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Purpose: To determine the diagnostic accuracy of manual regurgitation on pressure over the lacrimal sac (ROPLAS) versus lacrimal irrigation for screening nasolacrimal duct obstruction (NLDO) in adults prior to intraocular surgeries. Methods: This cross-sectional study took place in a tertiary eye care hospital in South Tamil Nadu, India. From January to December 2017 and included consecutive patients who presented for routine cataract surgery. Prospective data collection occurred in 8369 eyes of patients who underwent cataract surgery. All patients underwent ROPLAS testing by an ophthalmologist followed by lacrimal irrigation by trained ophthalmic assistants, rechecked or confirmed in equivocal cases by ophthalmologists who were masked to the ROPLAS status. The primary outcome, the sensitivity, specificity, positive, and negative predictive values to detect lacrimal occlusion by ROPLAS compared with lacrimal irrigation with 95% confidence intervals was estimated. Results: A total of 8369 eyes underwent cataract surgery during the time periods of the study. ROPLAS and lacrimal irrigation were performed in all eyes. The sensitivity of ROPLAS to diagnose NLDO correctly was 54.5% (95% CI, 44.8%�.9%) and its specificity was 100% (95% CI, 100%�0%). The positive and negative predictive values were 75.3% (95% CI, 65.6%-83.0%) and 99.4% (95% CI, 99.2%�.5%), respectively. Conclusion: We found that ROPLAS when used alone had very low sensitivity and low positive predictive value in detecting NLDO prior to cataract surgery as compared with lacrimal irrigation. Hence, we recommend performing ROPLAS and lacrimal irrigation in every patient as part of the routine preoperative workup prior to cataract surgery
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Objective To explore the clinical effect of lacrimal endoscope assisted minimally invasive lacrimal duct recanalization combined with silicone tube intubation in the treatment of lacrimal duct obstruction. Methods 3 cases(4 eyes)of the superior canaliculus obstruction,5 cases(6 eyes)of the inferior canaliculus,20 cases (29 eyes) of common canaliculus and 25 cases (36 eyes) of nasolacrimal duct were enrolled. They were randomly divided into two groups:Group A(40 eyes)treated with lacrimal endoscope assisted laser lacrimal forming combined with silicone tube implantation and Group B(36 eyes)with lacrimal endoscope assisted laser lacrimal forming combined with silicone tube implantation. The cases were all followed up for 3-6 months after treatment. Results Except the intraoperative bleeding,there were no significant differences in the incidence of various complications. All the eyes could be recanalized under the aid of lacrimal endoscope. The total effective rates were 87.50% and 91.43% in Group A and B,respectively. The difference was not statistically significant. Conclusion Lacrimal endoscope assisted minimally invasive lacrimal duct recanalization combined with silicone tube intubation is a safe,effective,and minimally invasive method to recanalize the lacrimal obstruction.
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Objective To explore the clinical effect of lacrimal endoscope assisted minimally invasive lacrimal duct recanalization combined with silicone tube intubation in the treatment of lacrimal duct obstruction. Methods 3 cases(4 eyes)of the superior canaliculus obstruction,5 cases(6 eyes)of the inferior canaliculus,20 cases (29 eyes) of common canaliculus and 25 cases (36 eyes) of nasolacrimal duct were enrolled. They were randomly divided into two groups:Group A(40 eyes)treated with lacrimal endoscope assisted laser lacrimal forming combined with silicone tube implantation and Group B(36 eyes)with lacrimal endoscope assisted laser lacrimal forming combined with silicone tube implantation. The cases were all followed up for 3-6 months after treatment. Results Except the intraoperative bleeding,there were no significant differences in the incidence of various complications. All the eyes could be recanalized under the aid of lacrimal endoscope. The total effective rates were 87.50% and 91.43% in Group A and B,respectively. The difference was not statistically significant. Conclusion Lacrimal endoscope assisted minimally invasive lacrimal duct recanalization combined with silicone tube intubation is a safe,effective,and minimally invasive method to recanalize the lacrimal obstruction.
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PURPOSE: To compare the usefulness of fluorescein dye disappearance test (FDDT) and dacryoscintigraphy in functional lacrimal blockage. METHODS: The present study included with 24 patients (37 eyes), who were diagnosed with functional lacrimal blockage and underwent silicone tube insertion in our clinic. Compared to postoperative symptom improvement, the results of FDDT and dacryoscintigraphy were analyzed. RESULTS: Significant correlations were observed with FDDT and dacryoscintigraphy results in 29 eyes before surgery. In 33 eyes, there were post-operative symptom improvements and the sensitivity of each exam was estimated at 87.8% in FDDT and 90.9% in dacryoscintigraphy. After intubation normal findings were observed in each examination and the symptoms improved in 7 out of 8 eyes. CONCLUSIONS: Both FDDT and dacryoscintigraphy were considered sensitive and efficient methods in the diagnosis and evaluation of functional lacrimal blockage. Both methods require caution regarding misinterpretation by false negatives and may be complementary as well as increasing diagnostic accuracy.
Subject(s)
Humans , Dideoxynucleosides , Eye , Fluorescein , Intubation , SiliconesABSTRACT
PURPOSE: The surgical efficacy of probing with silicone tube intubation for congenital and acquired lacrimal obstruction was investigated. METHODS: Medical records of 51 children (55 eyes) with lacrimal obstruction were reviewed. Twentyfive children (28 eyes) had congenital obstruction and 26 children (27 eyes) had acquired lacrimal obstruction. Age ranged from 13 to 78 months (mean 29.8 months). All of the children were examined preoperatively by dacryocystography and treated with probing and silicone tube intubation with or without inferior turbinate fracture. RESULTS: After the follow-up period of 6~41 months (mean 13.2 months), primary success rate of probing and silicone tube intubation was 88.1% (30/37 cases) : 88.9% (16/18 cases) in congenital obstruction and 73.3% (14/19 cases) in acquired obstruction. After combined inferior turbinate fracture and silicone tube intubation, success rate noted 100% in both congenital and acquired cases. The success rates showed 100% in the cases with maintenance period of silicone intubation over 16 weeks and 65.0% in the cases with maintenance period of silicone intubation under 16 weeks. The success rates revealed no statistical significance in etiology, age, obstruction site and lacrimal sac size. CONCLUSIONS: For congenital and acquired lacrimal apparatus obstruction in children, dacryocystography, probing, internal fracture of the inferior turbinate and silicone intubation should be maintained more than 16 weeks.
Subject(s)
Child , Humans , Follow-Up Studies , Intubation , Lacrimal Apparatus , Medical Records , Silicones , TurbinatesABSTRACT
The purpose of our study was to evaluate the effectiveness of endoscopic transnasal dacryocystorhinostomy(DCR) in patients who had lacrimal obstruction. Between June 1995 and December 1996, 19 patients(20 eyes) who had undergone endoscopic transnasal DCR were evaluated for follow up of at least 3 months. All patients were preoperatively examined by an otolaryngologist. Eleven cases were operated on intranasal diseases(sinusitis, septal deviation, enlarged middle turbinate) at the same time. Lacrimal obstruction was completely relieved in 16 patients (80%) for a follow-up of 3 months. Granulation was formed in 4 patients after 3months. There were two postoperative complications including bleeding and periorbital swelling on the first day after operation. In conclusion, endoscopic tansnasal DCR appears to be a safe, effective procedure which should be considered as an alternative to conventional external DCR for the surgical treatment of nasolacrimal duct obstruction.