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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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Tomita K, Matsuyama H, Akimoto M. Two cases of nasolacrimal duct obstruction operated by endoscopic dacryocystorhinostomy after orbital fracture reconstruction with an implant. Am J Ophthalmol Case Rep 2023; 30:101853. [PMID: 37168519 PMCID: PMC10165391 DOI: 10.1016/j.ajoc.2023.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 05/13/2023] Open
Abstract
Purpose To report two cases of nasolacrimal duct obstruction (NLDO) caused by orbital fracture reconstruction with an implant successfully treated with endoscopic dacryocystorhinostomy (EnDCR). Observations Two patients presented with NLDO after orbital fracture reconstruction with an implant. Case 1 was a 67-year-old female. She became aware of epiphora in her left eye after undergoing orbital fracture reconstruction with an implant for a left orbital floor fracture 14 years previously. Dacryocystitis was diagnosed based on a lacrimal syringing test because of pus reflux. Computed tomography (CT) showed that the implant was inserted on the left orbital floor, crossing into the lacrimal sac; dacryoendoscopy showed that the implant blocked the nasolacrimal duct. EnDCR was performed without implant removal. The symptoms resolved postoperatively. Case 2 involved a 6-year-old male who had been aware of epiphora in his left eye since undergoing orbital fracture reconstruction with an implant for a left orbital floor fracture one month prior. Dacryocystitis was diagnosed based on a lacrimal syringing test because of pus reflux. CT showed an unclear implant location, but dacryoendoscopy showed that the implant blocked the nasolacrimal duct. The implant was removed. However, EnDCR was performed because there was no improvement in NLDO. The symptoms resolved after EnDCR. Conclusions and importance One previous report of NLDO after orbital floor fracture reconstruction was performed with external dacryocystorhinostomy with implant removal. Dacryoendoscopy and CT are useful for confirming the location of the implant and obstruction. Depending on the implant's location, it may be possible to perform EnDCR without removing the implant.
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Affiliation(s)
- Kosei Tomita
- Corresponding author. Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555, Japan.
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Van Swol JM, Myers WK, Nguyen SA, Eiseman AS. Revision dacryocystorhinostomy: systematic review and meta-analysis. Orbit 2023; 42:1-10. [PMID: 35942566 DOI: 10.1080/01676830.2022.2109178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The goal of this study is to determine if a certain revision DCR approach (external, endoscopic endonasal, laser transcanalicular) is superior to others. Additionally, this investigation evaluates the effect of the primary surgery on success of revision. METHODS This investigation is a systematic review and meta-analysis. All studies specifying type of primary DCR and revision DCR were included. Proportion of successes of each revision for every primary surgery was obtained from the included studies. Meta-analyses were performed to determine cumulative proportions of successes across studies. OUTCOME MEASURES Significant differences in the proportions yielded by meta-analysis of successes among different surgical approaches. RESULTS The type of primary surgery did not significantly influence overall revision success if the same procedure was used for the revision. Overall successes per each revision type were not significantly different. When performing subgroup analyses per each primary surgery, all methods of revisions were similar in efficacy with one exception: when the primary surgery was done using the laser transcanalicular approach, external revision outperformed repetition of the primary method. CONCLUSIONS Regarding success of re-operation, surgeons can use the method they are most comfortable with to perform DCR revisions. However, primary transcanalicular laser DCRs should be revised, if necessary, using the external approach.
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Affiliation(s)
- Joshua M Van Swol
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Walter K Myers
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew S Eiseman
- Department of Ophthalmology-Oculoplastic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Lacrimal Plasty with Dacryocystorhinostomy-Anastomosis Using Microsurgery. Plast Reconstr Surg Glob Open 2023; 11:e4730. [PMID: 36699214 PMCID: PMC9820782 DOI: 10.1097/gox.0000000000004730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 01/27/2023]
Abstract
Dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, but it has the disadvantage of creating a raw surface, which may lead to reocclusion due to the development of postoperative granulation tissue. In this study, we developed and evaluated an ideal new surgical method, dacryocystorhinostomy-anastomosis (DCR-A), involving end-to-side anastomosis under microscopic visualization that does not result in raw surfaces. Methods In DCR, the lateral aspect of the dacryocyst and the nasal mucosa are incised, and the mucosal valves are sutured together. In DCR-A, the occluded section of the dacryocyst or nasolacrimal duct was trimmed and anastomosed by circumferential suturing through a hole in the nasal mucosa. The success rate and the requirement for postoperative therapy were compared between 21 sides of DCR patients and 11 sides of nasal DCR-A patients. Results DCR-A was significantly better than conventional DCR. No additional postoperative therapy was required for DCR-A. Conclusion DCR-A improves symptoms of nasolacrimal duct obstruction to a greater extent than conventional DCR and does not require additional postoperative treatment.
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Rajabi MT, Shahraki K, Nozare A, Moravej Z, Tavakolizadeh S, Salim RE, Hosseinzadeh F, Mohammadi S, Farahi A, Shahraki K. External versus Endoscopic Dacryocystorhinostomy for Primary Acquired Nasolacrimal Duct Obstruction. Middle East Afr J Ophthalmol 2022; 29:1-6. [PMID: 36685339 PMCID: PMC9846961 DOI: 10.4103/meajo.meajo_238_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The purpose of the study is to compare the surgical outcomes and success rates of external dacryocystorhinostomy (EX-DCR) versus endoscopic endonasal DCR (EN-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANDO). METHODS This retrospective nonrandomized study was conducted at Farabi Eye Hospital and Noor Eye Hospital, Iran. A review of electronic medical records of all patients with PANDO who underwent EX-DCR or EN-DCR between January 2016 and 2018 was carried out. RESULTS A total of 803 patients underwent surgery, of which 618 patients (77%) were managed by EX-DCR and 185 patients (23%) by EN-DCR. The majority of cases (62%) were female. The mean age of the patients in EX-DCR and EN-DCR groups was 40.8 ± 14.2 and 34.3 ± 9.2 years, respectively. EX-DCR resulted in significantly less amount of pain compared to EN-DCR (P < 0.05). The success rate of surgery among EX-DCR and EN-DCR groups was 92.4% and 91.1%, respectively, and did not show statistically significant difference. A higher incidence of intraoperative hemorrhage requiring intervention was noted in the EN-DCR group (16.7% vs. 4.5%). Postoperative patient's satisfaction with EN-DCR and EX-DCR was 73% and 82%, respectively. CONCLUSION Both EX-DXR and endoscopic DCR surgeries have high success rates and low incidence of failure. The choice of DCR technique should be based on the experience of the surgeon and patient's lacrimal and nasal anatomy and preferences.
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Affiliation(s)
- Mohammad T. Rajabi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Kianoosh Shahraki
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Nozare
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Moravej
- Department of Eye, Eye Research Center, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Reza E. Salim
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Farideh Hosseinzadeh
- ENT and Head and Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Shabahang Mohammadi
- ENT and Head and Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran,Address for correspondence: Prof. Shabahang Mohammadi, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Azadeh Farahi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Kourosh Shahraki
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Su PY. Comparison of endoscopic and external dacryocystorhinostomy for treatment of primary acquired nasolacrimal duct obstruction. Taiwan J Ophthalmol 2018; 8:19-23. [PMID: 29675345 PMCID: PMC5890579 DOI: 10.4103/tjo.tjo_10_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE: The purpose of this study is to compare the success rates of endoscopic endonasal dacryocystorhinostomy (EN-DCR) and external DCR (EX-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANLDO). DESIGN: This was a retrospective, comparative, nonrandomized clinical study. METHODS: Reviewed medical records of PANLDO underwent DCR at Far-Eastern Memorial Hospital from May 2011 to June 2017. Data regarding the lacrimal passage system, comorbidities, surgical outcomes, and postoperative complications were analyzed. Anatomical success was defined as patency confirmed by intranasal endoscopic inspection of the ostium and successful lacrimal irrigation; functional success was defined as complete resolution of epiphora and positive fluorescein dye disappearance test, which were assessed at postoperative 6th months. RESULTS: One hundred and seventy patients (37 males, 133 females, mean age 57 years) underwent 178 DCR surgeries for PANLDO. The overall anatomical success rate was 94.4% (93.5% in EN-DCR vs. 95.8% in EX-DCR, P = 0.511) and functional success rate was 90.4% (90.7% in EN-DCR and 90.1% in EX-DCR, P = 0.909). Surgical outcomes were comparable between two groups. Complication rate was low in both groups, including 11 cases of early canalicular stent dislodge (7 in EN-DCR, 4 in EX-DCR), one case of postoperative nasal bleeding in EN-DCR, and two skin wound dehiscence and three cutaneous keloid formation in EX-DCR. None of these cases were concluded into surgical failure at the final visit. The time to symptoms relief was statistical significantly shorter in EN-DCR group (1.7 vs. 3.7 weeks in EX-DCR, P < 0.001). CONCLUSIONS: Success rate of DCR for PANLDO in our study was high, and complication rate was low for both endoscopic and external approaches. There was no statistically significant difference between them. EN-DCR provided higher satisfaction due to quicker recovery and lack of external incision. Endoscopic DCR should be considered as the primary treatment of choice for PANLDO.
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Affiliation(s)
- Pei-Yuan Su
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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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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Ghasemi H, Asghari Asl S, Yarmohammadi ME, Jafari F, Izadi P. External Dacryocystorhinostomy; Success Rate and Causes of Failure in Endoscopic and Pathologic Evaluations. IRANIAN JOURNAL OF PATHOLOGY 2017; 12:189-194. [PMID: 29531542 PMCID: PMC5835365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/05/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES External dacryocystorhinostomy (DCR) is the method of choice to treat nasolacrimal duct (NLD) obstruction and the other approaches are compared with it, with a failure rate of 4% to 13%. The current study aimed to assess the causes of failure in external DCR by postoperative endoscopic and pathological evaluation. METHODS The current retrospective cross sectional study followed-up113 patients with external DCR and silicone intubation for three months. Silicone tubes were removed after the third months. Failure was confirmed based on the clinical findings and irrigation test. Paranasal sinus computed tomography (CT) scanning, and endoscopic and pathological evaluations were performed in the failed cases. RESULTS Totally, 113 patients underwent external DCR. The patients included 71 females and 42 males. The mean age of the patients was 55.91 years; ranged from 18 to 86. Epiphora was the most common complaint before surgery (90.3%). Clinically, epiphora continued in 17 cases (15%), of which 94.11% had at least one sinus CT abnormality and 82.35% had at least one endoscopic abnormality. The most common endoscopic findings were deviated septum (70.6%), scar tissue (52.94%), concha bullosa (46.9%), septal adhesion (47.05%), enlarged middle turbinate (41.2%), and sump syndrome (11.7%). The failure was significantly associated with the chronicity of the initial symptoms (P-value=0.00). Pathologically, there were significant relationship amongst the failure rate, scar formation, and allergic rhinitis (P-values =0.00 and <0.05, respectively). CONCLUSION Preoperative endonasal evaluation and consultation with an otolaryngologist can improve surgical outcomes and help to have a better conscious to intranasal abnormalities before external DCR surgery.
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Affiliation(s)
- Hassan Ghasemi
- Dept. of Ophthalmology, Medical School, Shahed University, Tehran, Iran
| | | | | | - Farhad Jafari
- Dept. of Ophthalmology, Medical School, Shahed University, Tehran, Iran
| | - Pupak Izadi
- Dept. of Ophthalmology, Medical School, Shahed University, Tehran, Iran
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Joshi RS, Deshpande AS. Success Rate of Conventional Dacryocystorhinostomy in Post-acute Dacryocystitis Compared to Endonasal Dacryocystorhinostomy in Acute Dacryocystitis. J Ophthalmic Vis Res 2017; 12:290-295. [PMID: 28791062 PMCID: PMC5525498 DOI: 10.4103/jovr.jovr_264_15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To determine the success rate of conventional dacryocystorhinostomy (DCR) and endoscopic DCR performed in patients with acute dacryocystitis. Methods: Records of patients with acute dacryocystitis and operated during 2007–2008 were reviewed. Patients who completed a follow-up of 60 months were included in our study. Demographic characteristics, surgery types, success rate, and follow-up periods were recorded. Success was defined as the elimination of epiphora, absence of dacryocystitis, and negative syringing test result (i.e., unrestricted flow of irrigated saline to the nose). Results: A total of 67 patients were operated during the period. Fifty-seven patients completed the follow-up of 60 months. The mean age in the conventional and endoscopic groups was 39.5 ± 8.5 and 39.5 ± 8.4 years, respectively. The participants included 33 female and 24 male patients. Endoscopic DCR was performed in 28 (endoscopic group) and conventional DCR (conventional group) in 29 patients. Conventional DCR was performed after subsidence of the acute attack, which took an average of 10 days (range, 9–19 days). After a period of 60 months, patency on syringing and resolution of epiphora was documented in 26 patients in the conventional group (success rate, 89.7%) and 23 patients in the endonasal group (success rate, 82.1%) (P = 0.654). Conclusion: The success rates of conventional and endonasal DCR during a follow-up period of five years in patients with acute dacryocystitis are almost similar.
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Affiliation(s)
- Rajesh Subhash Joshi
- Department of Ophthalmology, Vasantrao Naik Government Medical college, Yavatmal-445001, Maharashtra, India
| | - Ajay Sharad Deshpande
- Ophthalmic Services of Orivision Nursing Home, Manish Nagar, Somalwada, Nagpur-440015, Maharashtra, India
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Somuk BT, Alim S, Sapmaz E, Demir HD, Taşkıran B, Göktaş G, Soyalıç H. Comparison of Endoscopic and External Dacryocystorhinostomy Results and Analysis of Patients' Satisfaction. Turk Arch Otorhinolaryngol 2016; 54:99-104. [PMID: 29392027 DOI: 10.5152/tao.2016.1722] [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] [Received: 05/18/2016] [Accepted: 10/02/2016] [Indexed: 11/22/2022] Open
Abstract
Objective Comparison of endoscopic and external dacryocystorhinostomy (DCR) results and evaluation of patients' satisfaction. Methods Forty six (35 females and 11 males) patients who underwent endoscopic DCR and 43 (37 females and six males) who underwent external DCR were included. Surgical success was objectively and subjectively assessed. The nasolacrimal duct was irrigated by a saline solution, and the saline solution was objectively visualized by endoscopy from the nose. Subjective assessment was performed asking the patients' epiphora. In addition to evaluating the success of the operation, satisfaction and result surveys were administered to the two groups. Results There was no statistically significant difference between the two groups in terms of age and sex (respectively p=0.486, p=0.23). However, the number of females was higher than the number of males in the two groups, and the difference was statistically significant (endoscopic-DCR p=0.01, external-DCR p=0.001). There was no statistically significant difference between the two groups in terms of postoperative bleeding and punctum damage. The success rate was 84.7% in the endoscopic DCR group and 90.6% in the external DCR group. There was no statistically significant difference in the success rate between the two groups (p=0.397). The survey results revealed that there was no statistically significant difference between the two groups in terms of patient satisfaction (p=0.397). Conclusion The results of many studies in the literature show operation success rates between the two groups that are similar to ours. Both techniques have advantages and disadvantages. Independent of the preferred procedure, our results show that functional success mainly determines patient satisfaction.
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Affiliation(s)
- Battal Tahsin Somuk
- Department of Otorhinolaryngology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Sait Alim
- Department of Ophtalmology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Emrah Sapmaz
- Department of Otorhinolaryngology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Helin Deniz Demir
- Department of Ophtalmology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Burcu Taşkıran
- Department of Ophtalmology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Göksel Göktaş
- Department of Otorhinolaryngology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Harun Soyalıç
- Department of Otorhinolaryngology, Ahi Evran University School of Medicine, Kırşehir, Turkey
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Anatomical and subjective success rates of endonasal dacryocystorhinostomy over a seven-year period. Eye (Lond) 2016; 30:1458-1461. [PMID: 27419832 DOI: 10.1038/eye.2016.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/13/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeEndonasal dacryocystorhinostomy (END-DCR) is a relatively novel approach that has recently been shown in some studies to provide similar success rates to the more traditional external approach for the treatment of nasolacrimal duct obstruction (NLDO). However, a range of success rates using this approach are reported within the literature and the majority of oculoplastic surgeons are still favouring the external approach. The purpose of this study was to review the anatomical and subjective success rates of END-DCRs performed over a 7-year period.Patients and methodsWe provide a review of the success rates of 288 END-DCRs for the treatment of acquired NLDO performed over a 7-year period by a single oculoplastic surgeon in Sydney, Australia. We describe the operative technique used and define anatomical success as demonstrated patency of the nasolacrimal drainage system at 10 weeks postoperatively while subjective success is defined as complete resolution or significant improvement of symptoms as reported by patients at the same time point.ResultsIn our study, we were able to demonstrate that out of 288 END-DCRs, an average anatomical success rate of 89.6% and an average subjective success rate of 81.3% were achievable.ConclusionsWe conclude that the success rates using our endonasal approach remain similar to those obtained using the external approach, as reported within the literature, and may be considered as a primary treatment option for acquired NLDO.
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Tong NX, Zhao YY, Jin XM. Use of the Crawford tube for symptomatic epiphora without nasolacrimal obstruction. Int J Ophthalmol 2016; 9:282-5. [PMID: 26949652 DOI: 10.18240/ijo.2016.02.20] [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: 10/13/2014] [Accepted: 06/01/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. METHODS A protocol was adopted for the management of symptomatic epiphora without nasolacrimal obstruction. Patients who suffered symptomatic epiphora without nasolacrimal obstruction in both eyes were included in the study. One eye was treated with Crawford tube intubation and the other eye was treated with medication therapy. Degree of watering, patient satisfaction, and symptomatic improvement were carefully evaluated by one of the authors at the end of the follow-up period, after Crawford tube removal, to ascertain functional results. RESULTS Thirty-seven adult patients (37 eyes) underwent Crawford tube intubation for functional epiphora. The mean follow-up time after removal of the tube was 14.8±4.8mo. The procedure was an overall success in 28 eyes (75.7%), with symptoms improving significantly. Two eyes (5.4%) were relieved of indoor epiphora, two (5.4%) had minimal epiphora outdoors, but only with wind or cold, and five (13.5%) continued to experience tearing both indoors and outdoors. Thirty of the patients (81%) expressed satisfaction with the procedure. CONCLUSION Crawford tube insertion is an effective, safe, simple, and relatively noninvasive treatment strategy for functional lacrimal system obstruction.
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Affiliation(s)
- Nyu-Xia Tong
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China; Zhejiang Provincal Key Lab of Ophthalmology, Hangzhou 310009, Zhejiang Province, China
| | - Ying-Ying Zhao
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China; Zhejiang Provincal Key Lab of Ophthalmology, Hangzhou 310009, Zhejiang Province, China
| | - Xiu-Ming Jin
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China; Zhejiang Provincal Key Lab of Ophthalmology, Hangzhou 310009, Zhejiang Province, China
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Sharma HR, Sharma AK, Sharma R. Modified External Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction. J Clin Diagn Res 2015; 9:NC01-5. [PMID: 26557549 DOI: 10.7860/jcdr/2015/15940.6624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Epiphora secondary to acquired nasolacrimal duct obstruction is a common ophthalmic problem in adults requiring surgical management. External dacryocystorhinostomy (DCR) is a reliable but difficult surgical technique for the treatment of nasolacrimal duct obstruction. PURPOSE To evaluate the success rate and complications of modified external DCR in patients with primary acquired nasolacrimal duct obstruction. MATERIALS AND METHODS This hospital based prospective interventional study included 56 patients with primary acquired nasolacrimal duct obstruction. Diagnosis of nasolacrimal duct obstruction was made through irrigation of the nasolacrimal drainage system. All patients were operated by modified technique of external DCR with anastomosis of the anterior lacrimal and nasal mucosal flaps only, whereas posterior mucosal flaps were excised. Patients were followed up for a period of 6 months. During the follow up, success rate and complications if any were recorded. Success was defined objectively by a patent lacrimal passage on irrigation and subjectively by the absence of watering or discharge. RESULTS The mean age of the study population was 39.23 ± 10.66 years, and 78.6% of patients were females (male to female ratio 1:3.7). The average operation time was 36.48 ± 4.72 minutes. Objective and subjective success rates were 92.9% and 89.3%, respectively after a follow up period of 6 months. Intraoperatively, haemorrhage occurred in 3 patients (5.3%) and laceration of the nasal mucosa in 4 patients (7.1%). Postoperative complications included significant lid swelling and periorbital ecchymosis in 3 patients (5.3%), epistaxis in 2 patients (3.6%) and hypertrophic scar in 2 patients (3.6%). CONCLUSION These results suggest that modified external DCR with anterior flaps anastomosis only is a simple, safe, less time consuming surgical technique that is easy to perform, and the outcome is comparable to conventional DCR.
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Affiliation(s)
- Hans Raj Sharma
- Assistant Professor, Department of Ophthalmology, Government Medical College , Jammu, Jammu and Kashmir, India
| | - Ashok K Sharma
- Associate Professor, Department of Ophthalmology, Government Medical College , Jammu, Jammu and Kashmir, India
| | - Rajni Sharma
- Senior Resident, Department of Ophthalmology, Government Medical College , Jammu, Jammu and Kashmir, India
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Segal KL, Van Tassel SH, Kim C, Hsu N, Kacker A, Lelli GJ. Comparison of the extrusion rate of Crawford tubes. Int J Ophthalmol 2015; 8:791-3. [PMID: 26309881 DOI: 10.3980/j.issn.2222-3959.2015.04.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/26/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the outcomes of dacryocystorhinostomy (DCR) using traditional Crawford tubes (TCT) and Crawford tubes with suture (CTS) in the lumen. METHODS Retrospective case series consisting of patients who underwent DCR between 2008 and 2013. RESULTS A total of 61 DCRs were performed on 50 patients. Patients who underwent DCR using CTS had higher rates of prolapse compared to the TCT group (50% vs 9.4%; P=0.003). Stent removal occurred earlier in patients who received CTS (3.3mo vs 5.1mo; P=0.004). Success rates were equivalent between the two groups (75% vs 81.1%; P=0.684). CONCLUSION CTS in the lumen increases the risk of prolapse, prompting earlier tube removal in patients following DCR for nasolacrimal duct obstruction (NLDO). Earlier removal of tubes does not appear to significantly decrease success rates.
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Affiliation(s)
- Kira L Segal
- Department of Ophthalmology, Weill Cornell Medical College, New York 10021, USA
| | - Sarah H Van Tassel
- Department of Ophthalmology, Weill Cornell Medical College, New York 10021, USA
| | - Charles Kim
- Department of Ophthalmology, Weill Cornell Medical College, New York 10021, USA
| | - Nicole Hsu
- Department of Otolaryngology, Weill Cornell Medical College, New York 10021, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medical College, New York 10021, USA
| | - Gary J Lelli
- Department of Ophthalmology, Weill Cornell Medical College, New York 10021, USA
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