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Yu Y, Zhou G, Li X, Wei J, Ke X, Wu L, Wu W, Yu B. Computed Tomography Signs of Sinonasal Inflammation in Patients with Acute Dacryocystitis. Am J Rhinol Allergy 2024; 38:333-338. [PMID: 39033418 DOI: 10.1177/19458924241262098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
BACKGROUND Nasal and paranasal sinus abnormalities may be related to nasolacrimal duct obstructive disease but are strongly debated. Data of acute disease stage are lacking. OBJECTIVE The purpose of this study was to determine if there are correlations between radiologic signs of sinus inflammation and acute dacryocystitis (AD). METHODS This cross-sectional controlled study was conducted at Wenzhou, Zhejiang Province, China from February 2021 to November 2023. Forty-four consecutive patients with AD and 50 consecutive patients with orbital tumors (the control group), who completed preoperative computed tomography scans, were enrolled to evaluate the extent of their inflammatory sinonasal disease by the modified Lund-Mackay score system. RESULTS The inflammation signs of the paranasal sinuses (total mean sinus scores, 95% CI [0.00, 2.00]; P < 0.001), namely the anterior ethmoid sinus(95% CI [0.00, 1.00]; P < 0.001), the posterior ethmoid sinus(95% CI [0.00, 0.00]; P = 0.003), the frontal sinus (95% CI [0.00, 0.00]; P = 0.02), and the ostiomeatal complex (P < 0.001) were more extensive in patients with AD when compared with the controls. The disease course was negatively correlated with the anterior ethmoid (P = 0.03) and frontal scores (P = 0.01). The symptom of eyelid swelling was positively correlated with the anterior ethmoid (P = 0.03), ostiomeatal complex (P = 0.004), and total sinus scores (P = 0.005). CONCLUSION Inflammatory sinus disease was found to be more frequent in patients with AD, which was gradually alleviated with the prolongation of the disease course. The mutual spread of inflammation particularly in the acute course may play an important role in lacrimal duct obstructive disease.
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Affiliation(s)
- Yueqi Yu
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Guangming Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xinyu Li
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
| | - Jinfei Wei
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyu Ke
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
| | - Linjuan Wu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
| | - Wencan Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bo Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Atkova EL, Borisenko TE, Yartsev VD. Anatomical requirements for dacryocystorhinostomy ostium patency. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08910-8. [PMID: 39141131 DOI: 10.1007/s00405-024-08910-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/11/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE To identify anatomical factors affecting the outcome of dcryocystorhinostomy (DCR). METHODS The study included the results of dacryocystography in 73 patients after DCR: 37 cases of failed DCR and 36 cases of successful DCR. Biometric characteristics of the formed ostium were evaluated: the horizontal size of the bony "window" and the soft tissue part of the ostium, the vertical size of the bony "window" and soft tissue ostium, the height of the fragment of the remaining bone above and below the line of the common canaliculus, and the height of the "pocket" formed below the lower edge of the ostium. Statistical analysis was performed using parametric and non-parametric statistical methods. Differences were considered significant at p ≤ 0.05. RESULTS Intergroup differences were identified in the values of the maximum horizontal size of the bony "window" (p = 0.015), the maximum horizontal size of the soft tissue "window" (p < 0.001), the maximum vertical size of the soft tissue "window" (p < 0.001), and the height of the fragment of the remaining bone below the level of the common canaliculus to the edge of the formed ostium (p = 0.004). CONCLUSION The stage of forming the bony "window" influences the success of DCR. Not only the position of the "window" is important, but also the geometric properties of the formed ostium.
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Affiliation(s)
- Eugenia L Atkova
- Lacrimal Pathology Department, Krasnov Research Institute of Eye Diseases, Rossolimo st., 11A, Moscow, 119021, Russia
| | - Tatiana E Borisenko
- Lacrimal Pathology Department, Krasnov Research Institute of Eye Diseases, Rossolimo st., 11A, Moscow, 119021, Russia
| | - Vasily D Yartsev
- Lacrimal Pathology Department, Krasnov Research Institute of Eye Diseases, Rossolimo st., 11A, Moscow, 119021, Russia.
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Atkova EL, Fedorov AA, Root AO, Krakhovetsky NN, Yartsev VD. Morphological features of regenerative processes after dacryocystorinostomy with the use of mitomycin C. Orbit 2023; 42:496-501. [PMID: 36263626 DOI: 10.1080/01676830.2022.2135115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/06/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the morphological features of regenerative processes in dynamics after dacryocystorinostomy (DCR) with the use of Mitomycin C (MMC). METHODS The study includes 31 cases. All patients underwent endonasal endoscopic DCR. Group 1 included 16 cases who received MMC injections. Group 2 included 15 cases who were treated with MMC on collagen sponge into the area of formed anastomosis. Biopsies for histological examination were taken on the 2nd, 5th, 7th, 14th, 21st, 28th and 60th days after the surgery. The samples were subjected to histological examination. RESULTS Activated fibroblasts were detected in patients of group 2 on the 5th day after the surgery which became the main cellular elements by the 14th day, and incomplete fibroblast mitoses were observed in group 1 by the 14th day. On the 28th day after the surgery, the transformation of the extracellular matrix into loose connective tissue was determined in patients of group 2, while single cellular elements represented by fibroblasts were preserved in biopsies obtained from patients of group 1. By the 60th day after the surgery, the restoration of a full-fledged epithelial lining was observed in all specimens. CONCLUSION With the injection of MMC, inhibition of collagenogenesis by depression of extracellular collagen matrix formation, production of abortive mitoses in cells and inhibition of maturation and transformation of fibroblasts occur. The regeneration process takes place after MMC injection under a relative decrease in fibroblast impact.
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Affiliation(s)
- Eugenia L Atkova
- Lacrimal pathology department, Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - Anatoliy A Fedorov
- Fundamental research in ophthalmology laboratory, Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - Anna O Root
- Outpatient clinic, Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - Nikolay N Krakhovetsky
- Lacrimal pathology department, Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - Vasily D Yartsev
- Lacrimal pathology department, Scientific Research Institute of Eye Diseases, Moscow, Russia
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Atkova EL, Astrakhantsev AF, Fedorov AA, Rein DA, Krakhovetsky NN, Yartsev VD. [The nasal mucosa and outcomes of dacryocystorhinostomy]. Arkh Patol 2019; 81:24-28. [PMID: 31006776 DOI: 10.17116/patol20198102124] [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
OBJECTIVE To investigate the impact of the nasal mucosa on the outcomes of dacryocystorhinostomy on the basis of morphologic findings. MATERIAL AND METHODS The investigation enrolled 73 patients who had undergone endonasal endoscopic dacryocystorhinostomy. Nasal mucosal biopsies were intraoperatively taken from all the patients. The obtained samples were subjected to standard histological examination, as well as to immunohistochemical study using an anti-alpha-smooth muscle actin antibody. To determine the intensity of inflammation in the tissue sample, a chronic inflammation score was calculated. The cell elements positively stained with α-smooth muscle actin were estimated using a semi-automatic method. The patients were divided into groups in accordance with the outcome of surgical treatment after 6 months. RESULTS An unfavorable outcome of dacryocystorhinostomy was observed in 10 (13.7%) patients. The samples obtained from the patients showed a higher chronic inflammation score (8.33%) and a larger number of the cell elements positively stained with α-smooth muscle actin (6026.38±1944.29). The correlation between the outcome of surgical intervention and the quantitative characteristics of myofibroblasts was statistically significant (p<0.05). CONCLUSION These studies suggest that there is a direct correlation of the efficiency of endonasal endoscopic dacryocystorhinostomy with the presence and degree of chronic nasal mucosal inflammation at baseline.
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Affiliation(s)
- E L Atkova
- Research Institute of Eye Diseases, Moscow, Russia
| | - A F Astrakhantsev
- N.A. Semashko Central Clinical Hospital Two, OAO 'RZhD', Moscow, Russia
| | - A A Fedorov
- Research Institute of Eye Diseases, Moscow, Russia
| | - D A Rein
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - V D Yartsev
- Research Institute of Eye Diseases, Moscow, Russia
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At'kova EL, Subbot AM, Krakhovetskiy NN, Yartsev VD, Rein DA. [Influence of fibrosis mediators on the outcomes of endoscopic endonasal dacryocystorhinostomy]. Vestn Oftalmol 2019; 135:19-26. [PMID: 31573553 DOI: 10.17116/oftalma201913504119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Fibrosis is the most important pathologic condition involved in undesirable outcomes of dacryocystorhinostomy. A number of biochemical factors are currently known to have an effect on wound healing by promoting excessive scarring. Isoforms of transforming growth factor β (TGF-β1) are considered the 'main' pro-fibrotic factor, but wound healing is also affected by other cytokines such as connective tissue growth factor (CTGF), which stimulates fibrosis, and fibroblast growth factor (FGF-2), which acts as antagonist to it. PURPOSE To investigate correlations between endoscopic endonasal dacryocystorhinostomy outcomes and certain mediators of fibrosis. MATERIAL AND METHODS The study included 45 cases of endoscopic endonasal dacryocystorhinostomy. The patients were grouped according to surgery outcome: patients with unsuccessful surgical treatment were assigned to group 1 (n=10); patients with successful surgical treatment - to group 2 (n=34). One patient was excluded from the study. Full-layer biopsy specimen were taken from patients' nasal mucosa before the surgery. TGF-β1, TGF-β2, TGF-β3, CTGF, FGF-2 concentrations were evaluated using ELISA and normalized by total protein concentration. RESULTS Surgical failure was observed in 10 cases (22.72%). CTGF concentration was significantly correlated with negative outcome (p<0.05) and was elevated in most specimen obtained from group 1. No significant correlation was noted between the concentrations of other evaluated cytokines in nasal mucosa specimens and the surgical outcome. CONCLUSION The study found a correlation between CTGF concentration in nasal mucosa and dacryocystorhinostomy outcome, which supports the hypothesis suggested by several authors linking dacryocystorhinostomy failure with chronic inflammation in nasal mucosa.
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Affiliation(s)
- E L At'kova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A M Subbot
- 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
| | - D A Rein
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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At'kova EL, Reyn DA, Yartsev VD, Subbot AM. [Influence of TGF-β cytokine and a number of other biochemical factors on regenerative process]. Vestn Oftalmol 2017; 133:89-96. [PMID: 28980572 DOI: 10.17116/oftalma2017133489-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Scarring is one of the main causes of surgical failure in a number of eye diseases, dacryologic conditions in particular. The process of wound healing, including postoperative wound healing, goes through several stages mediated by various biochemical factors, such as growth factors and pro- and anti-inflammatory cytokines. The balance between the latter directly influences the wound healing. However, current data on the effect of these factors on postoperative outcomes are few and contradictory. Thus, in dacryology as well as in other areas of ophthalmology, the role of cytokines and growth factors in healing of surgical wounds is being intensively researched.
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Affiliation(s)
- E L At'kova
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russia, 119021
| | - D A Reyn
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russia, 119021
| | - V D Yartsev
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russia, 119021
| | - A M Subbot
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russia, 119021
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Penttilä E, Smirnov G, Tuomilehto H, Kaarniranta K, Seppä J. Endoscopic dacryocystorhinostomy as treatment for lower lacrimal pathway obstructions in adults: Review article. ALLERGY & RHINOLOGY 2015; 6:12-9. [PMID: 25860166 PMCID: PMC4388871 DOI: 10.2500/ar.2015.6.0116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Obstruction of the lacrimal pathway is manifested by epiphora, infection, and blurred vision as well as ocular and facial pain. Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice. Dacryocystorhinostomy (DCR) is recognized as the most suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or in the nasolacrimal duct. The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity. During the past 2 decades, advances in rigid endoscopic equipment and other instruments have made it possible to obtain more information about the anatomic landmarks of the nasolacrimal system, which led to the development of less-invasive and safer endoscopic techniques. However, many parts of the treatment process related to endoscopic endonasal dacryocystorhinostomy (EN-DCR) still remain controversial. This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.
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Affiliation(s)
- Elina Penttilä
- Department of Otorhinolaryngology, and University of Eastern Finland, and Kuopio University Hospital, Finland
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