Effects of primary acquired nasolacrimal duct obstruction on tear film and ocular surface / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effects of primary acquired nasolacrimal duct obstruction(PANDO)on the tear film and ocular surface using LipiView ocular surface interferometer and Keratograph 5M anterior segment analyzer.METHODS: A self-controlled clinical trials. A total of 40 patients diagnosed with unilateral PANDO for at least 6mo who were admitted to our department from September 2021 to March 2022 were enrolled in the study, and the healthy eyes of the patients were assessed as control group. The LipiView ocular surface interferometer and Keratograph 5M anterior segment analyzer were used to measure the changes in related parameters of the tear film and ocular surface in both eyes.RESULTS: The non-invasive tear meniscus height(NITMH), stimulated NITMH, loss rate of upper meibomian gland, nasal and temporal ciliary redness index, temporal conjunctival redness index of the affected eyes were higher than healthy eyes(P<0.05), but there were no statistical differences in the non-invasive break-up time(NIBUT), loss rate of lower meibomian gland, nasal conjunctival redness index, dry eye grading, blink responses, partial blink rate and lipid layer thickness(LLT)between the both eyes(P>0.05).CONCLUSION: PANDO may lead to the aggravation of ocular surface inflammation and the loss of upper meibomian gland, and damage the ocular surface of patients. Attention should be paid to the early treatment of PANDO.

Cytopuncture microbiopsy during transcanalicular endoscopic lacrimal duct recanalization: A novel approach

Objective@#To describe the cytopuncture microbiopsy (CM) technique performed during transcanalicular endoscopic lacrimal duct recanalization (TELDR) in patients with primary acquired nasolacrimal duct obstruction (PANDO) as an alternative to open biopsy, the standard method used in collecting specimen.@*Methods@#This is a noncomparative, interventional case series with histopathologic correlation. Patients diagnosed with complete PANDO who underwent TELDR with balloon dacryoplasty and silicone intubation with CM at University of Santo Tomas Hospital from October 2014 to January 2017 were included.@*Results@#Twenty (20) tissue specimens from the lacrimal sac and nasolacrimal duct were obtained from 18 patients. There were 16 females and 2 males included in the study. Mean age was 57.5 years. All specimens revealed few clusters of benign epithelial cells with few degenerated mononuclear cells and lymphocytes, and singly scattered lymphocytes that are set in fibrinous background. Tissue cytology studies were negative for malignant cells.@*Conclusion@#CM is a minimally invasive procedure that offers an alternative to open biopsy technique that can be done routinely during TELDR.

Anatomy of lacrimal sac fossa affecting success rate in DCR surgery / Шинэ санаа Шинэ нээлт

Background@#Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults, standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of lacrimal fossa and DCR surgery result among Mongolians are our rationale of study.@*Goal@#To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed by the endoscopic endonasal approach.@*Methods@#METHODS: A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients were identified. Full success was defined as no symptoms of tearing after surgery and anatomical patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered to be statistically significant. Statistical analysis was performed using STATA for Windows version 11.2.@*Results@#There was no significant difference in age or gender distribution between the two groups. Frontal process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group (p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and 100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5). @*Conclusions@#A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in quality of life by using the Lac-Q standard questionnaire.

Clinical analysis of endoscopic-assisted RS silicone intubation for congenital nasolacrimal duct obstruction in children / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect and safety of endoscopic-assisted RS silicone intubation for congenital nasolacrimal duct obstruction after failed probing in children, in order to guide the clinical application.<p>METHODS: Retrospective case series. Totally 158 children(158 eyes)with congenital nasolacrimal duct obstruction who were failed probing in our hospital from September 2016 to September 2019 were selected as the research subjects. All patients underwent endoscopic-assisted RS silicone intubation. Regular follow-up was performed 1, 3, and 6mo after surgery. Observe the children's gender, age, treatment history, presence or absence of discharge before surgery; treatment effect; complications; types of nasolacrimal duct obstruction. Spearman's correlation coefficient calculation and analysis of the relationship between ages, times of probing and operation efficiency, Fisher's exact probability test for the operation efficiency of different types of nasolacrimal duct obstruction, and chi square test for the operation efficiency of presence or absence of discharge.<p>RESULTS: The total effective rate was 89.9%(142/158). The effective rate of surgery tends to decrease with age(Spearman's correlation coefficient <i>rs</i>= -1.000, <i>P</i><0.01). The effective rate of surgery showed a downward trend with the increase of the times of probing(Spearman's correlation coefficient <i>rs</i>= -1.000, <i>P</i><0.01). The efficiency of membranous nasolacrimal duct obstruction surgery is higher than that of complex nasolacrimal duct obstruction, and the difference is statistically significant(<i>P</i><0.05). It cannot be considered that there is a statistically significant difference in the effectiveness of the operation between the two symptoms with or without discharge(<i>P</i>>0.05). The main complications were: false passage formation(16 eyes, 10.1%), loss of tube(14 eyes, 8.9%), red eyes and irritated tears(18 eyes, 11.4%), punctums tissue adhesion(3 eyes, 1.9%), punctum granuloma formation(1 eye, 0.6%).<p>CONCLUSION: Endoscopic-assisted RS silicone intubation has a higher effective rate and better safety in the treatment of congenital nasolacrimal duct obstruction after failed probing in children. The effective rate of surgery decreases with age, and decreases with the increase of the times of probing. Membranous nasolacrimal duct obstruction is more effective than complicated nasolacrimal duct obstruction.

Anatomy of lacrimal sac fossa affecting success rate in endoscopic and external dacryocystorhinostomy surgery / Монголын Анагаах Ухаан

Introduction@#Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults, standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of lacrimal fossa and DCR surgery result among Mongolians are our rationale of study.@*Goal@#To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed by the endoscopic endonasal approach.@*Material and Methods@#A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients were identified. Full success was defined as no symptoms of tearing after surgery and anatomical patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered to be statistically significant. Statistical analysis was performed using STATA for Windows version 11.2.@*Results@#There was no significant difference in age or gender distribution between the two groups. Frontal process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group (p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and 100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5). @*Conclusions@#A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in quality of life by using the Lac-Q standard questionnaire.

Aplicación transoperatoria de mitomicina-C en la dacriocistorrinostomía externa: acuerdos y desacuerdos / Intraoperative application of Mitomycin-C in external dacryocystorhinostomy: agreements and disagreements

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.

A clinicobacteriological study of dacryocystitis in children

Background: Congenital Dacryocystitis occurs due to the congenital blockage of the nasolacrimal duct, which results from incomplete canalization of the nasolacrimal duct. It is a significant cause of ocular morbidity in children. When not treated early, complications such as recurrent conjunctivitis, acute on chronic dacryocystitis, lacrimal abscess and fistula formation can occur. It is also a threat to the integrity of the eye by becoming the source of infection to orbital cellulitis and panophthalmitis. In the era of antibiotic resistance, the microbiological workup of congenital dacryocystitis is very useful for subsequent treatment. Aim of the study was to determine the microbial profile of congenital dacryocystitis and the appropriate antimicrobial agents based on the sensitivity pattern of the isolated microorganisms.Methods: A total of 25 clinically diagnosed cases of dacryocystitis in children less than 5 years of age attending the outpatient department were included in the study. Samples were collected from these patients and processed by standard microbiological techniques. All the bacterial isolates obtained were subjected to antimicrobial susceptibility testing by using Kirby-Bauer disc diffusion method.Results: Culture positivity was noted as 56% in this study.' It is observed that Gram-positive bacteria were the predominant isolates of 86%. The predominant organism isolated was Streptococcus pneumoniae 43%, followed by Staphylococcus aureus 29%, Staphylococcus epidermidis 14% and Pseudomonas aeruginosa 14%. All Gram-positive organisms were highly sensitive to Gatifloxacin and least sensitive to Ciprofloxacin. All Gram-negative organisms were highly sensitive to Tobramycin and least sensitive to Ciprofloxacin and Gentamicin.Conclusions: Streptococcus pneumoniae was the common pathogen in congenital dacryocystitis. Gatifloxacin and Tobramycin are the most effective drugs. Microbial culture and sensitivity should be performed in all dacryocystitis cases. This would contribute to the choice of appropriate and effective antimicrobial agents.

External versus endoscopía Dacriocistorrinostomía con respecto a las complicaciones y los resultados: una comparación Estudio retrospectivo / External Versus Endoscopic Dacryocystorhinostomy Regarding Complications and Outcomes-A Comparative Retrospective Study

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

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.

Congenital nasolacrimal duct obstruction agent through failure to treat clinical analysis for the first time / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To report the data of 28 cases of congenital nasolacrimal duct obstruction who failed in the first probing of lacrimal passage in our hospital, summarize the strategy of retreatment. <p>METHODS: Retrospective study, selected 591 cases of children with 28 cases in our hospital from Feb. 1, 2013 to Dec. 31, 2017, all were for the first time of probing of lacrimal passage through failure of children with congenital nasolacrimal duct obstruction(not including traumatic and lacrimal duct abnormalities), collect the case history, the nasal situation, the age of the first time to probing of lacrimal passages, information such as case data before and after treatment.<p>RESULTS:In 28 cases, 15 cases with probing of lacrimal passage joint tube insertion second time, take the tube after cured, 10 cases treated with inferior turbinate, again with probing of lacrimal passage joint tube insertion, take the tube after cured, 2 cases of children with acute dacryocystitis often strikes, under general anesthesia with transnasal endoscopic dacryocystorhinostomy, 1 cases of children with bony nasolacrimal duct obstruction and strictures, with tears spill without overflow pus, pay a follow-up visit, sinus fully developed after the age of 13 under transnasal endoscopic dacryocystorhinostomy.<p>CONCLUSION: Congenital nasolacrimal duct obstruction of lacrimal duct exploration for the first time failed again take personalized ladder solution treatment, reasonable treatment of the disease.

Efficacy and economic benefit of endoscopic modified SHSI and En-DCR in the treatment of NLDO / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the medical effects and economic benefits between spherical headed silicone intubation(SHSI)and endoscopic dacryocystorhinostomy(En-DCR), to further verify the therapeutic effect of modified SHSI under endoscope on NLDO.<p>METHODS: The 43 patients with 50 eyes of NLDO were randomly divided into SHSI group(21 cases and 25 eyes)and En-DCR group(22 cases and 25 eyes). Then to compared the intraoperative bleeding volume, monocularoperation time, surgical discomforta, nd hospitalization time between the two groups of patients. Followed-up to 12mo after surgery, the clinical efficacy was evaluated according to the situation of tear overflow and lacrimal lavage at the last follow-up, and the cost-effectiveness ratio(C/E)was used to evaluate the economic benefits.<p>RESULTS: The intraoperative blood loss and surgical discomfort visual analogue scores of patients in the SHSI group were significantly lower than those in the En-DCR group(4.96±1.989mL <i>vs</i> 27.60±14.950mL, 2.84±0.64 <i>vs</i> 4.88±0.84). Monocular surgery time and hospital stay were significantly shorter than those in the En-DCR group(13.40±6.007min <i>vs</i> 59.64±12.786min, 0.50±0.010h <i>vs</i> 137.280±23.085h)(All <i>P</i><0.001). At the last follow-up, the clinical effectiveness rate of the two groups was no difference(88% <i>vs</i> 96%, <i>P</i>>0.05), but the C/E(13.57)of patients in SHSI group was far smaller than that of En-DCR(121.50).<p>CONCLUSION: Endoscopic SHSI and En-DCR are both effective surgical methods for nldo. But SHSI surgery is relatively lower difficult and has significant cost-effective advantages.

The treatment of the congenital nasolacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#Congenital nasolacrimal duct obstruction(CNLDO)has an incidence rate of 5.7% and there are many clinical treatments for the disease. But these treatments have been taken very randomly. Therefore, it is still a controversial topic on how to choose the best treatment. This paper will discuss the treatments of CNLDO so as to know the characteristics of each treatment for better clinical services.

Outcomes of intubation techniques in nasolacrimal duct blockage in adult age group: a comparative study based on Sindh, Pakistan population

Background: Nasolacrimal duct obstruction is listed under the heading of congenital diseases; on other hand it is also commonly present in adult age group. In population of Sindh we found these patients frequently. Through this study we revealed the surgical options for the treatment of Nasolacrimal duct obstruction in population of Sindh provenience of Pakistan. The objective of the study was to compare the outcomes of two different intubation techniques in treatment of Nasolacrimal duct obstruction between two age groups. Comparative study was conducted in the Department of Ophthalmology Al-Ibrahim Eye Hospital Karachi from May 2018 to June 2019.Methods: Total 136 numbers of patients were included on the bases of history, clinical examination and pre-operative syringing test. Non- probability convenient sampling was applied for data collection. Total 136 numbers of patients were divided into two groups on the bases of treatment and further subgroup on the bases of age ranges. Data were analyzed by SPSS version 20.0.Results: Frequency and percentage of recovery in six months in each subgroup with application of chi-square test. Frequency and percentage of post-operative complications prolong treatment and regurgitation and patency of tube in each group and subgroups.Conclusions: The results showed significant difference between the groups. Group A showed higher success rate with minimal percentage of complications and post-operative measurements in both age ranges as compare to Group B.

Result of Probing for Congenital Nasolacrimal Duct Obstruction in Children Less than 1 Year Versus Children Greater than 1 Year

Congenital obstruction of nasolacrimal duct is a very common cause of epiphora in new born children.Controversy exists regarding the natural course and management of children with congenital nasolacrimalduct obstruction. The present study was undertaken on 80 children of congenital nasolacrimal duct obstructionwith no previous intervention. They were divided into two groups of 40 each. Group 1 had children aged lessthan 1 year and Group 2 comprised of children older than 1 year. Probing was done under general anesthesia.The mean age of the patients in Group 1was 8.35±2.65 months and that of the children in Group 2 was27.5±11.98 months. The overall success rate of probing was 78.75%. Success rates in Group 1 and Group2 were 85% and 72.5%, respectively. The difference between the two groups was statistically insignificant.However, there was a significant difference in the success rate of probing depending on the type of obstruction(p<0.05). Membranous obstruction of NLD was associated with increased success rates of probing ascompared to firm obstruction of NLD (p=0.001230, Yates corrected Chi square =0.0009578). Probing is asafe option of treating congenital nasolacrimal duct obstruction. Probing is beneficial in older children althoughthe success rate of probing tends to decline with increasing age. Firm anatomical obstruction in nasolacrimalduct is associated with a decline in the success rate of probing.

Clinical Outcome and Factors Predictive of Outcome of Nasolacrimal Duct Probing for Congenital Nasolacrimal Duct Obstruction in Younger and Older Children Performed at a Regional Institute of Ophthalmology in Western India

2-6 % of full term newborn children manifest symptoms of congenital nasolacrimal duct obstruction. The most frequent presentation is tearing associated with mattering of the eyelashes and recurrent infection. We designed a study to compare the success rate of nasolacrimal duct probing for congenital nasolacrimal duct obstruction in younger and older children seen at our western regional institute of ophthalmology. Probing under general anaesthesia was done in a cohort of children presenting with congenital nasolacrimal duct obstruction . The demography ,clinical presentation, management and outcome of the cases were documented. Factors associated with success of the procedure were documented. Aim: The aim of the study was to document the clinical outcome and factors predictive of success of nasolacrimal duct probing for congenital nasolacrimal duct obstruction in younger and older children seen at our Western Regional Institute of Ophthalmology in India. Methods: The study was carried out at our Western Regional Institute of Ophthalmology. The study period was July 2018 to May 2019 . The study was a prospective interventional outcome study in an institutional cohort. Probing was reserved for patients with recurrent infection or acute dacryocystitis in children between 6 months to 9 months of age . Initial probing was the treatment of choice for children between one year and three years as well as older children above three years upto twelve years. Probing was performed under general anaesthesia. Patients were followed at 1 week, 3 weeks, 3 months and 6 months after the procedure. Outcome was defined as resolution of symptoms and signs of nasolacrimal duct obstruction as observed by the ophthalmologist as well as reported by the parents within 3 weeks of the procedure and continued remission for 6 months post procedure. Probing was done twice before the procedure was declared a failure. Statistical Analysis: Student t test and chi square test was used for statistical analysis . p<0.05 was taken as significant. The Fischer exact test was used to calculate the chi square value. Results: 25 eyes of 18 children with congenital nasolacrimal duct obstruction were subjected to probing during the time of the study. The age range was six months to eleven years. The overall success rate was 16/25(64%). The success rate for children less than or equal to three years was 8/9 (89%).The success rate in the age group three years to less than or equal to seven years was 7/12 (58.3%) . The success rate dropped to 25% (1/4) for children more than seven years of age. The success rate of nasolacrimal duct probing was observed to reduce with increasing age of the child. Persistent dacryocystitis, firm obstruction on nasolacrimal duct probing and repeat probing were statistically significantly associated with the outcome of probing. The children with any of the above factors had a lower success rate of nasolacrimal duct probing. Conclusion: The results of our study are comparable to other studies reporting outcome and predictive factors of nasolacrimal duct probing in younger and older children with congenital nasolacrimal duct obstruction. Children less than or equal to three years of age with congenital nasolacrimal duct obstruction could be successfully managed with nasolacrimal duct probing with great outcomes. Older children too had a reasonable outcome and age did not appear to be a significant factor affecting outcome. A firm obstruction on probing, persistent dacryocystitis and repeat procedure are significantly associated with the outcome of nasolacrimal duct probing. Conclusion: Children less than or equal to three years of age with congenital nasolacrimal duct obstruction can be successfully managed with nasolacrimal duct probing with great outcomes. Older children too had a reasonable outcome and age did not appear to be a significant factor affecting outcome. Thus in the light of the fact that probing is a safe and effective procedure , it appears logical to give a trial of initial nasolacrimal duct probing even to children older than three years. A firm obstruction on probing, persistent dacryocystitis and repeat procedure are significantly associated with the outcome of nasolacrimal duct probing.

External dacryocystorhinostomy conventional surgery versus Pawar implant: A comparative study

Purpose: External dacryocystorhinostomy (DCR) surgeries are cost-effective with excellent success rates. The present study was designed to compare the safety and efficacy of conventional external DCR versus external DCR using Pawar silicone implant in chronic dacryocystitis. Methods: This is a prospective, comparative, interventional case series over a period of 18 months with patients managed by external DCR surgery with and without Pawar implant. Institutional review board approval was obtained before the study. The success of the surgery was objectively measured by sac patency on syringing at the last follow up. Results: A total of 65 patients with chronic dacryocystitis were included in the study. The mean age of patients in the series was 41.43 years (median, 41 years; range, 12 years-60 years). All patients presented with epiphora (100%) and underwent external DCR and were chosen for conventional surgery (n = 33, 51%, group 1) or Pawar silicone implant surgery (n = 32, 49%, group 2) on a random basis. The mean duration of the surgery from the time of skin incision to skin closure for group 1 was 27.7 minutes (median, 26 minutes; range, 21-30 minutes) while in group 2, it was 75.5 minutes (median, 75 minutes; range, 60-88 minutes), which was statistically significant (P < 0.01). The success rate of the procedure done in group 1 was 90% which increased to 97% after the management of failed cases as compared to the success rate in group 2 of 91% and 94%, before and after the management of failed cases, respectively. Conclusion: External DCR using Pawar implant is a safe surgery which is faster than conventional external DCR with almost equal success rates between both the procedures.

Epiphora drainage by DCR – Long-term results

Background: Dacryocystorhinostomy (DCR) refers to the surgical procedure that is used to relieve the chronic obstruction of the nasolacrimal duct obstruction (NLDO). In a maxillofacial setting, NLDO may arise subsequent to a facial trauma or orthognathic surgery. There is a dearth of literature from this part of the world. This article intends to provide a single maxillofacial center experience in DCR. Materials and Methods: This is a retrospective, noncomparative, noninterventional, record audit type of study of all consecutive patients fulfilling inclusion and exclusion criteria. All patients with epiphora and diagnosed with lacrimal apparatus damage between 1 January 2008 and 31 December 2017 requiring DCR were considered for the study. Details of demographics, phase of treatment (primary/retreatment), types of bones involved, age, complications, period suffering from epiphora, and follow-up were obtained. All data were entered and analyzed using the Statistical Package for the Social Service (version 16; IBM). Descriptive statistics of the frequency and mean ± standard deviation (SD) as appropriate were presented. Chi-square test and one-way analysis of variance were used appropriately. P ≤ 0.05 was taken to be statistically significant. Results: In all, 83 patients fulfilled the inclusion and exclusion criteria. It is more common in males (n = 56, 67.47%) with a mean ± SD of 32.24 ± 10.80 (18–59 years) with 27 (32.53%) of them presenting primarily after fractures. Fracture was the most common pathology seen in 81.93% (n = 68) of cases, while the rest were as a result of orthognathic cases. Le Fort II and III set of bones contributed to 59% of cases, while the orbitonasal complex contributed to only three cases. NLD obstruction was seen in 68 (81.9%) of cases. On an average, the patients suffered for 9.3 ± 6.74 months (range 0.5–22 months) before seeking treatment and the average follow-up was 31.07 ± 11.69 months (range 15–54 months). Discussion and Conclusion: Fractures and surgeries involving nasal bones carry an innate risk of damaging the NLD system. The pattern of need for DCR and occurrence of NLDO in this part of the world have been described. The extent of the anatomical variations and need for proper surgical planning are highlighted.

Choice of timing and methods of treatment for congenital nasolacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#Congenital nasolacrimal duct obstruction(CNLDO)is one of the most common ocular disorders in infants, and the main feature is a membranous obstruction of the distal end of the nasolacrimal duct. Methods are considered to treat with CNLDO, including lacrimal sac massage, probing, silicone intubation, balloon dacryocystoplasty, and dacryohynostomy. Recently, the combination use of lacrimal endoscopes may increase the success rate of surgery. Because many CNLDOs can resolve spontaneously, there are still some controversies in the timing of surgery and the choice of treatment options. The aim of the review is to provide a reference for the treatment of CNLDO.

Lysosomal enzymes and mannose 6-phosphate receptors in the lacrimal drainage system: Evidence and its potential implications

Purpose: To investigate the presence and patterns of lysosomal enzymes and mannose 6-phosophate receptor (MPRs) in human lacrimal drainage system. Methods: The study was performed on healthy lacrimal sacs and nasolacrimal ducts obtained from exenteration samples immediately after surgery and frozen at ?80°C for subsequent analysis. Soluble proteins' extract was used for enzyme assays, sodium dodecyl sulfate–polyacrylamide gel electrophoresis (PAGE), native PAGE, activity staining, and western blot analysis. Membrane proteins were separately assessed for detection of mannose 6-phosphate receptors, MPR 46. Sepharose gels, 4-methylumbelliferyl substrates, and antibodies against common lysosomal enzymes and MPRs were used. Enzyme assays were carried out in triplicate to ascertain the results. Results: Differential lysosomal enzyme activities were documented, and among them acid phosphatase and ?-hexosaminidase were found to be high. Western blot analysis using enzyme antibodies and subsequent activity staining confirmed strong signals for moderately expressed enzymes such as fucosidase, glucuronidase, and mannosidase. Membrane extracts demonstrated the presence of MPR 46, which indicates the possible roles of cation-dependent MPRs in lysosomal targeting in human lacrimal drainage system. Conclusion: This study provides a proof of principle for the presence of differential lysosomal activity and mannose 6-phosphate ligand transport receptors in human lacrimal drainage system and hypothesizes the potential implications of their dysfunctions.

Sex and age morphometric variations in bony nasolacrimal duct and fossa for lacrimal gland in Mexican population / Variaciones morfométricas de sexo y edad en el conducto nasolagrimal óseo y la fosa de la glándula lagrimal en la población mexicana

Primary acquired nasolacrimal duct obstruction is greater in women over 40 years and has been associated with morphometric variations in the osseous nasolacrimal duct, which varies according to age and sex. The objective is to determine variations regarding sex and age of the nasolacrimal duct and osseous fossa for lacrimal gland. One hundred sixteen dry orbits from Mexican population were analyzed; subdivided into four groups based on age and sex. The length, transverse and anteroposterior diameters of the bone entrance of the nasolacrimal duct, and the length and width of the fossa for lacrimal gland were determined. Statistical tests were applied to determine the significance of the differences found between groups. The nasolacrimal duct in women had shorter length than men in both age groups. The entrance had a wider transverse diameter in women than men independently of age and its anteroposterior diameter was shorter in men under 40 years than over 40 years. The fossa for lacrimal gland was larger in women under 40 years than in men of same age group and women over 40 years old. The lower third of the was wider in women under 40 years than in women over 40 years. Our study confirms significant differences between sex and age groups in some of the morphometric measurements of bony nasolacrimal duct and fossa for lacrimal gland in Mexican population. Comparative studies with and without clinical illness are needed to clarify if the bony characteristics of those structures participate in the etiopathogenesis and distribution differences observed in sex, age and ethnicity of thisillness.

La obstrucción de la vía lagrimal inferior es mayor en mujeres mayores de 50 años y se ha asociado a variaciones morfométricas en la entrada ósea del conducto nasolagrimal (CNL), las cuales varían según edad y sexo. El objetivo del presente estudio es determinar las variaciones respecto a sexo y edad de los diámetros de la entrada ósea del CNL, longitud del CNL y fosa de la glángula lagrimal (FL) ósea. Se analizaron 116 órbitas secas de población mexicana, los cuales a su vez fueron subdivididos en dos subgrupos en base a la edad y sexo. Se determinaron los diámetros transverso y anteroposterior de la entrada ósea del CNL, la longitud del CNL y la longitud y anchura de la FL. Se aplicaron pruebas estadísticas para determinar la significancia de las diferencias entre los grupos de estudio. La longitud del CNL fue menor en mujeres que en hombres en ambos grupos de edad. En cuanto a la entrada ósea del CNL, el diámetro transverso de fue significativamente menor en hombres que en mujeres independientemente de la edad y el diámetro anteroposterior fue menor en hombres < 40 que en > 40. La longitud de la FL fue mayor en mujeres < 40 años que en hombres del mismo rango de edad y que en mujeres > 40 años. La anchura de la FL en el tercio inferior fue menor en mujeres > 40 años que < 40 años. El resto de las mediciones de la FL no presentó diferencias significativas por sexo ni grupo de edad. Nuestro estudio confirmó que existen diferencias entre sexo y grupo de edad en algunas mediciones morfométricas del CNL y FL óseas en población mexicana. Se necesitan estudios comparativos entre personas con y sin obstrucción clínica de vía lagrimal inferior para esclarecer si las características óseas de estas estructuras participan o no en la etiopatogenia y las diferencias de distribución en género, edad y etnia de esta enfermedad.