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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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Vinciguerra A, Resti AG, Rampi A, Bussi M, Bandello F, Trimarchi M. Endoscopic and external dacryocystorhinostomy: A therapeutic proposal for distal acquired lacrimal obstructions. Eur J Ophthalmol 2022; 33:1287-1293. [PMID: 36254409 PMCID: PMC10152216 DOI: 10.1177/11206721221132746] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endoscopic (END-DCR) and external dacryocystorhinostomies (EXT-DCR) are nowadays considered the gold standard techniques for non-oncologic distal acquired lacrimal disorders (DALO). However, no unanimous consensus has been achieved on which of these surgeries is the most suitable to the individual patient. Herein, we review the available literature of the last 30 years with the aim of defining a simple and reproduceable treatment algorithm to treat DALO. A search of PubMed, EMBASE, Scopus and Cochrane databases was last performed in December 2021 to examine evidence regarding the role of END-DCR and EXT-DCR in primary and revision surgeries. If considered primary surgeries, END-DCR should be preferred in case of intranasal comorbidities, given the possibility to directly visualize and treat potential intranasal pathologies. Conversely, EXT-DCR should be chosen in case of need/preference for local anesthesia, given the major historical experience and wider surgical field that helps to resolve intra-operatory complications (e.g., bleeding) in an uncollaborative patient. In the absence of the abovementioned conditions, the decision of one or other approach should be discussed with the patient. In recurrent cases, END-DCR should be considered the treatment of choice given the major likelihood to visualize the causes of primary failure and directly resolve it. In conclusion, END-DCR should be considered the treatment of choice in revision cases or in primary ones associated with intranasal pathologies, whereas EXT-DCR should be chosen if local anesthesia is needed. In the absence of these scenarios, it is still open to debate which of these two approaches should be used.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck Department, Ophthalmology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Rampi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck Department, Ophthalmology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
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Giordano Resti A, Vinciguerra A, Bordato A, Rampi A, Tanzini U, Mattalia L, Bandello F, Trimarchi M. The importance of clinical presentation on long-term outcomes of external dacryocystorhinostomies: Our experience on 245 cases. Eur J Ophthalmol 2021; 32:2646-2651. [PMID: 34806462 DOI: 10.1177/11206721211059702] [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: 11/17/2022]
Abstract
PURPOSE External dacryocystorhinostomy (EXT-DCR) is a surgical approach commonly used to treat post-canalicular acquired lacrimal obstruction whose success rate has been described, equally with endoscopic DCR, to be superior to other available treatments. METHODS At San Raffaele Hospital, Milan (Italy), from January 2008 to December 2020, 245 EXT-DCRs were performed. All patients underwent routine pre-operative work-up including Jones tests and probing and irrigation of the lacrimal pathway; when necessary, a multidisciplinary approach with nasal endoscopy was performed. The surgical approach was followed by positioning of a bicanalicular stent which was left in place for 6 months. Success was defined as resolution of clinical signs/symptoms and free lacrimal flow on functional test. RESULTS Of the cases enrolled, 26.9% were treated for recurrent epiphora (group 1), and 73.1% for epiphora associated with chronic dacryocystitis (group 2). After a median follow-up of 71 months, group 1 had success at T0 (1 month) and T1 (long-term) of 81.8% and 60.6%, respectively, compared to 93.8% and 77.7% in group 2. Statistical analysis showed a significant association with surgery both at T0 (p = 0.018) and T1 (p = 0.012) with group 2 showing better outcomes. Additionally, the cosmetic outcome of the external scar was defined as invisible in 91.8% of cases and slightly visible in 8.2%. CONCLUSIONS External dacryocystorhinostomy provides long-term reliable results particularly in case of chronic dacryocystitis. Moreover, the optimal esthetic outcome of the external scar should be no longer considered the only guiding principle of treatment modality, particularly in the elderly.
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Affiliation(s)
- Antonio Giordano Resti
- Division of Head and Neck Department, Ophthalmologic Unit, 9372IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Alessandro Vinciguerra
- School of Medicine, 18985Vita-Salute San Raffaele University, Milano, Italy.,Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Alessandro Bordato
- Division of Head and Neck Department, Ophthalmologic Unit, 9372IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, 18985Vita-Salute San Raffaele University, Milano, Italy
| | - Andrea Rampi
- School of Medicine, 18985Vita-Salute San Raffaele University, Milano, Italy.,Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Umberto Tanzini
- School of Medicine, 18985Vita-Salute San Raffaele University, Milano, Italy.,Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Luisa Mattalia
- School of Medicine, 18985Vita-Salute San Raffaele University, Milano, Italy.,Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesco Bandello
- Division of Head and Neck Department, Ophthalmologic Unit, 9372IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, 18985Vita-Salute San Raffaele University, Milano, Italy
| | - Matteo Trimarchi
- School of Medicine, 18985Vita-Salute San Raffaele University, Milano, Italy.,Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
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Iandelli A, Carobbio ALC, Migliardi R, Catalani M, Mazzola F, Parrinello G, Peretti G, Canevari FR. Application of a symptoms score questionnaire after conjunctivodacryocystorhinostomy: outcomes. ACTA ACUST UNITED AC 2021; 41:248-254. [PMID: 34264918 PMCID: PMC8283396 DOI: 10.14639/0392-100x-n0881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/10/2021] [Indexed: 11/23/2022]
Abstract
Objective To evaluate medium/long term outcomes and patient satisfaction through relief of symptoms and improved quality of life (QoL) after Jones tube conjunctivodacryocystorhinostomy (JT-CDCR) using the Naso Lacrimal Duct Obstruction symptom-score (NLDO-SS). Methods We conducted a retrospective, non-comparative, multicentric study including patients with complete obstruction of the superior and inferior proximal lacrimal drainage system. All patients underwent JT-CDCR, and the patency of the tube was evaluated with saline irrigation and endoscopic examination. We assessed patient satisfaction and quality of life administering the NLDO-SS. Results We enrolled 16 patients, for a total of 21 eyes operated. The success rate for procedures was 81%. The success rate for single parameters was globally 95.9%; if considered separately, ocular symptoms and nasal symptoms were respectively 94.3% and 100%. Conclusions JT-CDCR was a reliable procedure, able to solve symptoms in a majority of patients and guaranteed a good quality of life over a long period of time.
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Affiliation(s)
- Andrea Iandelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Andrea Luigi Camillo Carobbio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Renata Migliardi
- Department of Ophthalmology, Ospedale Policlinico di Monza, Monza, Italy
| | - Maurizio Catalani
- Department of Otorhinolaryngology, Istituto Clinico Cellini Humanitas, Turin, Italy
| | - Francesco Mazzola
- Department of Otorhinolaryngology, Head and Neck Surgery, National Cancer Institute Regina Elena, Rome, Italy
| | | | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Frank Rikki Canevari
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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