Efficacy of mitomycin C in modified transcanalicular diode laser dacryocystorhinostomy / Eficácia da mitomicina C na dacriocistorrinostomia transcanalicular com laser diodo modificada

ABSTRACT Objective: To evaluate the efficacy of mitomycin C in anatomical and functional success after modified transcanalicular diode laser dacryocystorhinostomy. Methods: A prospective, double-blinded, randomized placebo-controlled study compared the effect of topical mitomycin C on modified transcanalicular diode laser dacryocystorhinostomy. Group 1 had modified transcanalicular diode laser dacryocystorhinostomy with topical saline, while Group 2 had modified transcanalicular diode laser dacryocystorhinostomy with topical mitomycin C. Success was defined as anatomical patency and relief of symptoms at the end of 6 months. Results: Six months after surgery, Group 1 (30 patients) showed anatomical and functional success rates of 86.7% and 83.3%, respectively. Group 2 (32 patients) showed anatomical and functional success rates of 87.5% and 84.3%, respectively. There was no statistically significant difference between the groups 1 and 2 (p = 1.000). Conclusion: The use of mitomycin C did not improve the anatomical and functional success rates of modified transcanalicular diode laser dacryocystorhinostomy compared to placebo.

RESUMO Objetivo: Avaliar a eficácia da mitomicina C no sucesso anatômico e funcional após dacriocistorrinostomia transcanalicular com laser de diodo. Métodos: Estudo prospectivo, duplo-cego, randomizado e controlado por placebo. Comparou o efeito da mitomicina C tópica na dacriocistorrinostomia transcanalicular com laser de diodo. No Grupo 1, foi utilizada apenas solução salina tópica, enquanto no Grupo 2 foi utilizada mitomicina C tópica. O sucesso foi definido como permeabilidade da via lacrimal e alívio dos sintomas ao final de 6 meses. Resultados: Seis meses após a cirurgia, o Grupo 1 (30 pacientes) apresentou taxas de sucesso anatômico e funcional de 86,7% e 83,3%, respectivamente. O Grupo 2 (32 pacientes) apresentou taxas de sucesso anatômico e funcional de 87,5% e 84,3%, respectivamente. Não houve diferença estatística significante entre os Grupos 1 e 2 (p=1,000). Conclusão: O uso de mitomicina C não melhora as taxas de sucesso anatômico e funcional do dacriocistorrinostomia transcanalicular com laser de diodo em comparação ao placebo.

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

Reliability of endoscopic dye transit test for prediction of functional success after diode laser and external dacryocystorhinostomy / Confiabilidade do teste endoscópico do corante na predição do sucesso funcional após dacriocistorinostomia com laser diodo e externa

ABSTRACT Purpose: To determine the reliability of the endoscopic dye transit test for the prediction of functional success after dacryocystorhinostomy. Methods: A cross-sectional study was conducted with 50 patients who underwent external dacryocystorhinostomy Group or transcanalicular dacryocystorhinostomy Group and had anatomically patent ducts during irrigation, with a minimum 6-month follow-up. The external dacryocystorhinostomy, defined as the time from instillation of the dye into the conjunctival sac until its flow from the rhinostomy site, was performed in all patients. Positive predictive value of the endoscopic dye transit test to assess functional success was analyzed. The cutoff point was determined using a receiver operating characteristic curve. Results: Of the 50 patients, 44 (88%) exhibited subjective improvement or complete resolution of epiphora (functional success). The best cutoff point for the endoscopic dye transit test was 60 s. Of 39 patients with endoscopic dye transit test £60 s, 38 (97.4%) exhibited functional success, demonstrating a 97.4% positive predictive value. Conclusion: The endoscopic dye transit test £60 s is a reliable tool to predict functional success and good prognosis after external or laser transcanalicular dacryocystorhinostomy.

RESUMO Objetivo: Determinar a confiabilidade do teste endoscópico do corante na predição do sucesso funcional após dacriocistorrinostomia. Métodos: Estudo transversal com 50 pacientes submetidos ao grupo de dacriocistorrinostomia externa ou grupo dacriocistorrinostomia transcanalicular e que possuíam dutos anatomicamente patentes pela irrigação, com seguimento mínimo de 6 meses. A dacriocistorrinostomia externa, definida como o tempo desde a instilação do corante no saco conjuntival até o fluxo do local da rinostomia, foi realizada em todos os pacientes. O valor preditivo positivo do teste endoscópico do corante para avaliar o sucesso funcional foi analisado. O ponto de corte foi determinado usando uma curva característica de operação do receptor. Resultados: Dos 50 pacientes, 44 (88%) apresentaram melhora subjetiva ou resolução completa da epífora (sucesso funcional). O melhor ponto de corte para o teste endoscópico do corante foi de 60 s. Dos 39 pacientes com teste endoscópico do corante £60 s, 38 (97,4%) apresentaram sucesso funcional, demonstrando um valor preditivo positivo de 97,4%. Conclusão: O teste en­doscópico do corante £60 s é uma ferramenta confiável para predizer o sucesso funcional e o bom prognóstico após dacriocistorrinostomia transcanalicular externa ou a laser.

Valor del ultrasonido en el diagnóstico de los tumores del saco lagrimal / Value of the ultrasound in the diagnosis of lacrimal sac tumor

RESUMEN Los tumores del saco lagrimal son extremadamente raros, y el benigno primario más común es el papiloma escamoso. Clínicamente se manifiestan como una zona de tumefacción en la región cantal medial, asociado a epifora y dacriocistitis crónica-recurrente. Dentro de las pruebas de imagen recomendadas están: dacriocistografía, tomografía computarizada, resonancia magnética y dacrioescintifotografía. Sin embargo, muy pocos sugieren el uso del ultrasonido. Se presenta el caso de un papiloma mixto del saco lagrimal diagnosticado por ultrasonido. Se trata de una paciente femenina de 39 años, quien fue remitida por cuadros repetidos de dacriocistitis derecha en los últimos 3 años. En consulta se constató celulitis preseptal ipsolateral, por lo que se indicó antibiótico-terapia, y se logró la remisión de los signos inflamatorios agudos, pero persistió el aumento del volumen cantal medial derecho. La vía lagrimal se exploró y se comprobó que estaba obstruida. Se realizó ultrasonido, donde el saco lagrimal derecho apareció ocupado por una masa ecogénica, que se extendía al conducto lacrimonasal y mostraba ligera vascularidad. Seguidamente se hizo tomografía computarizada, y se confirmaron los hallazgos ecográficos, pero sin lograr delimitar la lesión intrasaco descrita, aún tras la administración de contraste yodado endovenoso. Se sugirió dacriocistitis crónica derecha, secundaria al tumor intrasaco de aspecto benigno, probable papiloma, por lo que se efectuó cirugía y examen histopatológico que ratificaron dicho diagnóstico. En conclusión, el ultrasonido del saco lagrimal es un método complementario de gran valor, que en algunos casos hará el diagnóstico, y en otros brindará información que optimizará la decisión de quienes serían tributarios a estudios más complejos(AU)

ABSTRACT Lacrimal sac tumors are extremely rare, and the most common benign primary is squamous papilloma. Clinically, they manifest as a zone of swelling in the medial canthal region, associated with epiphora and chronic-recurrent dacryocystitis. Among the recommended imaging tests are dacryostography, computed tomography, magnetic resonance imaging, and dacryoscintifotography. However, very few suggest the use of ultrasound. The case of a mixed papilloma of the lacrimal sac diagnosed by ultrasound is presented. This is a 39-year-old female patient, who was referred for repeated cases of right dacryocystitis in the last three years. In consultation, ipsolateral preseptal cellulitis was found, for which antibiotic therapy was indicated, and the remission of acute inflammatory signs was achieved, but the increase in right medial canthal volume persisted. The lacrimal duct was explored and found to be obstructed. Ultrasound was performed, where the right lacrimal sac appeared occupied by an echogenic mass, which extended to the lacrimal duct and showed slight vascularity. Subsequently, computed tomography was performed, and the ultrasound findings were confirmed, but without defining the described intrasaccal lesion, even after administration of intravenous iodinated contrast. It was suggested chronic right dacryocystitis, secondary to apparently benign intrasaccal tumor, probable papilloma, so surgery and histopathological examination were performed, which that ratified the diagnosis. In conclusion, ultrasound of the lacrimal sac is a complementary method of great value, which in some cases will make the diagnosis, while in others it will provide information that will optimize the decision of those who would be candidate to more complex studies(AU)

Bilateral simultaneous endoscopic dacryocystorhinostomy: outcome and impact on the quality of life of the patients

Introduction: Bilateral simultaneous endoscopic dacryocystorhinostomy (endo-DCR) has received little attention in the literature, thus many surgeons continue to address bilateral nasolacrimal duct obstruction at two stages, rather than in the same setting. Objective: To evaluate the feasibility and the outcome of simultaneous bilateral Endo- DCR and its impact on the quality of life of the patients. Methods: We have conducted a retrospective analysis of patients who underwent bilateral simultaneous endo-DCR between March 2013 and February 2017 at our tertiary care institution. The reviewed data included clinical presentation; operative details; success rate; pre and postoperative evaluation of the symptoms of the patients, using the Nasolacrimal Duct Obstruction Symptom Score Questionnaire; satisfaction of the patients, and improvement in the quality of life, assessed by the Glasgow Benefit Inventory (GBI) questionnaire. Results: Out of 128 cases in which endo-DCRs were performed, 13 were bilateral (26 sides). Postoperative success was documented in 24 of the 26 sides (92.3%), with a mean follow-up duration of 16.2 months. The two failed sides were reported in the same case. The preoperative symptom score ranged between 12 and 80 (mean ± standard deviation [SD]: 38.23 ± 15.7). The postoperative symptom score was significantly lower (mean ± SD: 5.4 ± 12.9). The success rates in unilateral and bilateral cases were comparable, with no statistically significant difference. A notable improvement in the quality of life of the patients was also reported, with a mean GBI score of 81.38 ± 12.37. Conclusion: Our results support that a simultaneous bilateral endo-DCR is a safe procedure that offers a high success rate, spares the patient from the stress of a second surgery, provides the patient with a bilateral resolution of the symptoms, and confers an immediate improvement in the quality of life of the patients (AU)

The outcomes of 326 external dacryocystorhinostomy operations in children with dacryostenosis - 30-year experience of an oculoplastic surgeon / Os resultados de 326 operações de dacriocistorrinostomia externa em crianças com dacrioestenose - 30 anos de experiência de um cirurgião oculoplástico

ABSTRACT Purpose: To report demographic features and surgical outcomes of 320 children undergoing external dacryocystorhinostomy for dacryostenosis. Methods: We performed a retrospective evaluation of the records of patients aged <16 years who underwent external dacryocystorhinostomy. Patient demographic features and success rates of the operations were analyzed from the data records. Children with <12-month follow-up were not enrolled in the study. Results: We identified 326 operative records of 320 children (162 [50.6%] girls and 158 [49.4%] boys) who underwent external dacryocystorhinostomy with a mean follow-up of 26.03 ± 11.11 months. Overall, we evaluated 116 (35.6%) cases of congenital nasolacrimal duct obstruction. Our series demonstrated a 99.4% success rate for external dacryocystorhinostomy. Conclusions: External dacryocystorhinostomy in children has a high success rate if performed by an experienced oculoplastic surgeon.

RESUMO Objetivo: Relatar as características demográficas e os resultados cirúrgicos em 320 crianças submetidas à dacriocistorrinostomia externa para dacrioestenose. Métodos: Foi realizada uma avaliaçãodos prontuários de pacientes com idade <16 anos submetidos à cirurgia de dacriocistorrinostomia externa. Características demográficas do paciente e taxa de sucesso das operações foram analisadas a partir dos registros de dados. Crianças com menos de 12 meses de acompanhamento não foram incluídas no estudo. Resultados: Foram identificados 326 registros operatórios de 320 crianças (162 [50,6%] meninas e 158 [49,4%] meninos) que foram submetidas à dacriocistorrinostomia externa com um seguimento médio de 26,03 ± 11,11 meses. No geral, avaliamos 116 (35,6%) casos de obstrução congênita do ducto nasolacrimal. Nossa série demonstrou uma taxa de sucesso de 99,4% para a dacriocistorrinostomia externa. Conclusão: A dacriocistorrinostomia externa em crianças tem uma alta taxa de sucesso se for realizada por um cirurgião oculoplástico experiente.

Bacteriological profile in conjunctival, lacrimal sac, and nasal specimens and conjunctival normalization time following external, endoscopic, and transcanalicular multidiode laser dacryocystorhinostomy / Perfil bacteriológico e tempo de normalização conjuntival de espécimes de conjuntiva, saco lacrimal e nasais após dacriocistorrinostomia externa, endoscópica e transcanalicular com laser de multi diodo

ABSTRACT Purpose: To compare the conjunctival, lacrimal sac, and nasal flora cultures and conjunctival normalization time following external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) dacryocystorhinostomy (DCR) and to evaluate the relationship between culture positivity and surgical success. We further performed antibiotic sensitivity analyses for lacrimal sac culture samples. Methods: A total of 90 patients with primary acquired nasolacrimal duct obstruction were recruited and divided into EX-DCR (n=32), EN-DCR (n=28), and TC-DCR (n=30) groups. Conjunctival, nasal, and lacrimal sac cultures and antibiograms were analyzed. Results: In all three groups, coagulase-negative Staphylococcus (CNS) was predominantly isolated preoperatively from the conjunctiva, nose, and lacrimal sac and postoperatively from the conjunctiva. Preoperative and postoperative conjunctival culture positivity rates were similar between all the groups (p>0.05). A statistically significant difference in the growth rate of culture in the lacrimal sac was observed between the three groups (p=0.001). CNS and Staphylococcus aureus cultures were predominantly sensitive to linezolid, teicoplanin, tigecycline, vancomycin, and mupirocin. Conjunctival normalization times were similar between the three groups (p>0.05). Anatomical and functional success rates were not found to be significantly correlated with preoperative conjunctival and lacrimal sac culture positivity (p>0.05). Conclusions: Similar rates of preoperative and 1-week postoperative conjunctival culture positivity were observed in all the groups; a significantly lower bacterial growth rate was observed in postoperative conjunctival cultures. CNS was the most commonly isolated organism. Bacterial growth rates in the lacrimal sac samples were significantly higher in the EN-DCR group. Bacterial growth rates obtained preoperatively from the conjunctival and lacrimal sac culture samples were not correlated with DCR success.

RESUMO Objetivo: Comparar a flora conjuntival, do saco lacrimal e nasal com o tempo de normalização após dacriocistorrinostomia (DCR) externa (EX-), endoscópica (EN-) e transcanalicular a laser de multi diodo (TC-) para correlacionar a positividade da cultura com o sucesso cirúrgico, assim como identificar a sensibilidade aos antibióticos em amostras de saco lacrimal. Métodos: Neste estudo prospectivo, 90 pacientes com obstrução do canal nasolacrimal adquirida primária foram incluídos e divididos em grupos EX-DCR (n=32), EN-DCR (n=28) e TC-DCR (n=30). Culturas e antibiogramas conjuntivais, nasais e do saco lacrimal foram analisados. Resultados: Staphylococcus coagulase-negativo (CNS) foi o organismo predominante isolado no pré-operatório (conjuntiva e nariz), no transoperatório (saco lacrimal) e pós-operatório (conjuntiva), nos 3 grupos. Taxas de positividade de cultura da conjuntiva pré- e pós-operatórias nos três grupos foram semelhantes (p>0,05). A diferença nas taxas de crescimento do saco lacrimal dos três grupos foi estatisticamente significativa (p=0,001). CNS e S. aureus foram mais sensíveis a linezolida, teicoplanina, a tigeciclina, vancomicina e mupirocina. O tempo de normalização conjuntival foi semelhante nos três grupos (p>0,05). Não houve relação estatisticamente significativa entre as taxas de sucesso anatômicas e funcionais e a positividade da cultura conjuntival e de saco lacrimal pré-operatória (p>0,05). Conclusões: Pacientes submetidos a EX-DCR, EN-DCR, e TC-DCR apresentaram positividades de cultura conjuntival semelhantes no pré-operatório e na 1a semana pós-operatória. Houve uma redução significativa na taxa de crescimento das culturas da conjuntiva pós-operatórias. O organismo mais comumente isolado foi o CNS. A taxa de crescimento de bactérias a partir do saco lacrimal foi significativamente maior no grupo PT-DCR. O crescimento bacteriano da conjuntiva no pré-operatório e de amostras do saco lacrimal no transoperatório não se relacionaram com o sucesso da DCR.

Sondaje de vías lagrimales previa dilatación canalicular con gel viscoelástico versus sondaje directo / Lachrymal duct probing after canalicular dilation with viscoelastic gel vs direct probing

Objetivo: comparar la técnica de sondaje de vías lagrimales previa dilatación canalicular con gel viscoelástico con el sondaje directo. Métodos: se realizó un estudio analítico prospectivo de cohorte no concurrente en 136 ojos pertenecientes a pacientes con obstrucción congénita del conducto lacrimonasal atendidos en la Consulta de Oftalmopediatría del Hospital Pediátrico Docente Pepe Portilla, de Pinar del Río, a quienes se les realizó sondaje de vía lagrimal, desde enero del año 2008 a julio de 2013. Se conformaron dos grupos de estudio, ambos de 68 ojos, uno con la técnica quirúrgica de sondaje directo, y un segundo grupo donde se aplicó dilatación previa de la vía excretora con gel viscoelástico. Resultados: en el primer grupo se presentaron complicaciones en el 45,59 por ciento. Se logró el 54,41 por ciento de curación y fue reintervenido el 32,35 por ciento. En el segundo grupo se logró el 97,92 por ciento de curación sin complicaciones incluyendo a 6 ojos de pacientes mayores de 3 años, y fue necesario reintervenir a un solo paciente. Conclusiones: el sondaje del conducto lacrimonasal previa dilatación con Healon minimiza las complicaciones y la necesidad de reintervención, y posibilita su empleo efectivo en pacientes mayores de 3 años(AU)

Objective: to compare the lachrymal duct probing technique after canalicular dilation canalicular with viscoelastic gel or with direct probing. Methods: prospective, analytical and non-concurrent cohort study carried out in 136 eyes from patients with congenital nasolachrymal duct obstruction, who were seen at the ophthalmological pediatric service in Pepe Portilla teaching pediatric hospital located in Pinar del Rio and who underwent lachrymal duct probing in the period of January, 2008 through July,2013. Two study groups were formed with 68 eyes each, one treated with direct probing, and the other with previous dilation of the excretory duct with viscoelastic gel. Results: the first group showed some complications in 45,59 percent of patients; 54,41 percent recovered and 32,35 percent were reoperated. In the second group, 97,92 percent managed to recover without complications, including 6 eyes from patients older than 3 years. It was necessary to re-operate a patient. Conclusions: nasolachrymal duct probing after dilation with Healon minimizes complications and need for reoperation, thus facilitating its use in patients aged over 3 years(AU)

Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis

PURPOSE: To identify and analyze the role of preoperative computed tomography (CT) in patients with tearing symptoms with nasolacrimal duct obstruction (NLDO). METHODS: We retrospectively reviewed the medical records and CT results on 218 patients who complained of tearing symptoms with NLDO between January 2014 and December 2014. All patients were recruited from Kim's Eye Hospital's outpatient clinic and assessed by clinical history, examination, and CT to evaluate periocular pathology and nasolacrimal drainage system. Patients with abnormal findings assessed by preoperative CT were further reviewed. RESULTS: CT was performed on 218 patients (average age, 58.2 ± 11.9 years). Of these, 196 (89.9%) had endonasal dacryocystorhinostomy, 14 (6.4%) declined surgery, and 8 (3.7%) were inoperable due to abnormal CT findings. Soft tissue opacity was the most common finding which 243 cases (85.9%) of 283 obstructed nasolacrimal duct and 89 cases (81.7%) of 109 non-obstructed nasolacrimal duct showed it. Thirty-nine (17.8%) of 218 patients showed either maxillary sinusitis or ethmoidal sinusitis and 32 (14.7%) of 218 patients presented with periocular inflammation. Other abnormal CT findings included septal deviations, previous fractures, masses, and structural abnormalities of nasal cavity. CONCLUSIONS: Preoperative CT imaging is useful in the assessment of both nasolacrimal drainage and nearby anatomical structures. This information will be helpful in planning surgical interventions and management of NLDO.

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.

Primary Systemic Amyloidosis Involving the Lacrimal Sac

No abstract available.

Tear Stasis Caused by Severely Protruded Lacrimal Puncta Treated by Novel Punctal Fixation Technique

No abstract available.

Diode laser-assisted transcanalicular dacryocystorhinostomy: the effect of age on the results / Dacriocistorrinostomia transcanalicular auxiliada por laser de diodo: o efeito da idade sobre os resultados

ABSTRACT Purpose: The aim of this study was to explore the effect of age on the success of transcanalicular diode laser-assisted dacryocystorhinostomy (TCDCR). Methods: Seventy patients (70 eyes) who underwent transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction as a primary surgery were included in this retrospective, nonrandomized study. The patients were divided into two groups according to age. Mean ages were 21.3 ± 3.3 in group 1 and 60.3 ± 7.3 in group 2. The records of the 3-, 6-, and 12-month follow-up examinations were evaluated, and the anatomical and functional outcomes were noted. Functional success was defined as the absence of epiphora as indicated by the patient. Anatomical success was determined as patency of the neo-ostium with irrigation. Results: At the 3-month follow-up, 67% cases in group 1 showed anatomical success and 52% showed functional success; in group 2, the rates were 100% and 92%, respectively. Functional and anatomical success rates were the same for both the 6- and 12-month visits; 46% in group 1 and 76% in group 2. The results in group 2 were significantly better at all three follow-up visits (p<0.05). Conclusions: This study clearly showed that the older patients experienced better transcanalicular diode laser-assisted dacryocystorhinostomy results than the younger patients. The diminished inflammatory response in the older population may be a possible contributing factor to these results. .

RESUMO Objetivo: O objetivo deste estudo foi explorar o efeito da idade sobre o sucesso de dacriocistorrinostomia transcanalicular auxiliada por laser de diodo (TCDCR). Método: Setenta olhos de setenta pacientes submetidos dacriocistorrinostomia transcanalicular auxiliada por laser de diodo para o tratamento da obstrução nasolacrimal como cirurgia primária foram incluídos neste estudo retrospectivo, não randomizado. Os pacientes foram divididos em dois grupos segundo a idade. As idades médias foram 21,3 ± 3,3 no grupo 1 e 60,3 ± 7,3 no grupo 2. Os registros do acompanhamento pós-operatório aos três, seis e 12 meses, foram avaliados, observando resultados anatômicos e funcionais. Sucesso funcional foi definido como a ausência de lacrimejamento, conforme informado pelo paciente. Sucesso anatômico foi determinado como a permeabilidade do novo óstio à irrigação. Resultados: Nos três meses de acompanhamento, 67% dos casos no grupo 1 apresentou sucesso anatômico, e 52% mostraram sucesso funcional. No grupo 2, as taxas foram de 100% e 92%, respectivamente. Taxas de sucesso funcionais e anatômicas foram as mesmas para ambos os seis e 12 meses de visitas: 46% no grupo 1 e 76% no grupo 2. Os resultados do grupo 2 foram significativamente melhores em todas as três visitas pós-operatorias (p<0,05). Conclusões: Este estudo mostra claramente que os pacientes mais idosos apresentam melhores resultados à dacriocistorrinostomia transcanalicular auxiliada por laser de diodo comparados aos mais jovens. A resposta inflamatória diminuída na população mais velha é um possível fator que contribuiu para estes resultados. .

Surgical Outcomes of Canalicular Trephination Combined with Endoscopic Dacryocystorhinostomy in Patients with Distal or Common Canalicular Obstruction

PURPOSE: This study investigated the surgical outcomes of canalicular trephination combined with endoscopic dacryocystorhinostomy (DCR) in patients with a distal or common canalicular obstruction. It also identified the factors affecting surgical success rates associated with this technique. METHODS: We retrospectively reviewed the medical records of 57 patients (59 eyes) in whom a canalicular obstruction was encountered during endoscopic DCR. All patients were treated with endoscopic DCR, followed by canalicular trephination and silicone tube placement. The surgical outcome was categorized as a functional success according to the patient's subjective assessment of symptoms, including epiphora, and as an anatomical success according to a postoperative nasolacrimal duct irrigation test. Surgical success rates were compared based on age, sex, location of the obstruction, number of silicone tubes, and experience of the surgeon. RESULTS: Functional success was achieved in 55 of 59 eyes (93%) at one month, 50 eyes (84%) at three months, and 46 eyes (78%) at six months. Anatomical success was achieved in 58 of 59 eyes (98%) at one month, 52 eyes (88%) at three months, and 50 eyes (84%) at six months. There was a statistically significant difference in surgical outcome according to the experience of the surgeon. The anatomical success rate at the six-month follow-up exam was 95.4% in the >5 years of experience group, and 53.3% in the <5 years of experience group (p = 0.008, Pearson chi-square test). CONCLUSIONS: The success rate of canalicular trephination combined with endoscopic DCR in patients with a distal or common canalicular obstruction decreased gradually during the six-month follow-up period. In particular, patients undergoing procedures with experienced surgeons tended to show excellent surgical outcomes at the six-month follow-up exam.

Dacriocistorrinostomia endoscópica: nossa experiência e revisão de literatura / Endoscopic dacryocystorhinostomy: our experience and literature review

Objetivo: Apresentar nossa experiência em dacriocistorrinostomia endoscópica, discutindo os resultados com os encontrados na literatura. Métodos: O material desse estudo consistiu de 16 dacricistorrinostomias realizadas em 12 pacientes acompanhados no período de 2009 a 2011. Analisamos sexo, idade no momento da cirurgia, etiologia da dacriocistite, quadro clínico, número de cirurgias necessárias para a correção, seguimento pós-operatório. Resultados: Houve predomínio do sexo feminino em relação ao masculino (5:1) com idades entre 8 e 71 anos, com média de 35,2 anos. Com relação à etiologia, oito foram classificados como idiopáticos; três, pós-traumáticos e um iatrogênico. Os pacientes foram acompanhados em média durante o período de seis meses, com melhora dos sintomas. Apenas dois pacientes evoluíram com permanência de epífora, sendo um deles reoperado com êxito por via externa. Conclusão:A cirurgia endoscópica endonasal deve ser considerada nos pacientes com obstrução das vias lacrimais, devido ao seu alto índice de sucesso, além de ser um procedimento seguro, com menor morbidade e proporcionar melhor resultado estético.

Objective:To present our experience in endoscopic dacryocystorhinostomy, discussing the results with those found in the literature. Methods: The material in this study consisted of sixteen surgeries performed in twelve patients followed between 2009 to 2011. We analyzed gender, age at surgery, etiology of dacryocystitis, clinical features, number of surgeries required to repair, follow-up. Results: There was a predominance of females compared to males (5:1) aged between 8 and 71 years, mean35.2 years. With regard to etiology, eight were classified as idiopathic, three, posttraumatic, and one, iatrogenic. Patients were followed on average over the period of six months, with improvement of symptoms. Only two patients had persistence of epiphora, one being reoperated successfully by external approach. Conclusion: Endoscopic endonasal surgery should be considered in patients with lacrimal obstruction, due to its high success rate, besides being safe procedure with less morbidity and give better cosmetic results.

Effects of Nasopore Packing on Dacryocystorhinostomy

PURPOSE: To investigate the effects of placement of the absorbable packing material Nasopore at the anastomosis site of newly formed mucosal flaps on postoperative re-bleeding, discomfort, and on the success rate of dacryocystorhinostomy (DCR). METHODS: A review of the medical records of patients with primary acquired nasolacrimal duct obstruction that underwent external or endonasal DCR by a single surgeon was performed. The degree of re-bleeding, discomfort, and postoperative results, including anatomical success, functional success and postoperative nasal findings such as granulation, synechiae, and membrane formation were compared in patients whose anastomosis site was packed with either Nasopore or Merocel, a non-absorbable packing material. RESULTS: A total of 77 patients (101 eyes) were included. Of the 101 eyes, 30 were packed with Nasopore, while 71 were packed with Merocel. The Nasopore group showed significantly better results than the Merocel group in the degree of re-bleeding and the level of patient discomfort (p = 0.000, 0.039, respectively; Pearson's chi-square test), whereas there were no statistically significant differences between the two groups in postoperative anatomical and functional success (p > 0.05). CONCLUSIONS: Nasopore significantly reduced postoperative nasal re-bleeding and patient discomfort during the early post-surgical period, but failed to show an effect on the postoperative anatomical and functional success of DCR.

Effects of Nasopore Packing on Dacryocystorhinostomy

PURPOSE: To investigate the effects of placement of the absorbable packing material Nasopore at the anastomosis site of newly formed mucosal flaps on postoperative re-bleeding, discomfort, and on the success rate of dacryocystorhinostomy (DCR). METHODS: A review of the medical records of patients with primary acquired nasolacrimal duct obstruction that underwent external or endonasal DCR by a single surgeon was performed. The degree of re-bleeding, discomfort, and postoperative results, including anatomical success, functional success and postoperative nasal findings such as granulation, synechiae, and membrane formation were compared in patients whose anastomosis site was packed with either Nasopore or Merocel, a non-absorbable packing material. RESULTS: A total of 77 patients (101 eyes) were included. Of the 101 eyes, 30 were packed with Nasopore, while 71 were packed with Merocel. The Nasopore group showed significantly better results than the Merocel group in the degree of re-bleeding and the level of patient discomfort (p = 0.000, 0.039, respectively; Pearson's chi-square test), whereas there were no statistically significant differences between the two groups in postoperative anatomical and functional success (p > 0.05). CONCLUSIONS: Nasopore significantly reduced postoperative nasal re-bleeding and patient discomfort during the early post-surgical period, but failed to show an effect on the postoperative anatomical and functional success of DCR.