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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.
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@#AIM: To explore the effect of nasal septum deviation(NSD)on the curative effect of endonasal endoscopic dacryocystorhinostomy(EES-DCR).<p>METHODS: Totally 84 patients(84 eyes)who have been diagnosed with chronic dacryocystitis in our hospital from June 2017 to May 2019 were collected and then the patients were divided them into two groups according to whether NSD existed through the preoperative nasal endoscopy. Group A included 42 patients(42 eyes)who had no NSD while Group B included 42 patients(42 eyes)who had NSD(mild or moderate). The EES-DCR was performed under general anesthesia in both groups. The preoperative treatment indexes, evaluative efficacy after 6mo follow up and nasal adhesion were compared between the two groups after operation.<p>RESULTS: The operation time and intraoperative blood loss of group B(69.9±13.1min, 51.8±16.4mL)exceeded group A(53.4±11.7min, 24.9±12.0mL)respectively(<i>P</i><0.05), while the hospitalization time between two groups showed no difference(<i>P</i>>0.05). Follow up for 6mo: the effective rate of group A was 86% while group B was 71%(<i>P</i>>0.05); No nasal adhesion was found in group A while 12% incidence existed in group B, with no difference between the two groups(<i>P</i>>0.05).<p>CONCLUSION: Patients who have chronic dacryocystitis combined with mild or moderate NSD do not need to perform a septoplasty simultaneously if the symptom does not accompany by nasal dysfunction. Only by performing the EES-DCR can achieve a quite good result.
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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.
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@#AIM: To investigate the optimal height of anastomotic in endoscopic dacryocystorhinostomy.<p>METHODS: This was a prospective randomized controlled study. Totally 229 patients(255 eyes)who were treated with endoscopic dacryocystostomy in Hankou Eye Hospital of Wuhan Aier from January 2019 to August 2020 were selected as the research objects. Including three types of patients: acute dacryocystitis, chronic dacryocystitis and nasolacrimal duct obstruction. Each type of patients were randomly divided into four groups: A, B, C and D. The No.7 lacrimal passage probe was inserted from the upper lacrimal puncta into the bone hole of lacrimal passage stoma. The probe head was close to the upper end of the bone hole, and the angle between the probe and the horizontal line of inner and outer canthus was measured α. Group A α1: -15°to +15°; Group B α2: +16°to +30°; Group C α3: +31°to +45°; Group D α4: +46°to +75°. All patients were followed up to 3mo postoperative. The amount of intraoperative blood loss, operation time and postoperative efficacy were recorded.<p>RESULTS: At 3mo postoperative, the intraoperative blood loss in Group A was more than that in Groups B, C and D, and the operation time was the longest. The operation time of Group D was shorter than that of Groups A, B and C(all <i>P</i><0.05), but there was no significant difference between Groups B and C(<i>P</i>>0.05). The curative effect of Group B was the best and the Group D was the worst(all <i>P</i><0.05), and there was no significant difference between Group A and Group C(<i>P</i>>0.05).<p>CONCLUSION: The probe angle from +16°to +30°was the optimal height of anastomotic in endoscopic dacryocystorhinostomy.
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@#AIM:To compare the effect of self-crosslinking sodium hyaluronic gel, Nasopore, and gelatin sponge in endonasal endoscopic dacryocystorhinostomy(En-DCR).<p>METHODS:Totally 72 patients(90 eyes)of chronic dacryocystitis admitted to our hospital from June 2019 to June 2020, and randomly divide them into three groups. Self-crosslinking sodium hyaluronic gel(group A), Nasopore(group B), and gelfoam(group C)were used during the En-DCR. Comfort level, bleeding, complication and epiphora, lacrimal situation were observed 2wk, 1, 2, 3, 6mo after surgery. Comparison of cure rate and effective rate.<p>RESULTS: The patients were followed up for 6mo after operation. The cure rate of lacrimal system reconstruction was 97% in group A, 89% in group B and 94% in group C. There was no meaningful statistical difference among the three groups(<i>P</i>>0.05). The effective rate of lacrimal system reconstruction was 91% in group A, 56% in group B and 87% in group C(<i>P</i><0.05). There was significant statistical difference between groups A and B or between groups B and C(<i>P</i><0.0167), however, there was no meaningful statistical difference between groups A and C(<i>P</i>>0.0167). Postoperative comfort level was better and bleeding was more severe in the group of A than in group B(<i>P</i><0.0167). In terms of complications, there was less scar proliferation in group A than in group B(<i>P</i><0.0167), the rate of synechiae in groups A and B was higher than in group C(<i>P</i><0.0167).<p>CONCLUSION:Intraoperative application of self-crosslinking sodium hyaluronic gel to packing the anastomotic stoma makes the procedure simple and can effectively inhibit scar proliferation and conducive to the epithelialization of the anastomotic stoma, improve the cure rate of En-DCR. In addition, with more comfort. It is a simple, safe, comfortable and efficient absorbable anastomotic stoma packing material.
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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
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Humans , Adolescent , Adult , Middle Aged , Dacryocystorhinostomy/methods , Retrospective Studies , Endoscopy/methods , Lacrimal Duct ObstructionABSTRACT
@#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.
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@#AIM: To investigate the independent influencing factors of endoscopic dacryocystorhinostomy in the treatment of lacrimal duct diseases.<p>METHODS: Retrospectively analysis of the cases of 280 patients(316 eyes)with lacrimal duct diseases treated by endoscopic dacryocystorhinostomy in Hankou Eye Hospital of Wuhan Aier from Oct. 2015 to Mar. 2019, summarizd the efficacy and analyzed the independent factors of efficacy by using the ordered Logistic regression.<p>RESULTS: The total cure rate was 52.2%, the total improvement rate was 30.7%, and the total invalid rate was 17.1%. Rhinitis(<i>OR</i>=95.58), frequency of eye ointment injection after operation(<i>OR</i>=0.001), history of lacrimal duct catheterization(<i>OR</i>=0.0009), history of lacrimal laser(<i>OR</i>=94.73),packing material(<i>OR</i>=0.002)were the independent factor influencing the efficacy.<p>CONCLUSION: Rhinitis and history of lacrimal laser are the factors to reduce the curative effect of endoscopic dacryocystorhinostomy; regular injection of eye ointment after operation, history of lacrimal duct catheterization and filling of absorbable materials, which are beneficial to improve the curative effect of operation.
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@#AIM: To discuss the advantage, improvement, safety and effectiveness of improved endoscopic dacryocystorhinostomy in the treatment of chronic dacryocystitis.<p>METHODS: Eighty cases of chronic dacryocystitis with two different surgical methods were randomly selected and divided into common endoscopic dacryocystorhinostomy(80 cases with 82 eyes)and improved endoscopic dacryocystorhinostomy(80 cases with 84 eyes)according to operation. Compared to observe cure rate, improvement rate, total effective rate and patient satisfaction of two kinds of surgery by the last follow-up.<p>RESULTS: The cure rate, improvement rate, total effective rate and satisfaction rate were respectively 75.6%, 17.1%, 92.7% and 73.8% for Group A, 90.5%, 5.9%, 96.4% and 92.5% for Group B. Differences between the cure rate, improvement rate and total effective rate between two groups had statistical significance(<i>P</i><0.05).<p>CONCLUSION: The cure rate and improve symptom of improved endoscopic dacryocystorhinostomy is superior to the common endoscopic dacryocystorhinostomy, safe and effective.
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@#AIM: To observe the clinical effects of modified endoscopic dacryocystorhinostomy(EDCR)for chronic dacryocystitis and try to find out an effective adjuvant method to improve the long-term effect of the modified surgery.<p>METHODS: Totally 136 cases(158 eyes)of chronic dacryocystitis were enrolled in the study and randomly divided into two groups:treatment group(80 eyes)and control group(78 eyes).The treatment group underwent the modified EDCR(intraoperative mytomycin C combined with silicone tube implatation and the use of tobramycin and dexamethasone eye ointment).The control group was only applyed mytomycin C during EDCR.The postoperative follow-up period was for 3-12mo.<p>RESULTS: At 6mo postoperatively,the cure rate and total effective rate of the treatment group were 95.0%, 98.8% respectively,and the control group of it were 75.6%, 93.6%.The effective rate of the treatment group was higher than that of the control group significantly(<i>χ</i><sup>2</sup>=11.90,<i>P</i><0.05).<p>CONCLUSION: The modified EDCR is a new surgical method which can prevent postoperative cicatricial adhesion and elevate surgical effective rate, and it has clear field, minimal invasion, quick recovery, exact effect and less recurrence.
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PURPOSE: To evaluate the efficacy of endonasal revision using triamcinolone-soaked nasal packing in patients exhibiting recurrence of epiphora after endoscopic dacryocystorhinostomy. CASE SUMMARY: Four patients (4 eyes) who presented with the chief complaint of recurrence of epiphora after endoscopic dacryocystorhinostomy underwent endonasal revision under local anesthesia. On nasal endoscopy, granulation tissue and membranous tissue around the osseous foramen was removed during endonasal revision. According to the operator's judgement, the osseous foramen was additionally expanded. Following insertion of a silicone tube, triamcinolone-soaked nasal packing was used for intra-nasal packing. The silicone tube was removed after follow-up of more than 12 weeks. Immediately after removing the silicone tube, there was free passage of saline on lacrimal syringing as well as complete resolution of epiphora. At over 6 months of follow-up after tube removal, there was no recurrence of epiphora in any of the 4 patients. CONCLUSIONS: Triamcinolone-soaked nasal packing may be considered in patients with failed endoscopic dacryocystorhinostomy.
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Humans , Anesthesia, Local , Dacryocystorhinostomy , Endoscopy , Follow-Up Studies , Granulation Tissue , Lacrimal Apparatus Diseases , Recurrence , Silicon , Silicones , TriamcinoloneABSTRACT
Background: To compare the post operative ostial patency at the rhinostomy site in the patients undergoing the primary endoscopic dacryocystorhinostomy, using Mitomycin-C application and Merocel packing. Methods: The patients visiting the Otorhinolaryngology out patients department at the tertiary referral hospital were included in this study. The study was prospective in nature and comprised of 50 patients suffering from primary dacryocystitis. Endonasal endoscopic dacryocystorhinostomy was done in the patients suffering from the chronic dacryocystitis with postsaccular obstruction of lacrimal system. The patients were divided in two equal groups containing 25 patients in each group. In first group (Group- A) Mitomycin-C (0.5 mg/ml for 15 min) was locally applied at the rhinostomy site and nasal cavity was packed with bactigras after the surgery, whereas in the second group, nasal cavity was packed with Merocel after reposition of the flap without application of any drug. Follow up was done every week in the first month, then monthly till the six months after the surgery. The post operative results were compared in terms of ostial patency at the rhinostomy site at one month, three months and six months of follow up. The surgical technique used remained same throughout the period of study. Results: The post operative ostial patency of rhinostomy stoma was better in the group of the patients undergoing application of Mytomycin-C at the rhinostomy site as compared to the packing of the nasal cavity with Merocel. The difference between both the groups was statistically significant. The rhinostomy created was free from synachiae and granulation tissue formation on follow up examination in the group of the patients having application of Mitomycin-C at the time of surgery. Ultimately the ostial patency was better in the patients having application of Mitomycin-C. Conclusion: Mitomycin-C has statistically significant beneficial effect in the maintenance of ostial patency after primary endonasal endoscopic dacryocystorhinostomy as compared to the merocel packing alone after the surgery.
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Aim: The study aims to report a single trainee’s experience of learning and performing endoscopic endonasal dacryocystorhinostomy (En‑DCR). Settings and Design: This study was a retrospective, interventional case series. Subjects and Methods: Fifty‑four eyes of fifty patients presenting at a tertiary eye care center over 1 year were included in the study. All cases underwent endoscopic DCR with mitomycin‑C and silicone intubation. The parameters studied included demographics, clinical features, intraoperative details, and postoperative ostium evaluation. Stent removal and nasal endoscopy were performed at 6 weeks and a further ostium evaluation at 3 and 6 months following surgery. Anatomical success rate was defined as patent irrigation, and functional success rate was defined as positive functional endoscopic dye test and absence of epiphora. Results: Fifty‑four eyes of fifty patients were operated, and three cases were lost to follow‑up after surgery. The mean age at presentation was 34 (4–75) years. Clinical diagnosis included primary acquired nasolacrimal duct (NLD) obstruction in 72% (39/54), acute dacryocystitis in 15% (8/54), failed DCR in 7% (4/54), and persistent congenital NLD obstruction in 5% (3/54). The first five cases needed intervention by the mentor for superior osteotomy. Common variations in anatomical landmarks were posterior location of sac, large ethmoidal bulla, high internal common opening, and thick maxillary bone. Surgical time taken in the last 27 eyes was significantly lesser compared to the surgical duration taken in the initial 27 cases (P < 0.05). Anatomical and functional success rate was 94% (48/51) at 6 months follow‑up period. Conclusions: Endoscopic En‑DCR has a good success rate when performed by oculoplastic surgery trainees. Nasal anatomical variations, instrument handling, and adaptation to monocular view of endoscope are few of the challenges for beginners. Structured skill transfer can help trainees to learn and perform En‑DCR with acceptable success rates.
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Chronic dacryocystitis results very often from obstruction to the nasolacrimal duct. It manifests as epiphora or watering of the eyes. The lacrimal sac gets expanded and also the wall of the sac gets thickened as a result of collection of mucopus due to obstruction of the nasolacrimal duct. Treatment of chronic dacryocystitis is by a surgical approach which consists of making an opening between the lacrimal sac and the nasal cavity above the obstruction. This operation is called dacryocystorhinostomy which can be done by external approach or nasal endoscopic approach. The intranasal or nasal endoscopic approach is the more functional route of surgery because it preserves the lacrimal apparatus as near normal as possible. Hence this surgery is being advocated as the first line of treatment for epiphora of chronic dacryocystitis. Experience of nasal endoscopic dacryocystorhinostomy done at Government Medical College, Government General Hospital, Nizamabad, Telangana is being reported with comparison of results published in literature.
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PURPOSE: To evaluate the correlation between clinical manifestation of patients with nasolacrimal duct obstruction and pathological characteristics of lacrimal sac and dacryolith found during endoscopic dacryocystorhinostomy. METHODS: This retrospective study included 158 patients (189 eyes) who received endoscopic dacryocystorhinostomy. We defined lacrimal dacryolith by gross discovery in the lacrimal sac during surgery or findings during pathological examination as dacryolith or calcification, including size and distribution in pathology slides. We correlated the relationship between the patients' clinical manifestations, surgical results, lacrimal sac's pathological findings including calcification, inflammation and fibrosis, and pathological findings of lacrimal sac dacryolith. RESULTS: Dacryolith was found in 61 eyes (32.3%) and among them, grossly found in 13 eyes (6.9%). Dacryolith's filling defect on dacryocystography was found in 17 eyes (9.0%) and based on grossly found dacryolith, dacryocystography's sensitivity and specificity were 58.8% and 1.7%, respectively. The average size of dacryolith was 0.3 +/- 0.8 mm2 with an average distribution of 20.1 +/- 17.9%. Distribution of dacryolith and the proportions of inflammatory cells and fibrosis in the lacrimal sac were negatively correlated (p < 0.05). The size of dacryolith and the proportions of fibrosis in the lacrimal sac were also negatively correlated (p = 0.008). In cases where the proportion of calcification in pathology slides was over 50%, the duration of symptoms in the calcification-dominant group was shorter than in other groups (p = 0.006). The success rates of endoscopic dacryocystorhinostomy with dacryolith and without dacryolith were 91.8% and 80.5%, respectively (p = 0.046). CONCLUSIONS: The patients with lacrimal sac dacryolith in nasolacrimal duct obstruction showed shorter duration of symptoms, lower fibrosis of lacrimal sac, and higher surgical success rates than the other cases. Therefore, additional research may be necessary to determine the mechanism of dacryolith formation and early treatment in nasolacrimal duct obstruction with lacrimal sac dacryolith.
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Humans , Dacryocystorhinostomy , Fibrosis , Inflammation , Nasolacrimal Duct , Pathology , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Ectrodactyly‑ectodermal dysplasia and clefting syndrome or “Lobster claw” deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD) obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR) which is a good alternative to lacrimal probing or open DCR in such a case.
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PURPOSE: To report the results of 15 endoscopic dacryocystorhinostomy (eDCR) cases using ultrasonic bone aspirator (UBA) and evaluate the UBA efficiency in these surgeries. METHODS: Fifteen eyes of 12 patients presenting with nasolacrimal duct obstruction were evaluated in the present study. eDCR and osteotomy were performed using UBA (Cusa excel, Integra, New Jersey, NJ, USA) from January 2014 to June 2014. RESULTS: All the patients showed complete resolution of the epiphora. There were no complications or recurrences for a minimum of 10 months postoperatively. CONCLUSIONS: This is the first report on eDCR using UBA. The surgeries were successful and no complications were observed. eDCR using UBA is an easy, safe and effective technique with minimal heat production, minimal damage to the surrounding soft tissue and quick and precise bone removal.
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Humans , Dacryocystorhinostomy , Lacrimal Apparatus Diseases , Nasolacrimal Duct , New Jersey , Osteotomy , Recurrence , Thermogenesis , UltrasonicsABSTRACT
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
PURPOSE: The success rate of endoscopic dacryocystorhinostomy has been increasing with the development of better instruments and techniques. We conducted this study to evaluate the clinical results of endoscopic dacryocystorhinostomy using a Microdebrider, which has also been used for functional endoscopic sinus surgery. METHODS: We selected 76 patients (with a total of 84 affected eyes) who had been diagnosed with a nasolacrimal duct obstruction. These patients underwent an endoscopic dacryocystorhinostomy using a Microdebrider, which removed both nasal mucosa and lacrimal sac mucosa and also trimmed the margins of the ostotomy site. We assessed patients' outcomes on an anatomical basis using a dye test and endoscopy, which were used to define the anatomical success. We also arbitrarily defined functional success as whether the subjective epiphora was absent. At a four to 18 month follow-up, we monitored the clinical course to examine any recurrent episodes. RESULTS: The symptoms were alleviated in 72 eyes, with a primary success rate of 85.7%. On nasal endoscopy, a functional failure was seen in four eyes. In these four eyes, the orifice was narrowed by the presence of either granulation tissue or conjunctivochalasis. By contrast, surgical outcomes were the anatomical failure in eight eyes. In these eight eyes, the orifice was obstructed by the presence of granulation tissue as well as the adhesion of nasal mucosa. CONCLUSIONS: Endoscopic dacryocystorhinostomy using a Microdebrider enabled us to make the large fistula while minimizing the damage of adjacent tissue. It might be the recommended surgery that reduces the complications and enhances the success rate.