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Purpose: To evaluate the role of tranexamic acid in controlling intra?operative and immediate post?operative bleeding during external dacryocystorhinostomy. Methods: This was a double?blinded randomized placebo?controlled trial. All patients diagnosed with primary acquired nasolacrimal duct obstruction presenting between June 2018 to December 2019 were included in the study. All patients in the study group received a single dose of 1 gm tranexamic acid injection intravenously 30 minutes before the surgery, whereas the patients from group B (placebo) received normal saline. The effect of the injection was measured in terms of duration of the surgery, surgical field grading, amount of total blood loss during the surgery, and the need for postoperative nasal packing. Results: A total of 96 patients were included, of whom 45 were males and 51 were females. The study group (Group A) included 51 patients (27 males and 24 females) and the control group (Group B) included 45 patients (18 males and 27 females). There were no statistically significant differences between the two groups in terms of the duration of surgery (48.43 ± 20.01 minutes vs. 53.38 ± 19.8 minutes, P = 0.228), view of the surgical field (P = 0.084), the amount of intraoperative blood loss (88.63 ± 69.34 mL vs. 88.89 ± 51.93 mL, P = 0.984) and requirement of postoperative nasal packing (54.9% vs 62.2%, P = 0.471). Conclusion: There seems to be little to justify the role of preoperative intravenous tranexamic acid injection in controlling intra?operative and immediate postoperative bleeding during external dacryocystorhinostomy.
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Purpose: Fibrin glue was used for anastomosis of lacrimal sac and nasal mucosal flaps and was compared with the conventional suture technique in external dacryocystorhinostomy. Methods: A prospective interventional randomized control study in which 50 consecutive patients of primary acquired nasolacrimal duct obstruction (PANDO) were equally allocated into two groups. The case group underwent glued technique of external dacryocystorhinostomy (Ext DCR) in which fibrin glue was used for the apposition of the anterior lacrimal sac and nasal mucosal flaps. In the control group, conventional technique of Ext DCR was used to suture the flaps. Functional success was assessed by improvement in epiphora and fluorescein dye disappearance test (FDDT), whereas anatomical success was assessed by lacrimal irrigation and endoscopic view of the osteotomy site. Results: The anatomical success in both the groups was 92%, whereas the functional success was 92% in the case group and 88% in the control group. The difference in the success rates between the two groups was statistically non?significant. Conclusion: Glued technique of Ext DCR is a simple and easy alternative to suturing of the flaps. Though the final outcome was comparable in both the groups, glue can be especially useful in uncooperative cases, in cases of excessive bleeding, or in situations where the flaps are very thin or have become friable
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RESUMEN Introducción: la dacriocistorrinostomía externa es la técnica más empleada por la mayoría de los cirujanos oculoplásticos para tratar a los pacientes con obstrucción del canal nasolagrimal. Es posible que los galenos cometan algunos errores en este tipo de cirugía, a pesar de los grandes avances en las tecnologías ópticas, las técnicas quirúrgicas y el uso de modernos materiales de intubación. La principal causa de los errores es el cierre de la osteotomía por tejido cicatrizal o de granulación, con la formación de sinequias en la cavidad nasal. La mitomicina C es el antibiótico alquilante más estudiado en la prevención del exceso de cicatrización en el área de la osteotomía; sin embargo, existen acuerdos y desacuerdos entre estudiosos del tema sobre la eficacia, dosis y tiempo de exposición de este medicamento. El papel de cada una de estas variables en el resultado final de la cirugía es controversial. Objetivo: brindar evidencias sobre el papel de la aplicación transoperatoria de la mitomicina C en la dacriocistorrinostomía externa. Métodos: se realizó una revisión de la bibliografía actualizada disponible en idioma español e inglés. Se consultaron los textos completos y resúmenes en las bases de datos: PubMed, Ebsco, Google Académico y Scielo. También se revisaron novedosos artículos en prestigiosas revistas especializadas. Conclusiones: la mayoría de los autores coinciden en que este medicamento contribuye a elevar la tasa de éxito de la dacriocistorrinostomía externa; aunque su aplicación es segura, todavía se estudian algunas variables que mejorarían su eficacia.
ABSTRACT Introduction: external dacryocystorhinostomy is the most used technique by oculoplastic surgeons to treat patient with nasolacrimal duct obstruction. Physicians may make some mistakes in this type of surgery despite great advances in optical technologies, surgical techniques and the use of modern materials for intubation, The main cause of errors is the closure of the osteotomy due to scar tissue or granulation with synechia formation in the nasal cavity. Mitomycin-C is the most studied alkylating antibiotic in the prevention of excessive scarring in the osteotomy area; however, there are some agreements and disagreements among scholars on the efficacy, dosage and time of exposure of this drug. The role of each of these variables in the final outcome of the surgery is controversial. Objective: to provide some evidences about the transoperative application of Mitomycin-C in external dacryocystorhinostomy. Methods: a review of the updated bibliography available in Spanish and English languages was carried out. Complete texts and abstracts were consulted in the databases: PubMed, Ebsco, Google Scholar and Scielo. Novel articles were also reviewed in prestigious specialized journals. Conclusions: must authors agree that this drug appears to improve the success rate of external dacryocystorhinostomy. Although its application is safe, some variables are still being studied that would improve its efficacy.
Subject(s)
General Surgery , Dacryocystorhinostomy , Mitomycin , Lacrimal Apparatus , Lacrimal Duct ObstructionABSTRACT
Aim: To compare external dacryocystorhinostomy (DCR) and endoscopic approaches in terms of success rate and complications. Methods: In this randomized, interventional, comparative study, ninety-four patients (108 surgeries) participated in this study, 58 cases of endoscopic dacrocystorhinostomy and 50 cases of conventional external dacrocystorhinostomy were performed between December 2013 and December 2016 in the Ophthalmology department and in association with the Otorhinolaryngology department in "Diwaniya" teaching hospital in Iraq. All the patients had detailed general medical and ocular history, and they also underwent ocular and ENT examinations to exclude any nasal pathology. The level of blockage was diagnosed by lacrimal syringing and probing. Surgery was done under general anesthesia using a hypotensive technique in all patients, and the surgical outcomes and both intra and post-operative complications were analyzed. Results: Ninety-four patients (32 males and 62 females; mean age, 56 years) underwent 108 dacrocystorhinostomy surgeries for acquired Nasolacrimal duct obstruction. The success rate associated with the endoscopic procedure was higher than that associated with the external approach [53 (91.4%) versus 41 (82.0%)]; however, the difference was not statistically significant (p=0.148). Moreover, the success rate was even better following revision in both surgical procedures [55 (94.8%) versus 42 (84.0%)] and was much better with endoscopic type and showing a nearly significant value (P=0.064). The odds ratio and 95 % confidence interval were 3.49 and (0.87-13.97), respectively, which seems to demonstrate that endoscopic surgery is associated with approximately 3.5 times better successful rate in comparison with open surgery. The patients that wished to perform surgical intervention for the other eye were associated significantly more with the endoscopic procedure compared with the open procedure [54 (93.1%) vs. 40 (69.0%), respectively, (P=0.043), OR=3.38, 95% CI (0.99-11.54)] Conclusion: The endoscopic approach offered a better operation success rate for acquired Nasolacrimal duct obstruction compared with an external approach
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Dacryocystorhinostomy/methods , Retrospective Studies , Endoscopy/methods , Lacrimal Duct ObstructionABSTRACT
Purpose: To describe the outcome of external dacryocystorhinostomy (DCR) as a suitable alternative to dacryocystectomy (DCT) in cases of isolated lacrimal sac rhinosporidiosis. Methods: This was a retrospective, interventional case series. Institutional review board approval was obtained for the study. The chart review of 13 patients who underwent external DCR surgery for isolated lacrimal sac rhinosporidiosis between July 2012 and May 2018 was performed. Demographic details, clinical presentation, preoperative and intraoperative findings, surgical technique used, postoperative management, surgical outcome and duration of follow up were reviewed for each patient. Results: Thirteen patients were included in the study. Nine (69.2%) were male and four (30.8%) were female. The mean age was 22.1 years (range: 8–46 years). Involvement was unilateral in all cases. The commonest presenting complaint was epiphora with discharge seen in 10 cases (76.9%). An intrasac granuloma was grossly identified intraoperatively in 12 out of the 13 patients. Mean follow up was 26.9 months (range: 1.5–68 months). Till the last follow up, all cases were symptom free and did not have any evidence of recurrence of infection. Conclusion: From this series of cases reported by the authors, external DCR with appropriate precautions to prevent recurrence appears to be a suitable alternative to conventional DCT with excellent long-term outcomes without disease recurrence.
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Purpose: To compare the efficacy of a single perioperative bolus dose of intravenous antibiotic versus postoperative oral antibiotic prophylaxis for prevention of surgical site infection (SSI) in external dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO). Methods: This was a prospective randomized controlled study with a noninferiority design. Patients undergoing external DCR surgery were randomized into two groups A and B. Patients in group A received a single bolus dose of intravenous cefazolin 1 g at surgery, whereas those in group B received oral cephalexin 500 mg postoperatively twice a day for 5 days. Allocation concealment was ensured by sequentially numbered opaque sealed envelopes (SNOSEs). Both groups were advised identical postoperative local wound care regimens. Any clinical evidence of SSI at 4 weeks of follow-up in either group was the main outcome measure. Results: In all, 338 patients randomized into two groups of 169 patients each participated in this study. At follow-up of 4 weeks, only one patient in group B developed postoperative SSI. None in group A developed postoperative SSI. Other potential risk factors for postoperative SSI were also analyzed by univariate and multivariate analyses but none achieved statistical significance in either group. Conclusion: Our results demonstrate that a single bolus dose of perioperative intravenous antibiotic offers adequate prophylaxis against postoperative SSI and compares favorably with the more commonly used oral antibiotic prophylaxis in external DCR for PANDO in our population and our practice scenario.
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Cervicofacial emphysema (CFE), mostly seen after trauma or dental procedures, is an unexpected, extremely rare condition after uncomplicated dacryocystorhinostomy (DCR). It may be misdiagnosed as angioedema or necrotizing fasciitis. In this article, we present the case of a 40-year-old female with CFE twice after uncomplicated unilateral DCR for left and right sides on different operative days. CFE was confirmed by computed tomography, demonstrating extensive air within subcutaneous tissues of the face, neck, and orbital cavity. Subcutaneous crepitation supported the diagnosis. This is the first case report, to the best of our knowledge, describing a patient with recurrent massive CFE after each unilateral DCR.
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Objetivo: describir los resultados de la cirugía dacriocistorrinostomía externa en un año. Métodos: se realizó un estudio observacional, descriptivo longitudinal prospectivo en 25 pacientes, 28 ojos. Se consideraron las variables sexo, color de piel, edad, lado afectado, etiología, complicaciones y resultados de la cirugía. Resultados: hubo 7 pacientes masculinos y 18 femeninos; de ellos, 16 blancos y 9 no blancos con una diferencia estadísticamente significativa (p= 0,043). La edad promedio fue de 69 ± 11 años. En 13 pacientes (52,0 por ciento) se afectó el lado izquierdo y en el 68,0 por ciento la etiología fue involutiva con significación estadística (p= 0,0003). El sangramiento transoperatorio se presentó como complicación en el 24,0 por ciento de los pacientes. El 92,0 por ciento refirió mejoría de la sintomatología después de operados. Según el criterio del cirujano, la mejoría objetiva se obtuvo en el 88,0 por ciento de los casos. La dacriocistorrinostomía externa fue más frecuente en mujeres blancas encontradas entre su sexta y séptima década de vida. El lado izquierdo fue el más afectado con predominio de la etiología involutiva. Las complicaciones fueron escasas; dentro de ellas predominó el sangramiento transoperatorio. Conclusiones: la mayoría de los pacientes sintieron mejoría después de la cirugía; el criterio del cirujano estuvo a favor de los resultados positivos en la cirugía dacriocistorrinostomía externa(AU)
Objective: to describe the results of external dacryocystorhinostomy surgery in one year. Methods: a prospective, longitudinal descriptive and observational study was conducted in 28 patients from 25 patients. The study variables were gender, race, age, affected side, etiology, complications and surgery outcomes. Results: there were 7 male and 18 female patients, 16 Caucasians and 9 non-Caucasians with statistically significant difference (p= 0,043). The mean age was 69 ± 11 years. The obstruction involved the left side in 13 patients (52 percent) and involution was the main etiology in 68 percent with statistical significance (p= 0,0003). Perioperative bleeding was the main complication (24 percent). In the group, 92 percent said the symptoms had reduced after surgery, and according to the surgeon, objective improvement was attained in 88 percent of cases. Conclusion: external dacryocystorhinostomy was more frequent in Caucasian women aged 60 to 70 years. The left side was the most affected, with prevailing involution etiology. There were minimum complications, being perioperative bleeding predominant. Most of the patients felt better after surgery and the surgeon´s criteria were in favor of the positive results of this surgery(AU)
Subject(s)
Humans , Male , Female , Aged , Dacryocystitis/surgery , Dacryocystitis/therapy , Dacryocystorhinostomy/statistics & numerical data , Lacrimal Duct Obstruction/etiology , Epidemiology, Descriptive , Lacrimal Duct Obstruction/pathology , Longitudinal Studies , Observational Study , Prospective Studies , Data Interpretation, StatisticalABSTRACT
Purpose: To study the cosmetic outcome of external dacryocystorhinostomy (Ex-DCR) and to detect the factors affecting it. Patients and Methods: Prospective randomized interventional study included forty patients who were treated by 40 Ex-DCRs. In twenty patients, medial canthal vertical incision was used and in the other twenty cases, subciliary incision was used. The skin was closed using vicryl 6-0 or prolene 6-0 interrupted sutures, and each one was randomly used in twenty patients (10 patients of each incision type). Cosmetic outcome was evaluated 6 months postoperative by the patients and by an oculoplastic surgeon on a four grades scale. Cosmetic results and its correlation to patients’ age, sex, skin complexion, type of incision, and type of skin sutures were studied. Results: The mean scar grading was 0.98 ± 1.0 and 1.3 ± 1.0 in patients’ and examiner’s assessment. About 27.5% described their scars as cosmetically significant. The cosmetic outcome was significantly affected by the type of incision with only 5% significant scars in subciliary incision group. Prolene 6-0 suture was associated with better cosmetic results with 15% significant scars. 50% of dark-skinned patients showed cosmetically significant scars. Although no correlation was found between patients’ age and cosmetic outcome, pediatric patients showed higher tendency to scar visibility with mean scar grade 1.2 ± 1.0 and 1.5 ± 0.9 in patients’ and examiner’s assessment. Conclusion: Dark skinned and pediatric patients are more prone to visible Ex-DCR scar. The use of subciliary approach and prolene 6-0 skin sutures is associated with more favorable cosmetic outcome.
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Neoplasms of the lacrimal drainage system are uncommon, but potentially life‑threatening and are often difficult to diagnose Among primary lacrimal sac tumors, benign mixed tumors are extremely rare. Histologically, benign mixed tumors have been classified as a type of benign epithelial tumor. Here we report a case of benign mixed tumor of the lacrimal sac.
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PURPOSE: To report a case of nasolacrimal duct obstruction occurring in a patient with Wegener granulomatosis treated successfully with endoscopic dacryocystorhinostomy. CASE SUMMARY: A 36-year-old female diagnosed with Wegener's granulomatosis 3 years prior and treated with rituximab and currently taking azathioprine 100 mg presented with a 1-year history of left epiphora and mucus in the left eye. Her left tear meniscus was higher than the right and was a hard stop with lacrimal probe when a lacrimal probing test was performed. Mucus was regurgitated during lacrimal irrigation and middle turbinate was not observed due to granuloma in the nasal cavity. Dacryocystography showed proximal nasolacrimal duct obstruction and a well-defined dacryocystocele 6 x 5 x 6 mm in size was observed on the left lacrimal fossa on facial 3D computed tomography. After synechiolysis for a granuloma in the nasal cavity, endoscopic dacryocystorhinostomy was performed and silastic sheet sutured on the nasal septum to prevent resynechia. After 2 weeks and 4 months, the silastic sheet and silicon tube were removed, respectively. The patient was asymptomatic following surgery and there was no regurgitation during lacrimal irrigation test. The ostium was patent at 5 months after surgery using the endoscopic dye test. CONCLUSIONS: Nasolacrimal duct obstruction occurring in a patient with Wegener's granulomatosis can be treated effectively with endoscopic dacryocystorhinostomy even if the nasal cavity is narrow due to granuloma.
Subject(s)
Adult , Female , Humans , Azathioprine , Dacryocystorhinostomy , Granuloma , Lacrimal Apparatus Diseases , Mucus , Nasal Cavity , Nasal Septum , Nasolacrimal Duct , Silicones , Tears , Turbinates , Granulomatosis with Polyangiitis , RituximabABSTRACT
AlM: To evaluate the clinical efficacy of canalicular intubation combined with external dacryocystorhinostomy ( ext-DCR ) for treatment of chronic dacryocystitis and upper lacrimal duct stenosis. METHODS:Thirty-three patients (33 eyes) with chronic dacryocystitis and upper lacrimal duct stenosis who underwent canalicular intubation combined ext-DCR were retrospective analyzed. The silicon tube was indwelt for 6mo. All cases were re-examined 1wk;1, 3, 6, 9mo post-operation, flow of tears, pus excretion and lacrimal duct clearance were observed. RESULTS: Clear lacrimal duct ratio was 100% in all cases during 1wk~6mo post-operation; Silicon tube was removed 6mo post-operation, 3mo after tube removal, rechecking reported 32 cases with clear lacrimal duct (97%) and 1 case with resistant duct (3%). Two cases ( 6%) with minor lacerations, no other complications were observed. CONCLUSlON: Canalicular intubation combined ext-DCR is an effective treatment for chronic dacryocystitis and upper lacrimal duct stenosis.
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AIM:To find an efficient and simple surgical procedure of the external dacryocystorhinostomy ( EXT- DCR) in the treatment of chronic dacryocystitis. METHODS:A total of 270 cases were performed in this retrospective study. A comparison of clinical effects and hemorrhage complications between the experimental group, in which 189 eyes of 167 patients that underwent traditional EXT-DCR without packing, and the control group, in which 121 eyes of 103 patients that underwent traditional EXT-DCR with Vaseline gauze were performed. The postoperative follow-up ranged from 6 to 36mo ( the mean follow-up was 15±3. 6mo). RESULTS: There were no significant differences in the curative rates between the two groups (97. 9% vs 97. 5%, P>0. 05). But the incidence rate of moderate or severe postoperative nasal bleeding was lower in the experimental group (15. 9%, 30 eyes) than the control group (31. 4%, 38 eyes) and PCONLUSION: The traditional EXT - DCR without packingis an effective procedure and is more effective in reducing moderate or severe postoperative bleeding when the intraoperative anastomose and the postoperative drainage are well done and the intraoperative bleeding is well controlled.
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AlM: To observe the therapeutic effects of improved external dacryocystorhinostomy. METHODS:Retrospective analysis on 94 patients with monocular chronic dacryocystitis in our hospital from October 2010 to December 2013 were taken the improved external dacryocystorhinostomy. The improved surgery which was based on the traditional surgery including: 1. Nasal packing after anesthesia to relieve the pain and bleeding; 2. Not cut the medial palpebral ligament; 3. Suture the upper membrane of the nasal mucosa only;4. Pipe placement;5. Skin layered hairdressing suture. The patients were follow-up 3mo-2a after operation. RESULTS: Ninety-three cases of patients cured with completely asymptomatic, no epiphora or mucopurulent secretion flow out from the lacrimal punctum, unobstructed lacrimal irrigation, the efficiency is 99%, 1 case of patient was epiphora, obstructed lacrimal irrigation, 1% was invalid. CONCLUSlON:The improved external dacryocystorhinostomy is an effective surgical method which is easy to operate with high cure rate and its long term effect is precise.
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PURPOSE: To report the clinical findings and the treatments of patients with dacryocystocele, presenting as an uncommon mass in the medial canthal area of adults. CASE SUMMARY: Five patients, diagnosed with dacryocystocele, complained of epiphora and mucopurulent discharge and were found to have a medial canthal mass. Four of these patients presented with symptoms of acute dacryocystitis. One patient underwent repeated endonasal dacryocystorhinostomy (endonasal DCR) with silicone implantation, but the epiphora returned a few months after the treatment. The patient then received external dacryocystorhinostomy (external DCR) with silicone implantation. Two patients experienced recurrence after the first endonasal DCR and, therefore, received repeat endonasal DCR with silicone implantation via a maximum excision of the enlarged lacrimal sac. One patient underwent external DCR with silicone implantation due to acute inflammation with chronic dacryocystitis, and one attempted conservative treatment after refusing any surgical procedure but suffered a relapse. In the surgical cases, no patients experienced recurrence after the final procedure, and they all had a favorable course during the 6 to 14 months of follow-up. CONCLUSIONS: Dacryocystocele in adults always requires a surgical procedure. Additional maximum excision of the lateral wall of an enlarged lacrimal sac could be performed to reduce the possibility of recurrence.
Subject(s)
Adult , Humans , Dacryocystitis , Dacryocystorhinostomy , Follow-Up Studies , Inflammation , Lacrimal Apparatus Diseases , Recurrence , SiliconesABSTRACT
PURPOSE: To determine the surgical results of bicanalicular silicone tube and e-PTFE (expanded polytetrafluoroethylene) stent in external dacryocystorhinostomy without flap. METHODS: Sixteen patients had been placed with bicanalicular silicone tube and e-PTFE stent and 17 patients with silicone tube only in external dacryocystorhinostomy without flap. We examined the presence of epiphora symptom, passage of dye, and inflammatory change or granuloma formation of nasal mucosa at postoperative 1 day, 1 week, 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 24 weeks. RESULTS: Success rate was higher in double stent group (81.3%) than that in control group (76.5%). But there was no statistically significant (difference between two groups. p=0.085). At nasal endoscopic examination, one case (6.3%) of granuloma was noted in double stent group, and two cases (11.8%) in control group. Membraneous obstruction was not observed in double stent group but one case (5.9%) in control group. CONCLUSIONS: In case of structural deteriolation of midface including nasolacrimal duct, placement of bicanalicular silicone tube with e-PTFE stent may be an useful method in external dacryocystorhinostomy without flap.
Subject(s)
Humans , Dacryocystorhinostomy , Granuloma , Lacrimal Apparatus Diseases , Nasal Mucosa , Nasolacrimal Duct , Silicones , StentsABSTRACT
External dacryocystorhinostomy(DCR) has been a main surgery for epiphora since its introduction, offering the advantages of the complete formation of the ostium, the formation of flap, and potential application in all cases suffering from chronic epiphora although the disadvantages of postoperative morbidity and a cutaneous scar. In this study, the authors report the extent of patient's content for epiphora and skin scar in 131 cases treated with external DCR perfomed on 112 patients between december 1994 and January 1996. DCR incision followed the periorbital relaxed skin gension lines in order to minimize cutaneous scar. External DCR were combined with silicone intubation of the lacrimal drainage system. The medical records of all patients undergoing external DCR procedures were reviewed retrospectively in detail. the authors asked about postoperative epiphora and skin sacr through the questionnaire or the telephone. Phtients with follow-up periods less than 6 months or conjunctivo-dacryocystorhinostomy were not included in the study. Of 131 cases, 126 were improved for epiphora in comparision with preoperative state after a single attempt, yielding a success rate of 96.2%. Of 131 cases, 129(98.2%) did not express discontent for skin scar. Although endonasal DCR is considered as an increasingly attractive alternative to external DCR, external DCR is still a good procedure to treat epiphora in unexperienced surgeon for endonasal DCR.