PMCID: PMC10908912 DOI: 10.1007/s12070-023-04311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/20/2023] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To analyse the result of endoscopic endonasal dacryocystrhinostomy with or without preservation of nasal mucosal flap. STUDY DESIGN Randomised prospective cohort design. SETTING Tertiary academic centre. SUBJECTS AND METHODS 100 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups. Standard surgical procedure of endoscopic endonasal dacryocystorhinostomy was carried out except for the preservation of flap in group A and without preservation of flap in group B. Additional surgeries were done according to necessity. Postoperatively, patients were followed up on OPD-basis at the end of 1st week, 2nd week, 1st month, and 3rd month. Symptomatic improvement was assessed and patency checked by syringing by the ophthalmologist. RESULTS Nil intraoperative complications (p < 0.05) and nil postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96% at 3rd month in case group A and 98%, 92% and 82% respectively at the end of 2nd week, 1st month and 3rd month in group B. Nasal endoscopy of all surgical failures showed restenosis in both groups and synechiae in 2 patients in group B. CONCLUSIONS Preservation of nasal mucosal flap with modification around stoma can be used to cover the bared bone with avoidance of granulation tissue formation reducing the risk of closure of ostium with large rhinostomy and improve success of endoscopic endonasal DCR.
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Affiliation(s)
- Aneena Chacko
- Department of ENT, Amala Institute of Medical sciences, Kerala, 680555 India
| | - Yashveer J.K.
- Department of ENT, Gandhi Medical College and Associated Hospital, Bhopal, MP 462001 India
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Navarro-Hernandez E, Galindo-Ferreiro A. Endocanalicular Laser Dacryocystorhinostomy and its modifications: A systematic review of techniques and success rates. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:692-704. [PMID: 35879174 DOI: 10.1016/j.oftale.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE the main objective of this work is to review the articles that refer to transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) in acquired nasolacrimal duct obstruction (NLDO), as well as its modifications. MATERIAL AND METHODS A systematic review of publications related to TCL-DCR of the lacrimal duct from 2000 to March 2021 was carried out in the MEDLINE, EMBASE and COCHRANE LIBRARY databases. The search terms in Spanish and English were: «Endocanalicular laser», dacryocystorhinostomy or «primary DCR-L» or «laser» and «tear ducts». RESULTS After subjecting the articles to the inclusion and exclusion criteria, we got 49 articles: 21 retrospective and 28 prospective studies. The bibliometric result obtained guaranteed, for this review, a level C recommendation according to the Scottish Intercollegiate Guidelines Network scale. CONCLUSIONS Currently, the classic TCL-DCR has lower success rates than its modifications, so we suggest using the latter. We prefer TCL-DCR with IS-MMC or TCDL associated with endoscopy techniques, without being able to opt for any option, since their success rates are very similar. We leave the choice to the discretion of the surgeon, depending on the management skills of endonasal techniques. More studies, with longer follow-up, and better defined criteria are necessary to clarify which is the best TCL-DCR technique.
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Affiliation(s)
| | - A Galindo-Ferreiro
- Servicio de Oftalmología, Hospital Universitario Río Hortega, Valladolid, Spain
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Magomedov MM, Atkova EL, Krakhovetskiy NN, Maydanova AA, Magomedova NM. [Modern methods in treatment of lacrimal system vertical part obliteration]. Vestn Otorinolaringol 2021; 86:86-94. [PMID: 34499454 DOI: 10.17116/otorino20218604186] [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: 11/18/2022]
Abstract
A review of the literature is devoted to the description of modern methods in treatment of lacrimal system vertical part obliteration. Particular attention is paid to various aspects of the most common surgical intervention - endonasal endoscopic dacryocystorhinostomy.
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Affiliation(s)
- M M Magomedov
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - E L Atkova
- The Research Institute of eye Diseases, Moscow, Russia
| | | | - A A Maydanova
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia.,The Research Institute of eye Diseases, Moscow, Russia
| | - N M Magomedova
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
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Isaev EV, Egorov VI, Isaev VM, Svistushkin VM, Pustovit OM. [Method of endonasal endoscopic dacryocystorhinostomy with plastic stoma formation]. Vestn Otorinolaringol 2021; 86:58-62. [PMID: 33720653 DOI: 10.17116/otorino20218601158] [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: 11/18/2022]
Abstract
The article presents modern methods of surgical treatment of chronic dacryocystitis, a brief historical review of various options for endonasal endoscopic dacryocystorhinostomy is carried out. The method of plastic seamless formation of dacryocystostomy, which does not require intubation of the lacrimal passages and/or using of silicone stoma dilators, is described. Between 2010 and 2019 at The State Budgetary Healthcare Institution of Moscow Area Moscow regional research clinical institute n.a. M.F. Vladimirskiy, according to the developed technique, 32 patients (32 eyes) with chronic dacryocystitis were operated on. According to the results of observation 1 year after surgical treatment, all 100% of patients recorded a positive result (absence or significant decrease in lacrimation, good anatomical visualization of dacryocystostomy with a good tear passage, both passive and during washing the lacrimal passages).
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Affiliation(s)
- E V Isaev
- Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russia
| | - V I Egorov
- Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russia
| | - V M Isaev
- Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russia
| | - V M Svistushkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O M Pustovit
- Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russia
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Vinciguerra A, Nonis A, Resti AG, Barbieri D, Bussi M, Trimarchi M. Influence of Surgical Techniques on Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 165:14-22. [DOI: 10.1177/0194599820972677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Endoscopic endonasal dacryocystorhinostomy (END-DCR) has increased as a valid alternative to the classic external approach to treat distal lacrimal obstruction. Different surgical varieties of the END-DCR approach have been proposed with no clear understanding of the best surgical technique. Data Source A comprehensive research was performed in PubMed, Embase, SCOPUS, and Cochrane databases with a final search on March 2020. Review Methods The aim of this search was to identify relevant END-DCR procedures performed with mechanical (Mecn-END-DCR) and powered (Pow-END-DCR) approaches to compare their functional success rate. In addition, the influence of mucosal flaps was evaluated. Articles were selected only if they were published later than 2000 and had at least 50 single-clinician surgical procedures performed. Excluded articles included acute infections, cancers, mixed cohort study, and revision cases. Results A total of 11,445 publications were identified and 2741 reviewed after screening; 15 articles were included after full-text review (0.6% of the initial articles reviewed). The mean success rate was 91.34% (95% CI, 87.1%-94.3%) for Pow-END-DCR and 89.5% (95% CI, 86.5%-91.9%) for Mecn-END-DCR with no significant difference between the surgical approaches ( P = .43). For mucosal flaps performed during END-DCR, the mean success rate was 89% (95% CI, 86%-91%) if mucosal flaps were used and 92% (95% CI, 88%-95%) if they were not used, with no statistical difference present ( P = .14). Conclusions Our analyses suggest that there are no differences in outcomes between mechanical and powered approaches in END-DCR and that mucosal flap preservation is not essential to achieve a superior END-DCR outcome.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Nonis
- CUSSB, University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department, Ophthalmologic Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Diego Barbieri
- Division of Head and Neck Department, Otorhinolaryngology 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
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
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Yim M, Wormald P, Doucet M, Gill A, Kingdom T, Orlandi R, Crum A, Marx D, Alt J. Adjunctive techniques to dacryocystorhinostomy: an evidence‐based review with recommendations. Int Forum Allergy Rhinol 2020; 11:885-893. [DOI: 10.1002/alr.22699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Michael Yim
- Department of Otolaryngology–Head and Neck Surgery Louisiana State University Shreveport Shreveport LA
| | - Peter‐John Wormald
- Department of Surgery‐Otolaryngology University of Adelaide Adelaide Australia
| | - Manon Doucet
- Department of Otolaryngology–Head and Neck Surgery Louisiana State University Shreveport Shreveport LA
| | - Amarbir Gill
- Division of Otolaryngology – Head and Neck Surgery University of Utah Health Salt Lake City UT
| | - Todd Kingdom
- Department of Otolaryngology–Head and Neck Surgery University of Colorado Denver CO
| | - Richard Orlandi
- Division of Otolaryngology – Head and Neck Surgery University of Utah Health Salt Lake City UT
| | - Alison Crum
- Department of Ophthalmology and Visual Sciences John A Moran Eye Center Salt Lake City UT
| | - Douglas Marx
- Department of Ophthalmology and Visual Sciences John A Moran Eye Center Salt Lake City UT
| | - Jeremiah Alt
- Division of Otolaryngology – Head and Neck Surgery University of Utah Health Salt Lake City UT
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Bohman E, Kugelberg M, Dafgård Kopp E. Long-term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions. Acta Ophthalmol 2020; 98:396-399. [PMID: 31580002 DOI: 10.1111/aos.14263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/08/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate long-term outcome and report reoperation rate of non-infected, complete acquired lacrimal drainage obstruction (ALDO) treated with canaliculodacryocystoplasty (CDCP) depending on site of stenosis. METHOD Consecutive adult patients with non-infected, complete ALDO treated with CDCP were followed for 76 months. Location of stenosis at preoperative visit and intraoperative probing was recorded, and during follow-up, recurrence of stenosis prompting additional surgery and complications were noted. Survival analysis was applied to compare reoperation rate depending on site of stenosis. A follow-up questionnaire was sent to patients not requiring reoperation asking to grade current epiphora problems. RESULTS Among 85 included cases (71 patients), 57 were classified as canalicular stenosis and 28 as nasolacrimal duct obstruction (NLDO) preoperatively. At the end of follow-up, 39% (33/85) of cases had required additional surgery due to persistent/recurrent symptoms. No statistical difference was found between these groups. During CDCP, 25 of the 57 preoperatively classified canalicular stenosis were found to have an additional obstruction below the sac. The group with only canalicular stenosis had a statistically significant higher survival compared with cases with NLDO or multiple obstructions (p = 0.03). Of patients responding to the follow-up questionnaire, 11/37 cases experienced epiphora often or constant. CONCLUSION Treating complete NLDO with CDCP results in a high reoperation rate and seems an insufficient alternative. Canaliculodacryocystoplasty (CDCP) may be discussed if preoperative examination indicates canalicular stenosis and dacryocystorhinostomy is not desirable. However, the patient needs to be aware of the higher risk for additional surgery, especially if a second stenosis is found during probing.
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Affiliation(s)
- Elin Bohman
- Department of Clinical Neuroscience Division of Ophthalmology and Vision Karolinska Institutet St. Erik Eye Hospital Stockholm Sweden
| | - Maria Kugelberg
- Department of Clinical Neuroscience Division of Ophthalmology and Vision Karolinska Institutet St. Erik Eye Hospital Stockholm Sweden
| | - Eva Dafgård Kopp
- Department of Clinical Neuroscience Division of Ophthalmology and Vision Karolinska Institutet St. Erik Eye Hospital Stockholm Sweden
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Bani-Ata M, Aleshawi A, Ahmad M, Saleh O, Ashour R, Khalil H, Alomari S, Alhowary AAA. Endoscopic dacryocystorhinostomy: A comparison of double-flap and single-flap techniques. Ann Med Surg (Lond) 2020; 54:1-5. [PMID: 32300477 PMCID: PMC7153027 DOI: 10.1016/j.amsu.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Dacryocystorhinostomy (DCR) is a procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct obstructed. This study aimed to compare the success rates of two different techniques in endonasal endoscopic DCR; namely single and double mucosal flap techniques. Material and methods A nonequivalent quasi-experiment design was used in this study. Retrospectively, patients underwent endoscopic DCR for primary nasolacrimal duct (NLD) obstruction were included. Patients were divided into the single-flap technique and the double-flap technique groups. Success was defined as the achievement of patency of the NLD throughout the period of follow-up with significant improvement in epiphora. Results Overall, 77 cases were included in the final analysis. Mean age was 41 years and 60% were female. Forty-six cases underwent the single-flap technique and 31 cases underwent the double-flap technique. Recurrence of NLD obstruction occurred in 11 (23.9%) cases in the single-flap group and in only one case (3.2%) in the double-flap group. Conclusion The modified double-flap technique for primary NLD obstruction resulted in less recurrence compared to the single-flap technique. Creating double flaps to cover any exposed lacrimal bone may reduce the rate of postoperative adhesions over the nasolacrimal duct ostium. DCR is used to restore the tears into the nose from the obstructed lacrimal sac. Single and double mucosal flap techniques can be used. Double-flap technique for primary NLD obstruction resulted in less recurrence.
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Affiliation(s)
- Majid Bani-Ata
- Otolaryngology Branch, Department of Special Surgery, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
| | | | - Muayyad Ahmad
- Clinical Nursing Department, School of Nursing, University of Jordan, Amman, 11942, Jordan
| | - Omar Saleh
- Ophthalmology Branch, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
| | - Raneem Ashour
- Otolaryngology Branch, Department of Special Surgery, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
| | - Hanen Khalil
- Otolaryngology Branch, Department of Special Surgery, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
| | | | - Ala A A Alhowary
- Department of Anesthesia, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
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9
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Endoscopic dacryocystorhinostomy with and without mucosal flap-is there any difference? Eye (Lond) 2019; 34:1449-1453. [PMID: 31767961 PMCID: PMC7468247 DOI: 10.1038/s41433-019-0716-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The nasal mucosa is sacrificed in conventional endoscopic dacryocystorhinostomies (EDCRs). Some surgeons, however, modify the technique by elevating a mucosal flap prior to creating the osteotomy with the aim of preserving the mucosa. To our knowledge, no clear-cut benefit of a mucosal flap has been established. The aim of this study is to examine the differences in surgical techniques and success rates of EDCRs with and without mucosal flap preservation. METHODS We carried out a medical record review of all patients who underwent primary EDCR at the Goldschleger Eye Institute from October 2009 to October 2017. The following data were retrieved from the medical database and analyzed: patient demographics (age at diagnosis and gender), medical history, examination findings, surgical details, postoperative success, complications, and follow-up. RESULTS A total of 107 patients who underwent 117 EDCRs participated in the study. Fifty-one patients comprised the group without a mucosal flap and 56 patients comprised the group with mucosal flap preservation. The medical history, presenting complaints, and preoperative examination findings were similar for both groups. The surgical success rate was not significantly different between the groups (82.1% without flap vs. 86.8% with flap, P = 0.478, Chi-square). CONCLUSION The findings of this comparison of EDCRs with and without mucosal flap preservation in a large patient population revealed no differences in surgical success or complications rates between the two procedures and, therefore, no benefit for adding flap preservation to conventional EDCRs.
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Ceylan SM, Erdoğan C, Sozen T, Kanmaz MA, Disikirik I, Jafarov S, Tahir E. The Fibrin Glue Application Enhances Surgical Success Rate in Endonasal Endoscopic Dacryocystorhinostomy With Lacrimal Sac Preservation. EAR, NOSE & THROAT JOURNAL 2019; 100:483S-488S. [PMID: 31625404 DOI: 10.1177/0145561319882123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study to compare lacrimal sac flap preserving techniques with or without fibrin glue in patients undergoing endoscopic endonasal dacryocystorhinostomy. A retrospective study included 132 patients who underwent unilateral endonasal dacryocystorhinostomy between February 2011 and March 2016. Patients were divided into 2 groups: the nonfibrin glue group (n = 66) and fibrin glue anastomosis group (n = 66). Surgical success was defined as the patients' subjective report of relief of epiphora and objective endoscopic confirmation of ostium patency confirmed by a positive functional dye test. These parameters were compared between the 2 groups. Both groups were similar, in terms of demographic and clinical characteristics. The surgical success rate was significantly higher in the fibrin glue anastomosis group (95.5%) than in the nonfibrin glue group (84.8%; P = .041). Complication rate was 6.1% in the nonfibrin glue group, whereas in the fibrin glue anastomosis group, it was 4.5%. The complication rate was similar in both groups (P = .99). Creation of an anastomosis between the lacrimal sac flaps and the nasal mucosa using fibrin glue improves the outcome of endonasal endoscopic dacryocystorhinostomy.
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Affiliation(s)
- Seyit Mehmet Ceylan
- Department of Otorhinolaryngology, School of Medicine, 390721SANKO University, Gaziantep, Turkey
| | - Ceren Erdoğan
- Department of Ophtalmology, Duztepe Yasam Hospital, Gaziantep, Turkey
| | - Tevfik Sozen
- Department of Otorhinolaryngology, School of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Mahmut Alper Kanmaz
- Department of Otorhinolaryngology, School of Medicine, 390721SANKO University, Gaziantep, Turkey
| | - Ilyas Disikirik
- Department of Ear Nose Throat Disease, Sani Konukoglu Hospital Practice and Research Center, Gaziantep, Turkey
| | - Shamkhal Jafarov
- Department of Ophtalmology, Duztepe Yasam Hospital, Gaziantep, Turkey
| | - Emel Tahir
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey
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At'kova EL, Zhukov OV, Krakhovetskiy NN, Yartsev VD, Reznikova LV. [Intraoperative prevention of dacryocystitis relapse]. Vestn Oftalmol 2018; 134:270-275. [PMID: 30499528 DOI: 10.17116/oftalma2018134051270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article reviews the literature devoted to modern intraoperative methods of preventing cicatricial process at the site of dacryostoma after endonasal endoscopic dacryocystorhinostomy. Despite the constant improvement of the surgery technique, complications in the postoperative period still occur. They include the formation of granulation tissue at the sites of dacryostoma, synechiae in the nasal cavity, or narrowing of the dacryostoma, which ultimately leads to a relapse of the disease. The main prevention methods are construction of flaps from the medial wall of the lacrimal sac, from mucosa of the nasal cavity, and intubation of the dacryostoma with the lacrimal implant. They are used separately and in various combinations.
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Affiliation(s)
- E L At'kova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - O V Zhukov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N N Krakhovetskiy
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - V D Yartsev
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - L V Reznikova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, Chair of Ophthalmology, 8-2 Malaya Trubetskaya St., Moscow, Russian Federation, 119991
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Kumar S, Mishra AK, Sethi A, Mallick A, Maggon N, Sharma H, Gupta A. Comparing Outcomes of the Standard Technique of Endoscopic DCR with Its Modifications: A Retrospective Analysis. Otolaryngol Head Neck Surg 2018; 160:347-354. [DOI: 10.1177/0194599818813123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To compare the outcomes of various techniques of endoscopic dacryocystorhinostomy (DCR). Study Design Retrospective case record analysis. Settings Tertiary care referral center. Subject and Methods Retrospective analysis of case records was carried out pertaining to the period from January 1996 to September 2017 with respect to patients who had undergone endoscopic DCR with either the standard technique or one of its modifications. Case notes showing well-documented preoperative evaluation, operative details, postoperative assessment, and minimum 6-month follow-up were considered. The outcomes were measured on the basis of patients’ postoperative symptoms, clinical examination, and sac-syringing results. Results A total of 423 patients were included in the study. Of these, 169 underwent standard endoscopic DCR; 87, endoscopic DCR with stent; 19, endoscopic DCR with mitomycin C; 62, powered DCR; 29, laser-assisted DCR; and 57, balloon DCR. There was no statistically significant difference in success rates, recurrences, or complications of various techniques at 3 or 6 months. Mean operating time was lowest for balloon DCR (mean ± SD, 27.1 ± 3.1 minutes), followed by standard endoscopic DCR (38.2 ± 3.6 minutes; P = .001). Conclusion Standard endoscopic DCR and its more sophisticated modifications were equally effective and safe in managing distal nasolacrimal drainage obstruction. Balloon DCR, followed by standard endoscopic DCR, was significantly faster than other techniques.
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Affiliation(s)
- Subodh Kumar
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Awadhesh Kumar Mishra
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Ashwani Sethi
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Ajay Mallick
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Nidhi Maggon
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Harikesh Sharma
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
| | - Anandita Gupta
- Department of Otorhinolaryngology–Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India
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Continuous Positive Airway Pressure Thresholds for Nasolacrimal Air Regurgitation in a Cadaveric Model. Ophthalmic Plast Reconstr Surg 2018; 34:440-442. [PMID: 29329173 DOI: 10.1097/iop.0000000000001042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To elucidate the mechanisms underlying nasolacrimal air regurgitation (AR) in the setting of continuous positive airway pressure therapy. METHODS Twelve nasolacrimal systems of 6 fresh female human cadavers were evaluated individually for AR using continuous positive airway pressure therapy before any nasolacrimal procedure. Cadavers were then randomly assigned to undergo nasolacrimal duct probing or endoscopic dacryocystorhinostomy and then each hemisystem was again evaluated for AR. The pressure where AR was first observed (discovery pressure) or maximum possible pressure in systems without AR was recorded. In systems that demonstrated AR, the pressure was then gradually decreased to the lowest pressure where regurgitation persisted. This pressure was recorded as the secondary threshold pressure. RESULTS None of the 12 unoperated nasolacrimal systems or the 6 systems that underwent nasolacrimal duct probing demonstrated AR through the maximum continuous positive airway pressure therapy (30 cm H2O). After endoscopic dacryocystorhinostomy, all 6 nasolacrimal systems demonstrated AR. The mean discovery pressure was 16.0 cm H2O (range, 14.0-18.0 cm H2O) and mean secondary threshold pressure was 7.25 cm H2O (range, 6.5-8.0 cm H2O). CONCLUSIONS Air regurgitation during continuous positive airway pressure therapy in the setting of prior endoscopic dacryocystorhinostomy can be replicated in a cadaver model. The secondary threshold pressures required for AR in this model were similar to AR pressures reported clinically. Prior to dacryocystorhinostomy, patients using continuous positive airway pressure therapy should be counseled on AR, and physicians should consider this phenomenon when evaluating ophthalmic complaints in postoperative patients on positive airway pressure therapy.
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Abstract
Background: Limited spatial nasal cavity in children, make pediatric dacryocystorhinostomy (DCR) a difficult surgical procedure. We apply a limited approach to pediatric DCR and follow them for their consequences. Materials and Methods: An experimental study was done in pediatric DCR with limited approach (age < 14-year-old). After written consent, with general anesthesia, with nasal endoscopic surgery, lacrimal bone is exposed and extruded. In contrast with routine procedure, ascending process of maxillary sinus reserve; and marsupialization and wide exposure to lacrimal sac was done only by lacrimal bone defect; and cannulation preserve with temporary silicone tube. Results: Between 2006 and 2012, 16 pediatric DCR was done by a unique surgeon in 2 otorhinolaryngologic centers. Before surgery 14 (87.5%) had epiphora, 3 (18.8%) had eye discharge, and 3 (18.8%) had eye sticky eye. Two (12.5%) had history of facial trauma, and 10 (62.5%) had congenital nasolacrimal duct insufficiency. Five (31.3%) had history of dacryocystitis. Patients were followed for 17 ± 9 months. Silicone tube stayed for 4 ± 2.5 months. We could follow 7 patients and minimal improvement or need to revision surgery considered as technical failure. After surgery, 3 patients had no epiphora with complete improvement; 2 had very good improvement with confidence of the patients and parents; 2 cases had unsuccessful surgery in our patients, who needs to another surgery. One of them had several probing and surgery before our endoscopic DCR. Conclusions: Limited approach in endoscopic DCR of pediatrics can be done in noncomplicated patients, with minimal manipulation, more confidence, and acceptable results.
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Affiliation(s)
- Seyyed Mostafa Hashemi
- Department of Otorhinolaryngology, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afrooz Eshaghian
- Department of Otorhinolaryngology, Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Mishra AK, Nilakantan A, Mishra S, Mallick A. Comparison of balloon dacryocystorhinostomy with conventional endonasal endoscopic dacryocystorhinostomy for relief of acquired distal nasolacrimal drainage obstruction and its impact on quality of life: A prospective, randomized, controlled study. Med J Armed Forces India 2017; 74:255-263. [PMID: 30093769 DOI: 10.1016/j.mjafi.2017.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022] Open
Abstract
Background We compared balloon dacryocystorhinostomy with conventional endoscopic dacryocystorhinostomy for the management of acquired distal nasolacrimal obstruction and the quality of life post procedure. Methods 98 patients, aged 10-73 years, were recruited and randomized into 2 groups of 49 each who underwent conventional endoscopic dacryocystorhinostomy (group 1) and 9 mm balloon assisted endoscopic dacryocystorhinostomy (group 2). Follow-up sessions were conducted at 3, 6 and 12 months post-op. Results Group 2 showed significantly shorter mean operative time (25.10 min versus 29.82; p < 0.001), lesser pain in the post-op evening (mean 2.12 versus 2.9 on NRS-11 pain scale; p < 0.001) as well as on first post-op day (mean 1.08 versus 1.73; p < 0.001). Success was achieved in 89.79% in group 1 and 93.87% in group 2 at 3 months (p = 0.46) which declined due to recurrences to 85.71% and 87.75% respectively at 12 months (p = 0.76). Complications occurred in 14 cases in group 1 and in 10 cases in group 2 (p = 0.34). All were minor. Mean GBI scores (for quality of life assessment) at 12 months follow-up were 27.20 and 28.38 respectively (p = 0.08). Conclusion The efficacy, safety and quality of life of balloon dacryocystorhinostomy and conventional endoscopic dacryocystorhinostomy were comparable. In addition, balloon dacryocystorhinostomy had significantly shorter operative time and lesser post-op pain.
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Affiliation(s)
| | - Ajith Nilakantan
- Professor & Head, Dept of ENT - HNS, Armed Forces Medical College, Pune 411040, India
| | - Sanjay Mishra
- Senior Adviser (Ophthalmology), Command Hospital (Central Command), Lucknow, India
| | - Ajay Mallick
- Classified Specialist (ENT-HNS), Base Hospital, Delhi Cantt 110010, India
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Double Posterior Based Flap Technique in Primary Endoscopic Dacryocystorhinostomy With and Without Using Powered Instrument. Indian J Otolaryngol Head Neck Surg 2017; 69:474-479. [PMID: 29238676 DOI: 10.1007/s12070-017-1227-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/06/2017] [Indexed: 10/18/2022] Open
Abstract
To demonstrate the surgical technique and outcomes of double posterior based flap technique in primary endoscopic dacryocystorhinostomy (DCR) with and without use of powered instrument. 28 patients of nasolacrimal duct obstruction were included in the study from September 2012 to February 2015. All underwent endoscopic dacryocystorhinostomy with double posterior based nasal and lacrimal flap technique. In patients of group A (14 patients), bone removal was done with the help of Smith-Kerrison punch forceps and in patients of group B (14 patients), powered drill has been used for the same. Patients were visited the endoscopic clinic at 1, 3, 6 months and 1 year after the surgery for post operative evaluation. Of 28 patients, 26(92.85%) were found free of symptoms at the end of 1, 3 and at 6 months. One from each group had recurrence of symptoms. At the end of 12 months of 25 patients, 3(12%) patients were found to have recurrence of symptoms of which 1(8.33%) patients was from group A and 2(15.38%) were from group B and failures were because of granulation tissue and stomal stenosis. Patients assisted with powered drill had more postoperative complications compared to cold instrument. Double posterior based flap technique in primary endoscopic DCR without the assistance of powered drill could be an effective surgical option for the patients of chronic nasolacrimal duct obstruction enabling early epithelisation by preventing peristomal granulation tissue resulting in encouraging surgical outcome with least postoperative complication.
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Green R, Gohil R, Ross P. Mucosal and lacrimal flaps for endonasal dacryocystorhinostomy: a systematic review. Clin Otolaryngol 2016; 42:514-520. [PMID: 27662629 DOI: 10.1111/coa.12754] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Historically dacryocystorhinostomy (DCR) has been performed externally with very good outcomes. Current literature shows comparable success rates between endonasal and external approaches. A common reason for the failure of a DCR is the reclosure of the nasolacrimal stoma by granulation tissue and synechiae. OBJECTIVE OF REVIEW A systematic review and critical evaluation of the evidence relating to the preservation of nasal mucosal flaps in DCR surgery. TYPE OF REVIEW AND EVALUATION METHOD A systematic review using the consort guidance for review of randomised control trials. SEARCH STRATEGY A search of the following evidence-based medicine databases was performed: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, Ovid, Medline, EMBASE and PubMed. The search was limited to English language articles, and the following key words were used: Endonasal, Endoscopic, Dacryocystorhinostomy, DCR, Mucosal Flaps, between years 1970 and 2015. RESULTS The best available evidence was level 1B, comprising two randomised control trials and three comparative studies included in the review. The main outcome measures used were lacrimal irrigation and absence of epiphora. Two of the studies demonstrated a statistically significant benefit of mucosal sparing either with nasal mucosal flaps or with lacrimal flaps. More debridement was needed, and granulation tissue was also seen in the groups without mucosal preservation. There was no difference in surgical complications between a mucosal and non-mucosal-sparing technique. CONCLUSIONS The overall quality of current evidence is poor, and there does however appear to be a trend towards improved outcomes and reduced granulation in groups where nasal mucosal and lacrimal flaps were preserved, but this is not clear-cut. There was no evidence of increased complication rates with mucosal-sparing techniques. We recommend that until further good quality research is available we should be performing a mucosal-sparing technique when performing DCR routinely.
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Affiliation(s)
- R Green
- ENT Department Ninewells Hospital, Dundee, UK
| | - R Gohil
- ENT Department Ninewells Hospital, Dundee, UK
| | - P Ross
- ENT Department Ninewells Hospital, Dundee, UK
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Ng DSC, Chan E. Techniques to minimize skin incision scar for external dacryocystorhinostomy. Orbit 2015; 35:42-45. [PMID: 26710168 DOI: 10.3109/01676830.2015.1099700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/21/2015] [Indexed: 06/05/2023]
Abstract
Although there has been a narrowing in the gap in successful functional outcomes between external and endonasal DCR, external DCR is still being frequently performed when cost, availability of additional surgical instruments and visual systems, surgeon's experience and preference are concerned. Nonetheless, skin incisions at the lateral nasal sidewall of the lower eyelid inevitably leave cutaneous scars. The purpose of this review is to evaluate the outcomes of current modified surgical practices that prevent a conspicuous scar in external DCR.
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Affiliation(s)
- Danny Siu-Chun Ng
- a Department of Ophthalmology and Visual Sciences , The Chinese University of Hong Kong, Mongkok , Hong Kong
| | - Edwin Chan
- b Department of Ophthalmology , Tung Wah Eastern Hospital , Hong Kong
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Herzallah I, Alzuraiqi B, Bawazeer N, Marglani O, Alherabi A, Mohamed SK, Al-Qahtani K, Al-Khatib T, Alghamdi A. Endoscopic Dacryocystorhinostomy (DCR): a comparative study between powered and non-powered technique. J Otolaryngol Head Neck Surg 2015; 44:56. [PMID: 26694716 PMCID: PMC4688968 DOI: 10.1186/s40463-015-0109-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstruction. Essentially there are two approaches: external and endoscopic. Several modalities are used in endoscopic DCR; all aiming to improve success rate, reduce complications, and shorten operative time. Both kerrison punch and drill are widely used in endoscopic DCR with non-conclusive knowledge about differences in operative details as well as on the outcome. The aim of this study is to compare between powered (drill) and non-powered (kerrison punch) DCR to clarify the superiority of one over the other. METHODS A retrospective chart review of 59 patients who underwent endoscopic DCR procedure at our institution from June 2013 until July 2014 (34 kerrison punch and 32 powered drill). Operative details, surgical outcome and complications were compared between both groups. RESULTS A total of 66 endoscopic DCRs were performed on 59 patients. Procedure success rate among kerrison punch group was 87.88% vs. 90.9% in powered drill group (p = 0.827), while complications for both groups were statistical not significant (p = 0.91). The mean operating time among kerrison punch group was significantly lower than in powered drill group (75 min vs. 125 min, p = 0.0001). CONCLUSION Kerrison punch showed significant reduction in operating time when compared to powered drill for endoscopic DCR. No statistically significant difference was found between both groups regarding procedures' success rate and complication.
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Affiliation(s)
- Islam Herzallah
- Department of Otolaryngology, Zagazig University, Zagazig, Egypt
| | - Bassam Alzuraiqi
- Department of Otolaryngology-Head & Neck Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Naif Bawazeer
- Department of Otolaryngology-Head & Neck Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Osama Marglani
- Department of Otolaryngology-Head & Neck Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ameen Alherabi
- Department of Otolaryngology-Head & Neck Surgery, Umm Al-Qura University, Makkah, Saudi Arabia.
- , P.O.Box 41405, Jeddah, 21521, Saudi Arabia.
| | - Sherif K Mohamed
- Department of Otolaryngology, Ain Shams University, Cairo, Egypt
| | - Khalid Al-Qahtani
- Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Talal Al-Khatib
- Department of Otolaryngology-Head & Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Ophthalmology, Umm Al-Qura University, Makkah, Saudi Arabia
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Jung SK, Kim YC, Cho WK, Paik JS, Yang SW. Surgical outcomes of endoscopic dacryocystorhinostomy: analysis of 1083 consecutive cases. Can J Ophthalmol 2015; 50:466-70. [DOI: 10.1016/j.jcjo.2015.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 06/11/2015] [Accepted: 08/24/2015] [Indexed: 11/27/2022]
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Safety and efficacy of adjunctive intranasal mitomycin C and triamcinolone in endonasal endoscopic dacryocystorhinostomy. Int Ophthalmol 2015; 36:105-110. [PMID: 26003991 DOI: 10.1007/s10792-015-0088-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
One of the common causes of failure in dacryocystorhinostomy for nasolacrimal duct obstruction (NLDO) is mucosal scarring and fibrosis around the ostium. Steroid and mitomycin C (MMC) can potentially reduce scarring by their action on the inflammatory and proliferative phase of wound healing, respectively. The purpose of this study is to evaluate the safety and efficacy of combined usage of adjunctive MMC and intranasal triamcinolone (TA) in endonasal endoscopic dacryocystorhinostomy (EE-DCR). This is a retrospective interventional case series. All patients underwent mechanical EE-DCR in two regional hospitals in Hong Kong from January 2005 to December 2006 were included. All received intraoperative MMC application for 5 min and gelfoam soaked with TA onto the ostium. Main outcome measures include the anatomical and functional success rate at follow-up at least 6 months after operation. Other outcomes include complications occurred during and after operation. A total of 73 EE-DCR were performed in 69 patients. Three patients had simultaneous bilateral DCR; one had sequential DCRs for both sides. At the last follow-up, anatomical success was achieved in 68 cases (93 %) and both anatomical with functional success in 67 cases (92 %). No major complication was observed. Minor complications included asymptomatic mucosal adhesion between the nasal septum and lateral nasal wall in one patient and moderate secondary hemorrhage in another. EE-DCR with adjunctive MMC and TA is a safe and successful procedure for the treatment of NLDO.
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Ali MJ, Wormald PJ, Psaltis AJ. The Dacryocystorhinostomy Ostium Granulomas: Classification, Indications for Treatment, Management Modalities and Outcomes. Orbit 2015; 34:146-51. [PMID: 25901394 DOI: 10.3109/01676830.2015.1014510] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM Ostium granulomas following dacryocystorhinostomy (DCR) have not been studied in detail previously. This study aims to classify the DCR-related granulomas based on their ostial locations and to assess the outcomes of their management. METHODS A retrospective consecutive case series of 47 ostial granulomas evaluated over a period of 2 years were included in this study. All patients underwent detailed endoscopic examination to assess the granuloma locations and their response to initial topical steroids treatment. Persistent granulomas either underwent further management with excision or intralesional steroids based on their location. Patients were followed up for a minimum of 6 months. The primary outcome measure was resolution of granuloma. RESULTS The mean age at presentation was 45 years with a female preponderance (68%). 70% (33/47) of granulomas were following external DCR and 30% (14/47) occurred in the setting of endonasal DCR. The most common location was an edge granuloma in 46.8% (22/47) followed by a combined granuloma in 21.2% (10/47). 91.4% (43/47) underwent initial treatment with topical nasal steroids. The remaining 4 (8.5%) underwent primary excision. Among those treated with topical steroids (n = 43), 9.3% (4/43) underwent further treatment with intralesional triamcinolone. Overall, 4.2% (2/47) recurred in 6 weeks following resolution and were treated with excision. CONCLUSION We recommend routine endoscopic evaluation of all the DCR ostia. Detection of granulomas in early stages and appropriate management as per guidelines proposed may aid in better outcomes.
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Ali MJ, Psaltis AJ, Wormald PJ. Dacryocystorhinostomy ostium: parameters to evaluate and DCR ostium scoring. Clin Ophthalmol 2014; 8:2491-9. [PMID: 25525327 PMCID: PMC4266414 DOI: 10.2147/opth.s73998] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM This study aims to provide a systematic protocol for the evaluation of a dacryocystorhinostomy (DCR) ostium and to propose a scoring system to standardize the assessment. METHODS Retrospective evaluation of 125 consecutive lacrimal ostia post-DCR was performed. Medical records were screened, and photographs and videos were assessed to note the details of various ostial parameters. The major time points in evaluation were 4 weeks, 6 weeks, 3 months, and 6 months post-DCR. The ostia were defined and parameters like shape, size, location, and evolution of ostium were noted. Evaluation parameters were defined for internal common opening (ICO), ostium stents, and ostium granulomas. Ostium cicatrix and synechiae were graded based on their significance. Surgical success rates were computed and ostium characteristics in failed cases were studied. RESULTS A total of 125 ostia were evaluated on the aforementioned ostium parameters. Because five ostia showed a complete cicatricial closure with no recognizable features, the remaining 120 ostia were studied. The ostium location was anterior to the axilla of middle turbinate in 85.8% (103/120) of the cases. Moreover, 76.6% (92/120) of the ostia were circular to oval in shape, with a shallow base. The ostium size was >8×5 mm in 78.3% (94/120) of the cases. The ICO was found to be located in the central or paracentral basal area in 75.8% (91/120). The anatomical and functional success rates achieved were 96% and 93.6%, respectively. All the five cases with anatomical failures showed a complete cicatrization and the ICO movements were poor in all the three cases of functional failure. CONCLUSION The article attempts to standardize the postoperative evaluation of a DCR ostium and provides a systematic protocol and scoring system for possible use by surgeons and researchers alike.
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Affiliation(s)
- Mohammad Javed Ali
- Dacryology Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Alkis James Psaltis
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
| | - Peter John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
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Ali MJ, Psaltis AJ, Wormald PJ. Long-term outcomes in revision powered endoscopic dacryocystorhinostomy. Int Forum Allergy Rhinol 2014; 4:1016-9. [DOI: 10.1002/alr.21398] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/06/2014] [Accepted: 07/08/2014] [Indexed: 11/06/2022]
Affiliation(s)
| | - Alkis James Psaltis
- Department of Surgery-Otolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
| | - Peter John Wormald
- Department of Surgery-Otolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
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Outcomes of endonasal dacryocystorhinostomy without mucosal flap preservation. Ophthalmic Plast Reconstr Surg 2014; 30:24-7. [PMID: 24398483 DOI: 10.1097/iop.0b013e3182a7502e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Dacryocystorhinostomy (DCR) is the standard procedure for the treatment of acquired nasolacrimal duct obstruction (NLDO) that can be performed through an external or endonasal approach. Both techniques create a fistula from the lacrimal sac into the nasal cavity via a bony osteotomy. Historically, external DCR has been considered the gold standard; however, recent reports suggest endonasal DCR is an effective alternative. There are numerous variations of endonasal DCR described in the literature that report variable success rates. The purpose of this study is to describe the approach and success rate with endonasal DCR in which nasal mucosa, bone, and lacrimal sac mucosa are sequentially removed. METHODS The authors retrospectively reviewed cases of endonasal DCR from 2004 to 2011 from 2 institutions (the University of California, San Diego, California, and the Fante Eye and Face Center in Denver, Colorado, U.S.A.). Patients with a history of epiphora and NLDO confirmed with punctal irrigation were included. Exclusion criteria were the presence of canalicular obstruction, history of orbital trauma, and prior DCR surgery. Success was defined as subjective relief of epiphora and confirmation of ostium patency with irrigation. RESULTS A total of 324 patients (74 men, 250 women; mean age 59.3) encompassing 407 endonasal DCR cases were included in the study. The total case success rate was 92.2% with an average follow-up time of 91.5 days. Revision surgery was performed in 7 of the failed cases and resulted in success in 6 of these cases. CONCLUSIONS Endonasal DCR is a simple and effective approach to surgically treat NLDO and offers success rates comparable with external DCR.
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Lombardi D, Mattavelli D, Accorona R, Turano R, Semeraro F, Bozzola A, Nicolai P. Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified? Otolaryngol Head Neck Surg 2014; 150:1071-7. [PMID: 24647640 DOI: 10.1177/0194599814527236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 02/18/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE). DESIGN Case series with chart review. SETTING Academic tertiary center. PATIENTS The study included 26 consecutive patients who underwent Endo-DCR for ADLSE between August 2005 and December 2013. MAIN OUTCOME MEASURES The success of the procedure was defined as complete complaint relief and DCR patency. Data on the time from referral to surgery, postoperative complications, and revision surgery are also reported. RESULTS The present patient series included 4 males (15.4%) and 22 females (84.6%) (mean age, 66 years). The mean time between referral and surgery was 0.88 days and the mean follow-up time was 29 months. All patients showed immediate relief from symptoms, with no ADLSE recurrences. Complete success was achieved in 25 (96.2%) cases; the only failure was in a patient who had previously undergone radioiodine treatment. In this case, revision Endo-DCR was not successful. The only perioperative complication (3.8%) was epistaxis in a patient who required revision surgery under general anesthesia. The definitive success rate was 96.2% after primary and revision surgery. CONCLUSIONS Endo-DCR enables rapid resolution of ADLSE with a very high success rate. Immediate surgery may reduce the risk of skin fistulization and/or orbital complications. DCR shrinkage and lacrimal obstruction are unlikely with Endo-DCR since the procedure is performed on an enlarged sac. The main advantage of Endo-DCR, compared with external DCR, is the absence of a skin incision in an inflamed and infected field.
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Affiliation(s)
- Davide Lombardi
- Department of Otorhinolaryngology, University of Brescia, Italy
| | | | - Remo Accorona
- Department of Otorhinolaryngology, University of Brescia, Italy
| | | | | | - Anna Bozzola
- Department of Otorhinolaryngology, University of Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology, University of Brescia, Italy
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Abstract
PURPOSE To describe the technique of endocanalicular laser dacryocystorhinostomy with mucosal flap creation and to report the outcomes of this technique. METHODS Prospective noncomparative case series of 7 patients with primary acquired nasolacrimal duct obstruction undergoing endocanalicular laser dacryocystorhinostomy with mucosal flap. The mucosal flap was created using an endoscopic endonasal approach. An endocanalicular approach was used to fashion the lacrimal sac opening and the osteotomy of the lacrimal sac fossa. RESULTS Nine procedures were performed in 7 female patients. Average patient age was 68±15 years. Intraoperative complications included bleeding during the creation of the mucosal flap in 1 patient. The procedure was associated with no pain to moderate pain in all cases. Anatomical success was achieved in 89% of procedures and symptomatic relief was achieved in 89% of surgeries for an average follow up of 10 ± 5 months. Only 1 patient required an external dacryocystorhinostomy revision because of postoperative restenosis. CONCLUSIONS Endocanalicular laser dacryocystorhinostomy provides a minimally invasive approach to epiphora with a good success rate. The addition of a nasal mucosal flap to this technique may aid in proper fistulization and should be studied in larger prospective trials.
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Barmettler A, Ehrlich JR, Erlich J, Lelli G. Current preferences and reported success rates in dacryocystorhinostomy amongst ASOPRS members. Orbit 2013; 32:20-6. [PMID: 23387450 DOI: 10.3109/01676830.2012.747211] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Success rates for endoscopic and external dacryocystorhinostomy vary widely (external 70-95%; endonasal 59-99%). We investigated surgical preferences and reported success rates in dacryocystorhinostomy amongst American Society of Ophthalmic Plastic and Reconstructive Surgery members. METHODS This retrospective study utilized a questionnaire sent to American Society of Ophthalmic Plastic and Reconstructive Surgery members. Information culled included number of cases performed, surgical approach, and results. RESULTS 214 (38% response rate) surveys were completed, representing over 7,054 cases in one year. 93.9% of respondents offer external dacryocystorhinostomy; 63.1% offer endonasal. Surgeons report an increased rate of post-operative tearing with endonasal versus external (35.6% versus 5.8%, p < 0.001) and post-operative dacryocystitis with endonasal versus external (13.2% versus 1.0%, p < 0.001). The top reasons for choosing endoscopic DCR were patient preference, no visible scar, and prior failed DCR. The top reasons for choosing external DCR were higher success rate, physician preference, and more long-term data on outcome. The majority of members use bicanalicular Crawford tubes (76%). Tubes were most commonly removed during post-operative months 2 (34.6%) and 3 (36.4%). CONCLUSIONS Despite papers reporting equivalent success rates between external and endonasal dacryocystorhinostomy, more American Society of Ophthalmic Plastic and Reconstructive Surgery members perform greater numbers of external dacryocystorhinostomy, prefer external dacryocystorhinostomy, and report a higher success rate with this approach.
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Affiliation(s)
- Anne Barmettler
- Weill Cornell Medical College, Department of Ophthalmology, New York, NY, USA
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Chong KKL, Lai FHP, Ho M, Luk A, Wong BW, Young A. Randomized trial on silicone intubation in endoscopic mechanical dacryocystorhinostomy (SEND) for primary nasolacrimal duct obstruction. Ophthalmology 2013; 120:2139-45. [PMID: 23672972 DOI: 10.1016/j.ophtha.2013.02.036] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 02/27/2013] [Accepted: 02/27/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To study the effect of bicanalicular silicone intubation on endonasal endoscopic mechanical dacryocystorhinostomy (EEM-DCR) for primary acquired nasolacrimal duct obstruction (PANDO). DESIGN Randomized clinical trial. PARTICIPANTS A total of 120 consecutive adults (103 females) with a presenting age of 64 ± 13.7 years (range, 39-92 years) underwent EEM-DCR for PANDO from November 2005 to May 2009 in a lacrimal referral center. METHODS The EEM-DCR was performed by 2 lacrimal surgeons using standard techniques. Patients were randomly assigned to receive or not receive bicanalicular silicone intubation for 8 weeks. No antimetabolite was used. All patients received a course of oral antibiotics during nonabsorbable nasal packing for flaps tamponade, which was removed at the first postoperative visit. Patients were assessed at 1, 3, 6, 12, 26, and 52 weeks after the operation. MAIN OUTCOME MEASURES Surgical success was defined by symptomatic relief of epiphora, reestablishment of nasolacrimal drainage confirmed by irrigation by 1 masked observer, and positive functional endoscopic dye test by the operative surgeon at 12 months postoperatively. Intraoperative and postoperative complications were recorded. RESULTS A total of 118 of the 120 randomized cases completed 12 months of follow-up. Two patients died of unrelated medical illnesses during follow-up. At 12 months postoperatively, there was no statistical difference in the success rate between patients with (96.3%) and without (95.3%) intubation (P=0.79). The odds ratio of failure without silicone intubation was 1.28 (95% confidence interval, 0.21-7.95). There was no difference in the incidence (P=0.97) or the time to develop (P=0.12) granulation tissue between the 2 groups. No significant difference was found between successful and failed cases in terms of age (P=0.21), sex (P=0.37), laterality (P=0.46), mode of anesthesia (P=0.14), surgeon (P=0.26), use of stent (P=0.79), or presence of granulation tissue postoperatively (P=0.39). CONCLUSIONS The current study design provided 90% statistical power to detect more than 21% difference in surgical outcome, and no such difference was found whether intubation was used or not used in EEM-DCR for PANDO at the 12-month follow-up. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Kelvin K L Chong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, HKSAR, China; Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, HKSAR, China.
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No thermal tool using methods in endoscopic dacryocystorhinostomy: no cautery, no drill, no illuminator, no more tears. Eur Arch Otorhinolaryngol 2013; 270:2677-82. [DOI: 10.1007/s00405-013-2408-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/15/2013] [Indexed: 11/25/2022]
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Ji QS, Zhong JX, Tu YH, Wu WC. New mucosal flap modification for endonasal endoscopic dacryocystorhinostomy in Asians. Int J Ophthalmol 2012; 5:704-7. [PMID: 23275904 DOI: 10.3980/j.issn.2222-3959.2012.06.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 11/09/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To describe a simple modification of fashioning the mucosal flap for endonasal endoscopic dacryocystorhinostomy (EES-DCR) in Asians and investigate its efficacy. METHODS A total of 120 patients with unilateral primary chronic dacryocystitis (PCD) were randomized into two groups: the new shaped nasal mucosal flap group (group A) and the removed nasal mucosal flap group (group B). All patients underwent standard EES-DCR. Patients in group A were performed a new shaped nasal mucosal flap covering the bared bone around the opened sac and those in group B was removed the nasal mucosal flap uncovering the bared bone. Patients were followed up for one year. The occurrence of granulation tissue, the proliferation of scar tissue and success rate of EES-DCR was compared. RESULTS In the present study, complete postoperative data were acquired from 54 patients in group A and from 57 patients in group B. During process of review, the occurrence of granulation tissue was at the ostium margins account for 15% (8/54) in group A and 39% (22/57) in group B (P<0.05). At the one-year review, scar tissue was present in 5 patients in group A compared with 18 in group B (P<0.05). The success rate of EES-DCR was 98% (53/54) in group A and 84% (48/57) in group B (P<0.05). CONCLUSION The simple modification of fashioning nasal mucosal flap can effectively cover the bared bone around the opened sac and reduce formation of granulation tissue, lessen the risk of scar tissue formation and closure of ostium, thus improve the success rate of EES-DCR in Asians.
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Affiliation(s)
- Qing-Shan Ji
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
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Jang HD, Kim SS. Results of Endonasal Dacryocystorhinostomy with Lacrimal Sac Flap and Silastic Sheet. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.12.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Duk Jang
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Sang Soo Kim
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
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