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Alicandri-Ciufelli M, Lucidi D, Aggazzotti Cavazza E, Russo P, Del Giovane C, Marchioni D, Calvaruso F. Classical vs. Retrograde Endoscopic Dacryocystorhinostomy: Analyses and Comparison of the Results. J Clin Med 2024; 13:3824. [PMID: 38999390 PMCID: PMC11242707 DOI: 10.3390/jcm13133824] [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: 05/08/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Background: In endoscopic dacryocystorhinostomy (DCR), surgical landmarks such as the maxillary line (ML) and the axilla of the middle turbinate (MT) guide the surgeon in identifying the lacrimal sac. The primary surgical risk associated with the classical technique, which involves directly opening the lacrimal sac, is the height of the bone drilling on the projection of the lateral wall of the nasal fossa. This poses a significant risk of damaging the orbit, the floor of the frontal sinus, and the anterior skull base. Furthermore, the anatomical variability in size and location of the lacrimal sac poses a risk for difficult and precise surgical identification. Recently, a 'retrograde' technique has been introduced to safely identify and expose the lacrimal sac. The aim of this study is to compare the results of retrograde DCR (rDCR) to a classic technique (clDCR), in terms of clinical recurrence and complications. Methods: A retrospective study on a cohort of 35 patients who underwent DCR at the ENT Department of the Modena University Hospital between January 2010 and October 2022 (18 clDCR and 17 rDCR) was performed. Minimum postoperative follow-up for inclusion was 12 months. We used the Fisher's exact test to compare the two techniques, comparing functional outcomes and clinical recurrence rates. Results: Clinical recurrence of nasolacrimal stenosis in clDCR patients was 50%, compared to 6% in those who underwent rDCR (p-value 0.005). Postoperative surgical complications were not significantly different between the two groups (p > 0.05). Conclusions: rDCR is a safe technique and has been shown to be a statistically more effective surgical technique than clDCR in reducing clinical recurrence rates.
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Affiliation(s)
- Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy; (M.A.-C.); (D.L.); (E.A.C.); (D.M.)
| | - Daniela Lucidi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy; (M.A.-C.); (D.L.); (E.A.C.); (D.M.)
| | - Elisa Aggazzotti Cavazza
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy; (M.A.-C.); (D.L.); (E.A.C.); (D.M.)
| | - Paolo Russo
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Cinzia Del Giovane
- Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, 41124 Modena, Italy;
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Daniele Marchioni
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy; (M.A.-C.); (D.L.); (E.A.C.); (D.M.)
| | - Federico Calvaruso
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy; (M.A.-C.); (D.L.); (E.A.C.); (D.M.)
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Bahner L, Zebralla V, Dietz A, Otto M, Pirlich M. Prospective, randomised clinical trial on the necessity of using a silicone intubarium in the context of endonasal-endoscopic dacryocystorhinostomy (EN-DCR) in patients with postsaccal lacrimal duct stenosis. Int Ophthalmol 2024; 44:293. [PMID: 38940962 PMCID: PMC11213761 DOI: 10.1007/s10792-024-03205-7] [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: 03/12/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND This prospective clinical study evaluates the effect of a silicone stent tube (SST) on the success rate of endonasal-endoscopic dacryocystorhinostomy (EN-DCR) to treat primary acquired nasolacrimal duct obstruction. METHODS Patients were randomly assigned to receive EN-DCR with or without SST intubation over a period of 3 months. The surgery was performed using standardized techniques. Patients were assessed at three different timepoints: one day, 12 weeks and 24 weeks after the surgery. The results were compared in order to evaluate statistical differences. Surgical success was determined by means of positive irrigation procedures, as well as by the improvement of symptoms and a high level of patient satisfaction. RESULTS A total of 56 randomized cases completed 24 weeks of follow up. 1 Patient dropped out due to malignant genesis of the nasolacrimal duct obstruction. After 24 weeks of follow up no statistically significant differences in levels of epiphora (p > .10) or patency (p > .16) were revealed. Comparisons regarding changes in time did not show levels of significance (p > .28). CONCLUSIONS This study could not confirm a statistically significant benefit or disadvantage for SST Insertion in EN-DCR.
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Affiliation(s)
- Lia Bahner
- University Hospital Leipzig, Leipzig, Germany
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Locatello LG, De Zan ER, Tarantini A, Lanzetta P, Miani C. External dacryocystorhinostomy: A critical overview of the current evidence. Eur J Ophthalmol 2024:11206721241249214. [PMID: 38689455 DOI: 10.1177/11206721241249214] [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: 05/02/2024]
Abstract
PURPOSE External dacryocystorhinostomy (ext-DCR) is still considered the gold standard in the treatment of distal lacrimal duct obstruction. Despite an overall high success rate, some patients do relapse after surgery and the ideal perioperative management has not been identified yet. The purpose of this study is to critically discuss the published evidence in the last five years on the medical and surgical management of external dacryocystorhinostomy. Furthermore, the drawbacks of the available literature and the perspectives in this field will be also highlighted. METHODS Systematic review of the literature in the last 5 years by using PubMed and Google Scholar. RESULTS A total of 64 articles were included. Many technical modifications and surgical refinements have been proposed but a formal comparison among the various techniques is hampered by methodological heterogeneity. The use of local anesthesia, and the perioperative adjunctive techniques to reduce the risk of restenosis are also gaining popularity but the level of evidence remains weak. CONCLUSION Ext-DCR offers satisfactory clinical outcomes even though there are many gray areas that need to be addressed in future high-quality studies.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | | | - Anna Tarantini
- Department of Medicine - Ophthalmology , University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology , University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine and Milan, Italy
- University of Udine, Department of Medicine (DAME), Via Colugna 50, 33100 Udine, Italy
| | - Cesare Miani
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
- University of Udine, Department of Medicine (DAME), Via Colugna 50, 33100 Udine, Italy
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Gani K, Castelhano L, Correia F, Reis LR, Escada P. Endoscopic and External Dacryocystorhinostomy: Long Term Result from a Tertiary Center in Portugal. Indian J Otolaryngol Head Neck Surg 2024; 76:1613-1618. [PMID: 38566741 PMCID: PMC10982182 DOI: 10.1007/s12070-023-04368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 04/04/2024] Open
Abstract
Dacryocystorhinostomy is the gold-standard for distal lacrimal obstructions. This study aims to report the demography, clinical presentation, influence of agger nasi opening, uncinectomy and septoplasty, the use of silicone stent tubes, complications and success of endoscopic and external dacryocystorhinostomy over a period of 11 years. Retrospective review of clinical records, from January 2012 to December 2022, at a tertiary center in Portugal. A total of 249 procedures, 6 external and 243 endoscopic, were performed, including 39 revision cases. There was a female predominance (79.9%) with a mean age at diagnosis of 66.4 years. Recurrent acute dacryocystitis, reported by 33.3%, was associated with higher success (p = 0.053). Agger nasi opening, uncinectomy and septoplasty were performed in 17.7%, 6.0% and 15.3% respectively, although associated with higher success rates, no statistically significant difference was found. Minor complication rates for both external and endoscopic approach was 33.3% and 32.1% respectively. Functional and anatomical success was 100% and 83.3%, respectively, for external dacryocystorhinostomy, and 91.4% and 85.1%, respectively, for endoscopic dacryocystorhinostomy. Revision surgery was associated with a worse anatomical success (p = 0.05). Endoscopic dacryocystorhinostomy is an effective and safe alternative to the external approach. Minor procedures can increase the success rate, but multicentre studies need to be performed for a statistically significant result.
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Affiliation(s)
- Kaamil Gani
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | | | | | - Pedro Escada
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Liu S, Zhang H, Zhang YR, Chen LJ, Yu XY. The efficacy of endoscopic dacryocystorhinostomy in the treatment of dacryocystitis: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37312. [PMID: 38489695 PMCID: PMC10939585 DOI: 10.1097/md.0000000000037312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND This article aimed to discuss the efficacy and safety of endoscopic dacryocystorhinostomy (EDCR) versus external dacryocystorhinostomy (EX-DCR) for the treatment of dacryocystitis by meta-analysis. METHODS All randomized controlled trials that met the inclusion and exclusion criteria were collected by searching the following databases: PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang, from the establishment of the database to June 2023. Meta-analysis was performed using Stata 17.0 software and review manager 5.4 software. In the collected trials, the observation group was treated with EDCR, whereas the control group was treated with EX-DCR. RESULTS A total of 10 studies involving 969 patients were included in this analysis. There was a similar surgical success rate in the treatment of dacryocystitis between the 2 groups (RR = 1.021, 95% CI [0. 803, 1.297], P = 0. 865). However, compared with the control group, patients in the observation group had a higher total effective rate of treatment (RR = 1. 195, 95% CI [1. 063, 1.343], P = .003), and shorter operative time (WMD = -23.640, 95% CI [-35.533, -11.747], P < .001), and less intraoperative blood loss (WMD = -50.797, 95% CI [-80.339, -21.255], P = .001), shorter length of hospital stays (WMD = -4.570, 95% CI [-5.992, -3.148], P < .001), and lower incidence of adverse events (RR = 0.295, 95% CI [0.173, 0.504], P < .001). CONCLUSION EDCR is an effective and safe surgical procedure for the treatment of dacryocystitis and can be used as an alternative to EX-DCR.
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Affiliation(s)
- Shui Liu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Ophthalmology, Zhongshan Torch Development Zone People’s Hospital, Zhongshan, Guangdong, China
| | - Huang Zhang
- Department of Ophthalmology, Zhongshan Torch Development Zone People’s Hospital, Zhongshan, Guangdong, China
| | - Yue-Rui Zhang
- Department of Ophthalmology, Zhongshan Torch Development Zone People’s Hospital, Zhongshan, Guangdong, China
| | - Li-Jun Chen
- Department of Ophthalmology, Zhongshan Torch Development Zone People’s Hospital, Zhongshan, Guangdong, China
| | - Xiao-Yi Yu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Shiina T, Yunoki T, Tachino H, Hayashi A. Comparative study of surgical outcomes regarding tear meniscus area and high-order aberrations between two different interventional methods for primary acquired nasolacrimal duct obstruction. Jpn J Ophthalmol 2024; 68:139-145. [PMID: 38499913 DOI: 10.1007/s10384-024-01050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/11/2023] [Indexed: 03/20/2024]
Abstract
PURPOSE To compare endonasal dacryocystorhinostomy (EN-DCR) with sheath-guided dacryoendoscopic probing and bicanalicular intubation (SG-BCI) by evaluating tear meniscus area (TMA) and total high-order aberrations (HOAs) for primary acquired nasolacrimal duct obstruction (PANDO). METHOD We retrospectively reviewed 56 eyes of 42 patients (7 men, 35 women; age, 72.7±13.1 years) who underwent EN-DCR or SG-BCI for PANDO in Toyama University Hospital from February 2020 to June 2022. In the EN-DCR and SG-BCI groups, we measured the patency of the lacrimal passage, preoperative and postoperative TMA, and HOAs of the central 4 mm of the cornea using optical coherence tomography (AS-OCT), six months postoperatively. RESULTS There was a positive correlation between preoperative TMA and preoperative HOAs in all cases. Postoperative patency of lacrimal passage was 100% in the EN-DCR and 80.8% in the SG-BCI group. There was a significant difference in the number of passages between the two groups (p = 0.01). Preoperative TMA and HOAs showed a significant postoperative decrease in both groups (EN-DCR group: p<0.01, p<0.01, SG-BCI group: p<0.01, p=0.03, respectively). We then calculated the rate of change of preoperative and postoperative TMA and HOAs and compared them between the two groups. The rate of change was significantly higher in the EN-DCR group than that in the SG-BCI group (TMA, p=0.03; HOAs, p=0.02). CONCLUSION Although both EN-DCR and SG-BCI are effective for PANDO, our results suggest that EN-DCR is more effective in improving TMA and HOAs.
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Affiliation(s)
- Tetsuo Shiina
- Departments of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Tatsuya Yunoki
- Departments of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Hirohiko Tachino
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Departments of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Li M, Li W, Sha Q, Yu L, Wang X. Analysis of the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis. Medicine (Baltimore) 2024; 103:e36934. [PMID: 38241549 PMCID: PMC10798723 DOI: 10.1097/md.0000000000036934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
To estimate the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis. The clinical data of 105 subjects with chronic dacryocystitis enrolled into our hospital were analyzed retrospectively. The subjects were distinguished into nasal endoscopic group (endoscopic dacryocystorhinostomy; i.e., 51 cases) according to their surgical methods and external-route group (external-route dacryocystorhinostomy; i.e., 54 cases). The therapeutic effect, lacrimal gland secretion function, tear film stability, degree of epiphora, lacrimal passage patency, complications, and recurrence rate were contrasted between the 2 groups. The nasal endoscopic group exhibited a higher effective remedy rate (98.04%) compared with the external-route group (83.33%). Three months postoperation, both groups showed improvements in lacrimal gland secretion function and tear film stability, with the nasal endoscopic group demonstrating more significant enhancement in lacrimal gland secretion function than the external-route group. Six months postoperation, a reduction in the degree of epiphora was observed in both groups, with the nasal endoscopic group displaying a more pronounced decrease in epiphora severity and a higher lacrimal passage patency rate than the external-route group. Furthermore, the nasal endoscopic group experienced lower incidences of postoperative complications and recurrence rates. Endoscopic dacryocystorhinostomy is safe and effective in the remedy of chronic dacryocystitis.
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Affiliation(s)
- Mingzhe Li
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Wenping Li
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Qian Sha
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Liuying Yu
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Xuefei Wang
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Otolaryngology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Office of Drug Clinical Trial Institution, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
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Fan YM, Yin XX, Gao N, Liu Z. Long-term outcomes of laser dacryoplasty combined with intubation using a new silicon tube in patients with lacrimal duct obstruction. Int J Ophthalmol 2023; 16:1475-1481. [PMID: 37724261 PMCID: PMC10475623 DOI: 10.18240/ijo.2023.09.14] [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: 01/04/2023] [Accepted: 07/05/2023] [Indexed: 09/20/2023] Open
Abstract
AIM To determine the 15-year outcomes of laser dacryoplasty (LDP) in patients with lacrimal duct obstruction; and to evaluate LDP combined with intubation using a new silicone tube to treat complicated cases. METHODS Patients with lacrimal duct obstruction and treated with LDP between April 2000 and April 2005 were investigated retrospectively. Totally 116 eyes with completed 15-year follow-up records were included in this study. For complicated cases (52 eyes of 52 patients), both LDP and intubation using a self-made silicon tube were performed. For patients with uncomplicated obstruction (64 eyes of 61 patients), only LDP was performed. Outcomes were assessed based on results of lacrimal irrigation and degree of symptoms during follow-up. RESULTS At the follow-up time of 15y, 81 eyes achieved full success (69.8%); 21 eyes got improved (18.1%); and 14 eyes were considered failure (12.1%). The success rate was 71.2% (37/52 eyes) for complicated cases; and 68.8% (44/64 eyes) for uncomplicated cases. No statistically significant difference between two groups was observed (P=0.961). No postoperative complication was observed. CONCLUSION LDP is a well-tolerated, simple, and effective procedure with satisfactory long-term outcomes in selected patients, which make it a good alternative to conventional dacryocystorhinostomy. In addition, intubation with the self-made mono-canalicular silicone tube facilitates the management of complicated cases with few complications.
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Affiliation(s)
- Yi-Meng Fan
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xiu-Xia Yin
- Department of Ophthalmology, Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an 710061, Shaanxi Province, China
| | - Ning Gao
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Zhao Liu
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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El Bouhmadi K, Loudghiri M, Oukessou Y, Rouadi S, Abada R, Roubal M, Mahtar M. Evaluation of the endoscopic revision of dacryocystorhinostomy failure cases: a cohort study. Ann Med Surg (Lond) 2023; 85:4218-4222. [PMID: 37663685 PMCID: PMC10473351 DOI: 10.1097/ms9.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/28/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The dacryocystorhinostomy (DCR) procedure is linked to a high success rate; however, cases of tearing recurrence are not rare and should be managed efficiently. Thus, evaluating cases of DCR failure allows highlighting the factors significantly impacting the results in order to realize better controlled primary surgeries. Material and method Twenty-eight patients were operated in our Otolaryngology Department for endoscopic revision of DCR failure between January 2019 and June 2022. Their clinical presentation, postoperative evolution, and findings of the primary and revision surgeries were assessed until the actual follow-up. Results The first surgery was based on an external approach in 17 patients and the bicanalicular silicone tube intubation was kept for a mean of 4.25 months. The recurrence delay varied from 0.5 to 9 months. Revision surgery revealed synechia in 10 patients, a completely closed DCR ostium in 22 patients (78.57%) by mucosal scarring and granulation, and lacrimal sac fibrosis in 16 patients (57.14%). A significant correlation was found between maintenance of the silicone intubation tube greater than or equal to 3 months and lacrimal sac fibrosis (P=0.016<0.05). Conclusion Thus, better controlled primary surgeries with optimal exposure, wild marsupialisation of the lacrimal sac and no longer systematic bicanalicular intubation which should be dedicated to difficult anatomies and canalicular affections should guarantee better functional results.
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Affiliation(s)
- Khadija El Bouhmadi
- Department of Otolaryngology, Head and Neck Surgery, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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Lan S, Yu JQ, Ke F, Li DK, Yu B, Liu ZK. Endoscopic dacryocystorhinostomy with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent incarceration. Int J Ophthalmol 2023; 16:1218-1223. [PMID: 37602353 PMCID: PMC10398523 DOI: 10.18240/ijo.2023.08.05] [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: 05/16/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023] Open
Abstract
AIM To investigate the feasibility of endoscopic dacryocystorhinostomy (En-DCR) with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent (NDS) incarceration. METHODS En-DCRs were performed on 44 chronic dacryocystitis patients (46 eyes) secondary to NDS incarceration from April 2016 to October 2022. The granuloma and scar tissues were separated, and the removal of NDS incarceration was achieved during the surgery; the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal, a bicanalicular silicone tube was implanted, and lacrimal size and condition were assessed. The tube was removed 3mo after surgery. During the final follow-up of 12mo when the surgery was completed, the complications and the rates of surgical success were assessed. RESULTS This study covered 40 patients (42 eyes). Intraoperatively, it was found that the lacrimal sac became small, and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes. At 12mo after surgery completed, the rates of the functional and anatomical success reached 80.95% (34/42) and 83.33% (35/42), respectively. Under the effect of intranasal ostial closure, seven eyes failed to achieve anatomical success. No serious complications (e.g., visual impairment, sinusitis, and orbital fat prolapse) was observed. CONCLUSION With the success rate over 80% and no serious complications, En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.
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Affiliation(s)
- Shan Lan
- Department of Radiology, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
| | - Jin-Qiang Yu
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
| | - Feng Ke
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
| | - De-Kun Li
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
| | - Bo Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Zhen-Kai Liu
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
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Acar Eser N, Ceylanoglu KS, Malkoc Sen E, Evren E. The influence of microorganisms on early relapses after external dacryocystorhinostomy. Int Ophthalmol 2023:10.1007/s10792-023-02709-y. [PMID: 37081132 DOI: 10.1007/s10792-023-02709-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Understanding the influence of microorganisms in patients with acquired nasolacrimal duct obstruction (NLDO) and investigating their effect on recurrence after external dacryocystorhinostomy (DCR). METHODS This prospective study included 50 patients. Evaluations were made before, on the first postoperative day and monthly after DCR. Nasolacrimal silicon tubes (NST) were removed after three months. Before the DCR, swab samples were taken from both hands and lower conjunctival fornices and from the lacrimal sac during the first DCR and from the relapsed cases during the second DCR. RESULTS Growth was observed in 90 (45%) cultures out of 200 and a total of 23 different strains were identified altogether. Staphylococcus aureus (40%) and Streptococcus pneumoniae (28%) were dominantly isolated which were all resistant to penicillin, tetracycline and erythromycin. Lacrimal syringing (LS) was successful in patients (100%) on the first postoperative day. After three months, before NST removal, purulent discharge from the punctum was observed in five patients, and blockage was detected by LS. S. pneumoniae was isolated from all five patients' obstructed side conjunctival cultures. Additionally, from their lacrimal sac, S. pneumoniae (4 patients), Capnocytophaga gingivalis, and Candida spp. (1 patient) strains were isolated. S pneumoniae was isolated in four out of five patients from the ipsilateral conjunctival and lacrimal sac cultures which obtained from the subsequent DCR. CONCLUSION Our results showed that S. pneumoniae was an isolated and persistent strain in cases with early recurrence even after a successful DCR.
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Affiliation(s)
- Nazan Acar Eser
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey.
| | - Kubra Serbest Ceylanoglu
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Emine Malkoc Sen
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Ebru Evren
- Ankara University School of Medicine Department of Medical Microbiology and İbn-I Sina Hospital Central Microbiology Laboratory, Ankara, Turkey
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