Characteristics and management of solitary fibrous tumor in lacrimal drainage system / 国际眼科杂志(Guoji Yanke Zazhi)

@#Solitary fibrous tumor is a rare mesenchymal tumor originating from fibroblasts. It was first reported in the pleura. In recent years, more and more cases of solitary fibroma in the extra pleural area have been reported. It has been reported that the tumor can occur in almost all sites. The structure and function of the lacrimal drainage system has its particularity, and there are still few reports about solitary fibroma of the lacrimal drainage system. Therefore, this article summarizes the existing reports of solitary fibroma of the lacrimal drainage system to analyse its clinical characteristics and treatment.

Comparação de eficácia entre as sondas monocanalicular e bicanalicular no tratamento da obstrução congênita das vias lacrimais / Efficacy of monocanalicular versus bicanalicular intubation in the treatment of congenital nasolacrimal duct obstruction

Resumo Objetivo: Avaliar e comparar a taxa de sucesso da intubação monocanalicular ou bicanalicular em pacientes com obstrução congênita do ducto lacrimonasal (OCDLN), levando-se em consideração a taxa de sucesso, a dificuldade do procedimento e o custo dos tubos. Métodos: Foram analisados retrospectivamente 54 prontuários, totalizando 58 vias lacrimais com diagnóstico de OCDLN, que realizaram intubação das vias lacrimais monocanalicular ou bicanalicular com tubos de silicone. Anamnese, exame oftalmológico geral, testes específicos, como o Teste do Desaparecimento do Corante (TDC) e Teste de Observação de Fluoresceína na Orofaringe (TOFO), e, caso necessário, exames complementares como a dacriocistografia, foram utilizados para diagnóstico e inclusão na pesquisa. Foram tratados com intubação os pacientes sem resposta adequada ao tratamento prévio, ou seja, que permaneceram com sintomas de secreção e epífora contínua após a realização de massagem de Crigler e sondagem. Resultados: A intubação monocanalicular foi realizada em 27 vias lacrimais e a intubação bicanalicular, em 31 vias lacrimais. A taxa de sucesso foi alta em ambos os métodos, com melhora em 26 (96,3%) vias lacrimais com sonda monocanalicular e em 30 (96,8%), com sonda bicanalicular (p=0,718). As duas técnicas apresentaram 100% de sucesso nos pacientes com até 2 anos e acima de 4 anos de idade (p=1). A taxa de sucesso entre os 2 e 4 anos de idade foi de 91,5% para as monocanaliculares e 87,5% para as bicanaliculares, (p=0,652). Conclusão: o presente estudo não mostrou diferença significativa no sucesso da intubação quando utilizando sondas mono ou bicanaliculares. A intubação monocanalicular mostrou-se de mais fácil execução, ao passo que o tubo bicanalicular possui menor custo.

Abstract Objective: to evaluate and to compare the success rate of monocanalicular or bicanalicular intubation in congenital nasolacrimal duct obstruction (CNDO) carriers in terms of success rate, difficulty of the procedure, and cost of the tubes. Methods: fifty-four CNDO carriers with 58 obstructed lacrimal vies (LV) who were submitted to lacrimal system intubation using mono or bicanalicular stent had their medical records analyzed. A clinical history, a general ophthalmologic examination, specific tests such as the fluorescein dye disappearance test (FDDT) and observation test of fluorescein in the oropharynx (OTFO) were used for diagnosis and inclusion in the study. Patients who continued exhibiting discharge and continuous epiphora after previous treatment, Crigler massage and probing, were treated surgically with intubation. Results: Monocanalicular intubation was performed on 27 LV and bicanalicular intubation was performed on 31 LV. High success rates were observed, with improvement in 26 (96.3%) with monocanalicular intubation and in 30 LV (96.8%) with bicanalicular intubation (p=0.718). Furthermore, both techniques were 100% successful in patients up to 2 and over 4 years of age (p=1). The success rates between 2-4 years of age were 91.6% in monocanalicular intubation and 87.5% in bicanalicular intubation (p=0.652). Conclusion: The success rate using monocanalicular or bicanalicular intubation to treat CNDO had no significant difference in the studied children. Furthermore, the monocanalicular tube was easier to use, while the bicanalicular tube had a lower cost.

Predictors of Silicone Tube Intubation Success in Patients with Lacrimal Drainage System Stenosis

PURPOSE: To evaluate prognostic factors affecting silicone tube intubation outcomes in Asian patients with lacrimal drainage system stenosis. METHODS: A retrospective review was conducted on the medical records of 822 patients (1,118 eyes) who had undergone silicone tube intubation to treat lacrimal drainage system stenosis between January 2011 and December 2012. Patients were divided into two groups: a success group and a failure group. Success was defined as the disappearance of epiphora symptoms, normalization of tear meniscus height, and the easy passage of fluid without resistance on the postoperative syringing test. Patient and ocular parameters were compared between the success and failure groups. RESULTS: A total of 994 eyes of 727 patients were included in analyses. Patients had a mean follow-up period of 34.11 ± 18.70 weeks. Silicone tube intubation was successful in 67.2% of participants. Significant differences between the success and failure groups were found for age (p < 0.001), history of ipsilateral facial palsy (p = 0.028), follow-up period (p < 0.001), and degree of passage on the preoperative syringing test (p = 0.001). Only age (p < 0.001) and degree of passage on the preoperative syringing test (p = 0.002) remained significantly associated with silicone tube intubation success in multivariate analysis. CONCLUSIONS: Age was negatively associated with silicone tube intubation success in patients with lacrimal drainage system stenosis. The success rate was higher in patients who showed easy passage of fluid without resistance on the preoperative syringing test. These factors should be considered by surgeons planning silicone tube intubation in patients with lacrimal drainage system stenosis.

Anatomic study of the lacrimal fossa and lacrimal pathway for bypass surgery with autogenous tissue grafting.

Purpose: To study the microsurgical anatomy of the lacrimal drainage system and to provide anatomical evidence for transnasal endoscopic lacrimal drainage system bypass surgery by autogenous tissue grafting. Materials and Methods: A total of 20 Chinese adult cadaveric heads in 10% formaldehyde, comprising 40 lacrimal ducts were used. The middle third section of the specimens were examined for the following features: the thickness of the lacrimal fossa at the anterior lacrimal crest, vertical middle line, and posterior lacrimal crest; the cross section of the upper opening, middle part, and lower opening of the nasolacrimal canal; the horizontal, 30° oblique, and 45° oblique distances from the lacrimal caruncle to the nasal cavity; the distance from the lacrimal caruncle to the upper opening of the nasolacrimal duct; and the included angle between the lacrimal caruncle–nasolacrimal duct upper opening junction and Aeby’s plane. Results: The middle third of the anterior lacrimal crest was significantly thicker than the vertical middle line and the posterior lacrimal crest (P > 0.05). The horizontal distance, 30° oblique distance, and 45° oblique distance from the lacrimal caruncle to the nasal cavity exhibited no significant differences (P > 0.05). The included angle between the lacrimal caruncle and the lateral wall middle point of the superior opening line of the nasolacrimal duct and Aeby’s plane was average (49.9° ± 1.8°). Conclusion: The creation of the bony tunnel should start from the middle or posterior middle part of the lacrimal fossa, extending toward the anterior inferior region with an optimal downward oblique angle of 45°.

Dacryocystographic Findings in Unilateral Epiphora with Patent Lacrimal Drainage System

PURPOSE: To evaluate the morphologic change in the lacrimal drainage system using dacryocystography in patients with unilateral epiphora with patent lacrimal drainage system. METHODS: Clinical records of patients referred to our clinic for epiphora between October 2007 and August 2011 were reviewed. The study group included 38 patients who had symptoms of unilateral epiphora with patent lacrimal drainage system. The studied patients included 10 males and 28 females with ages varying between 24 and 72 years. RESULTS: Abnormal dacryocystographic findings in the tearing eye were 78.9% and abnormal dacryocystographic findings in the asymptomatic eye were 47.4%. Common abnormal findings included distal nasolacrimal duct stenosis, distal nasolacrimal duct dilatation and nasolacrimal sac dilatation. CONCLUSIONS: In many cases, morphologic change in the lacrimal drainage system was observed in patients with unilateral epiphora with patent lacrimal drainage system. Dacryocystographic findings may contribute in devising a treatment plan for these patients.

Frequency and Characteristic Findings of the Common Canaliculus in Koreans

PURPOSE: To investigate the different types of anatomical connection between the lacrimal sac and the canaliculi using digital subtraction dacryocystography (DCG) in Koreans. METHODS: The authors of the present study performed digital subtraction DCG in Korean patients who presented with epiphora from January 2010 until December 2010. The 248 patients (496 eyes) who achieved a satisfactory DCG image were classified as follows: 1) type I: visible common canaliculus (CC), 2) type II: no visible CC and the canaliculi entering the sac at the point where they meet on the sac wall (common opening), 3) type III: no visible CC and common opening, and each canaliculus entering the sac from different points. RESULTS: Out of a total of 496 eyes, CC was observed in 449 eyes (type I: 90.5%). In 41 eyes (8.3%), the CC was absent (type II), but the upper and lower canaliculi joined at the wall of the lacrimal sac. In 6 eyes (1.2%), the upper and lower canaliculi entered the sac separately (type III). Eighteen patients (7.3%) showed different types of lacrimal drainage system between the 2 eyes. CONCLUSIONS: The CC may not exist in all patients, and the type of anatomical connection between the lacrimal sac and the canaliculi may be different between the eyes in the same individuals. Although such patients comprise a minority, anatomical knowledge of the lacrimal drainage system could be helpful to assess and manage patients with lacrimal drainage disorder.

Surgical Management of the Lacrimal Drainage System

Ahigh percentage of patients with disorders of the lacrimal drainage system present to the ophthalmologists with the complaint of epiphora. These patients complain of the blurred vision due to tear, and "mattering" and pain of the eyes due to secondary conjunctivitis and acute or chronic dacryocystitis. The aim of surgery on the lacrimal drainage system to relieve epiphora or acute and chronic inflammations of the eye and the lacrimal system. Although the causes of congenital and acquired obstructions are different, the accurate knowledge on the anatomy, the causes of obstruction, and the diagnostic methods is essential in the evaluation of patients with epiphora and for the optimal management of obstruction of the lacrimal drainage system. In this article the author will discuss the surgical managements of disorders of the lacrimal drainage system associated with age, focusing on the degree and position of obstruction from a review of the published data.

Resistance of Fluid Flow within the Nasolacrimal Duct

The presence of complete obstruction within the human lacrimal drainage system can be easily found. The partial obstruction within the lacrimal drainage system can be diagnosed with Jones dye test and radiologic test. However, above tests can't determine the degree of partial obstruction as qualitative methods. Authors designed the instrument that measures the resistance to constant fluid flow within the nasolacrimal duct. Author measured the resistance to 5 ml/min flow rate with stainless steel canula (internal diameter, 0.395 mm) within the nasolacrimal duct in 194 people (388 eyes) without epiphora. The means of the resistance in all cases are 187.64+/-42.37 mmHg.seconds/ml. There are no statistical significances in both eyes and sex groups. But in age groups between teens and 20s, 30s and 40s, 60s and over 70s, there are statistically significant. Between the age and the resistance the coefficiency of correlation(r) is 0.56 in right eye, 0.64 in left eye, 0.60 in both eyes and as a result of regression, statistical significance showed (p-value<0.01). Authors suggested the normal value of the resistance in age and sex groups quantitatively. On the basis of this measurement, it is possible to make the early diagnosis and the proper plan of treatment in the partial obstruction of the nasolacrimal duct, the differential diagnosis between epiphora from the partial obstruction within the nasolacrimal duct and from other causes.

Draining Capacity of the Nasolacrimal Duct in Normal Korean Adults

The presence of abnormality within the human lacrimal drainage system can be determined with syringing, probing, fluorescein dye disappearance test, and Jones test.But the degree of partial obstruction cannot be determined with these qualitative tests.For quantitative measurement of drainage capacity of nasolacrimal duct, authors designed an instrument that measures the fluid flow within the nasolacrimal duct from distilled water at constant height. We measured the drainage capacity with a stainless steel canula in 109 persons (218 eyes)without epiphora and impaired drainage system.The means of the drainage capacity in all cases are 4.42 +/-0.87 ml/min in right eye and 4.28 +/-0.83 ml/min in left eye.And the means of the drainage capacity in all cases are 4.46 +/-0.89 ml/min in male and 4.25 +/-0.92 ml/min in females.There are no statistic significances in laterality and sex. Normal values of drainage capacity of nasolacrimal ducts in Korean adults were suggested quantitatively according to age and sex.These values obtained in this study might help us to make early diagnosis and a proper plan of treatment in the partial obstruction of nasolacrimal duct, the differential diagnosis between epiphora from the partial obstruction within the nasolacrimal duct and those from other causes.

Success Rate of Silicone Tube Intubation

It has been Known that silicone intubation may be an effective procedure for total or partial obstruction in infants of age one year or less, and the older the patient, the lower the success rate. We had performed silicone intubation on 40 eyes of 39 patients from january 1995 to May 1996, and they were divided into 3 groups according to age: group 1, 6 months to 6 years: group 2,6 to 16.: group 3, one 16 years. The success rate was 92.4% in groups 1 and 2, respectively: 83.3% ingroup 3. The success rate in patients with partial obstruction in group 3 was 100% In view of the results of the present study, silicone intubation may be in primary procedure for partial obstruction of lacrimal drainage system.

Dacryoscintigraphy: The Assessment of Epiphora in Children

The value of dacryoscintigraphy in the assessment of lacrimal drainage system was examined in 20 children below 34 months of age, 28 symptomatic eyes and 12 asymptomatic eyes. Of 28 symptomatic eyes, 20(71%) had abnormalities of tear drainge on dacryoscintigraphy. Of 12 asymptomatic eyes, 10 had normal tear drainage systems on dacryoscintigraphy. Because of the good natural physiological character and simplicity of this procedure and lower risk of radiation hazard. dacryoscintigraphy is a useful technique in the assessment of lacrimal drainage systems in children with symptom of epiphora.

Clinical Observation on Silicone Intubation in Obstruction of lacrimal Drainage System

We report 23 cases of silicone stents intubation for obstruction of lacrimal drainage system in 23 patients with tearing and mucopurulent material discharge from January 1985 to April 1988. The success rate of silicone stents intubation was 47.4% and the most common site of obstruction was nasolacrimal duct(56.5%). 30.3% of patients had complications related to silicone stents, conjunctivitis, punctal erosion etc. With these results, we consider that congenital dacryostenosis, partical and complete nasolacrimal duct obstruction is mainly indicated for silicone stents intubation and better results will be gained if be done with acryocystorhinostomy to prevent complications related to silicone stents.