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1.
Arq. bras. oftalmol ; 84(1): 91-98, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1153095

ABSTRACT

ABSTRACT Purpose: Lacrimal probing is the treatment of choice for congenital nasolacrimal duct obstruction that does not have a spontaneous resolution; however, there is no consensus about the best time for probing and if it is superior to other therapies. The present study aimed to evaluate the effectiveness of lacrimal probing compared with other treatments/no intervention to treat congenital nasolacrimal duct obstruction. Methods: A systematic review of literature in PubMed, EMBASE, CENTRAL, clinicaltrials.gov, and LILACS databases up to December 2019 was performed. Randomized clinical trials that enrolled children diagnosed with congenital nasolacrimal duct obstruction and undergoing lacrimal probing were considered. Data extraction and a risk of bias assessment were conducted independently and in duplicate. The overall quality of evidence for each outcome was conducted using the Grading of Recommendations, Assessment, Development, and Evaluation classification system. Results: Four randomized clinical trials involving 423 participants were eligible. No statistically significant differences were observed in resolution rates between early probing and observation/late probing (two studies; risk ratio 1.00 [95% confidence interval 0.76-1.33]; p=0.99; low certainty evidence). One study reported better resolution rates with bicanalicular silicone stent intubation compared with late probing in the complex congenital nasolacrimal duct obstruction cases subgroup (risk ratio 0.56 [95% confidence interval 0.34-0.92]; p=0.02; moderate certainty evidence). Conclusions: Low certainty evidence suggests that early probing has the same success rate as late probing. Evidence of moderate certainty suggests that late probing has a lower success rate than bicanalicular silastic intubation in patients with complex congenital nasolacrimal duct obstructione.


RESUMO Objetivo: A sondagem lacrimal tem sido o tratamento de escolha para a obstrução lacrimonasal congênita que não apresenta resolução espontânea. Contudo, não há consenso sobre qual é a melhor época para a realização da sondagem e se ela é melhor do que outras terapias. O objetivo foi avaliar a efetividade da sondagem lacrimal no tratamento da obstrução lacrimonasal congênita. Método: Uma revisão sistemática da literatura foi realizada usando as plataformas eletrônicas PubMed, EMBASE, CENTRAL, clinicaltrials.gov e LILACS até o período de dezembro de 2019. Foram considerados ensaios clínicos randomizados envolvendo crianças com obstrução lacrimonasal congênita submetidas a sondagem lacrimal. A extração dos dados e avaliação do risco de viés foram feitas por dois autores independentemente. A análise da qualidade da evidência para cada desfecho foi realizada por meio do sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Resultados: Quatro ensaios clínicos randomizados foram incluídos, envolvendo 423 participantes. A metanálise mostrou que não houve diferença estatística na resolução da obstrução lacrimonasal congênita entre o grupo submetido à sondagem lacrimal precoce e o submetido à observação/sondagem tardia (2 estudos; risco médio 1.00 [intervalo de confiança de 95% 0.76, 1.33] p=0,99, I2=79%, baixa certeza de evidência). Um estudo evidenciou melhores resultados da intubação bicanalicular com silicone em comparação a sondagem tardia no subgrupo das obstruções lacrimonasais congênitas complexas, (1 estudo; risco médio 0.56 [intervalo de confiança de 95% 0.34, 0.92] p=0,02, moderada certeza de evidência). Conclusões: Há evidências de baixa qualidade de que a sondagem precoce tem a mesma taxa de sucesso que a sondagem tardia. Evidências de moderada certeza sugerem que a sondagem tardia tem menor chance de sucesso do que a intubação bicanalicular com silicone em casos de obstruções lacrimonasais congênitas complexas.


Subject(s)
Humans , Infant , Child , Dacryocystorhinostomy , Lacrimal Duct Obstruction , Nasolacrimal Duct , Randomized Controlled Trials as Topic , Retrospective Studies , Treatment Outcome , Intubation , Lacrimal Duct Obstruction/therapy
2.
Medicentro (Villa Clara) ; 24(3): 564-577, jul.-set. 2020. tab
Article in Spanish | LILACS | ID: biblio-1125016

ABSTRACT

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.


Subject(s)
General Surgery , Dacryocystorhinostomy , Mitomycin , Lacrimal Apparatus , Lacrimal Duct Obstruction
3.
Arq. bras. oftalmol ; 83(3): 229-235, May-June 2020. tab
Article in English | LILACS | ID: biblio-1131581

ABSTRACT

ABSTRACT Purpose: Mitomycin C has been used in ophthalmic surgery to mitigate postoperative scarring. However, the outcomes of endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction with adjunctive mitomycin C in children remain unknown. Our study was aimed to evaluate the efficacy and safety of adjunctive application of mitomycin C after endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction in children. Methods: This is a retrospective chart review performed in a tertiary eye care hospital involving children with congenital nasolacrimal duct obstruction, who underwent endoscopic-assisted probing from October 2013 to August 2015. We compared children who underwent endoscopic-assisted probing with mitomycin C (mitomycin C group) versus others who underwent endoscopic-assisted probing without mitomycin C (endoscopic-assisted probing group). The mitomycin C group received 0.2 mg/ml within 4 min to the nasolacrimal duct ostium using a cotton tip applicator immediately after probing. Probing was considered successful when patient complaints of tearing were reduced or the results of the dye disappearance test were normal. Demographic data, clinical features, and intraoperative and postoperative variables were correlated to the success rate. Results: The study sample comprised 68 lacrimal vies. The majority of children had bilateral obstruction and no previous history of probing. The mean age of the patients was approximately 4 years. Most obstructions were considered complex. The success rates were high in both groups (p>0.05). There were no adverse events related to the use of mitomycin C (p>0.05). Conclusions: Although mitomycin C has no adverse effects when applied to the opening of the nasolacrimal duct, its use after lacrimal probing for the treatment of congenital nasolacrimal duct obstruction does not improve the chance of success.


RESUMO Objetivo: A mitomicina C tem sido usada em cirurgia oftálmica para reduzir cicatrizes pós-operatórias. Entretanto, os resultados da sondagem endoscópica assistida para o tratamento da obstrução congênita do ducto nasolacrimal com mitomicina C adjuvante em crianças permanecem desconhecidos. Nosso estudo teve como objetivo avaliar a eficácia e a segurança da aplicação da mitomicina C após a sondagem endoscópica assistida para o tratamento da obstrução congênita do ducto nasolacrimal em crianças. Métodos: Trata-se de uma revisão retrospectiva de prontuários, realizads em um hospital terciário de oftalmologia, envolvendo crianças com obstrução congênita do ducto nasolacrimal, submetidas à sondagem endoscópica de Outubro de 2013 a Agosto de 2015. Comparamos crianças submetidas à sondagem endoscópica com mitomicina C (grupo mitomicina C) versus outros que foram submetidos à sondagem endoscópica sem mitomicina C (grupo de sondagem endoscópica). O grupo mitomicina C recebeu 0,2 mg/ml em 4 min para o óstio do ducto nasolacrimal usando um aplicador de ponta de algodão imediatamente após a sondagem. A sondagem foi considerada bem-sucedida quando as queixas de lacrimejamento dos pacientes foram reduzidas ou os resultados do teste de desaparecimento do corante foram normais. Dados demográficos, sinais clínicos, variáveis intra e pós-operatórias foram correlacionados com a taxa de sucesso. Resultados: A amostra do estudo foi composta por 68 vias lacrimais. A maioria das crianças apresentava obstrução bilateral e sem histórico prévio de sondagem. A média de idade dos pacientes era de aproximadamente 4 anos. A maioria das obstruções foi considerada complexa. As taxas de sucesso foram altas nos dois grupos (p>0.05). Não houve efeitos adversos relacionados ao uso da mitomicina C (p>0.05). Conclusões: Apesar a mitomicina C não tenha efeitos adversos quando aplicada à abertura do ducto nasolacrimal, seu uso após sondagem lacrimal no tratamento da obstrução congênita do ducto nasolacrimal não melhora a chance de sucesso.


Subject(s)
Humans , Child, Preschool , Dacryocystorhinostomy , Lacrimal Duct Obstruction , Nasolacrimal Duct , Retrospective Studies , Mitomycin
4.
Arq. bras. oftalmol ; 83(1): 1-4, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1088953

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Dacryocystorhinostomy/methods , Lasers, Semiconductor/therapeutic use , Lacrimal Duct Obstruction/diagnosis , Nasolacrimal Duct/physiopathology , Cross-Sectional Studies , Predictive Value of Tests , Reproducibility of Results , Contrast Media , Endoscopy/methods
5.
Chinese Medical Journal ; (24): 2422-2428, 2020.
Article in English | WPRIM | ID: wpr-877858

ABSTRACT

BACKGROUND@#Hasner valve incision has been recently introduced as a new treatment for ophthalmic patients with epiphora symptoms. The aim of this study was to examine whether surgical outcomes of Hasner valve incision for inferior nasolacrimal duct obstruction were different between pediatric and adult patients.@*METHODS@#A total of 53 eyes of 52 patients who underwent Hasner valve incision in the Beijing Tongren Hospital from October 2016 to November 2019 were retrospectively observed. Patients were divided into two groups, including pediatric group (23 eyes of 22 patients,  0.05).@*CONCLUSION@#Hasner valve incision was effective for both adult and children with inferior nasolacrimal duct obstruction, with no difference in surgical outcomes between the two groups.


Subject(s)
Adolescent , Adult , Child , Dacryocystorhinostomy , Humans , Lacrimal Duct Obstruction , Nasolacrimal Duct , Retrospective Studies , Treatment Outcome
6.
Rev. cuba. oftalmol ; 32(4): e806, oct.-dic. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1099105

ABSTRACT

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)


Subject(s)
Humans , Female , Adult , Papilloma/drug therapy , Dacryocystorhinostomy/methods , Dacryocystitis/etiology , Lacrimal Duct Obstruction/diagnostic imaging
7.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 191-195, 2019. tab
Article in English | LILACS | ID: biblio-1015264

ABSTRACT

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)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Quality of Life , Dacryocystorhinostomy/methods , Endoscopy , Postoperative Care , Preoperative Care , Lacrimal Apparatus Diseases/surgery , Lacrimal Apparatus Diseases/pathology , Nasolacrimal Duct/pathology
8.
Article in Korean | WPRIM | ID: wpr-738589

ABSTRACT

PURPOSE: We report a case of acute dacryocystitis diagnosed with abscess and rupture of lacrimal sac and fistula to posterior orbit during the operation. CASE SUMMARY: A 71-year-old woman visited our clinic with edema and pain in the eyelid from three days ago. For past four months, there was viscous of the left eye and tears. The patient had severe conjunctival chemosis and hyperemia, compared with the left eyelid edema and redness. Orbital CT scan showed orbital cellulitis, which was followed by systemic antibiotics and steroid therapy. On the 4th day of therapy, orbital abscess formation was observed in orbit MRI and surgical drainage was planned. During surgery, we found rupture of the posterior part of lacrimal sac and fistula to posterior orbit. Pseudomonas aeruginosa was identified in the bacterial cultures, and after the administration of appropriate antibiotics, the disease showed improved progress, and then additional dacryocystorhinostomy was performed. CONCLUSIONS: In our case, acute dacryocystitis rarely spread in orbit, which may lead to delayed diagnosis, orbital cellulitis and abscess, resulting in serious complications of vision threat. So, we think that it is necessary to consider surgical treatment more actively in the stage of chronic dacryocysitis.


Subject(s)
Abscess , Aged , Anti-Bacterial Agents , Dacryocystitis , Dacryocystorhinostomy , Delayed Diagnosis , Drainage , Edema , Eyelids , Female , Fistula , Humans , Hyperemia , Magnetic Resonance Imaging , Nasolacrimal Duct , Orbit , Orbital Cellulitis , Pseudomonas aeruginosa , Rupture , Tears , Tomography, X-Ray Computed
9.
Article in English | WPRIM | ID: wpr-741316

ABSTRACT

PURPOSE: We sought to evaluate the outcomes of external dacryocystorhinostomy (DCR) and mono-canalicular intubation in patients with total obstruction of one canalicus. METHODS: Sixteen eyes of 16 patients with nasolacrimal duct obstruction and a single canaliculus obstruction who had undergone external DCR and monocanalicular intubation of the intact canaliculus were retrospectively included in the present study. The monocanalicular tube (Mini Monoka) was left in place for at least two months. Munk epiphora grading for the evaluation of epiphora and irrigation was performed both preoperatively and at 6 months postoperatively. RESULTS: Mean patient age was 46 ± 14.2 (range, 18 to 76) years. The inferior canaliculus was obstructed in nine eyes (group A) and the superior canaliculus was obstructed in seven eyes (group B), respectively. Eight eyes had chronic dacryocystitis and two of these eyes also had a history of acute dacryocystitis attack. Mean preoperative Munk scores were 3.89 in group A and 4.0 in group B. Ocular surface irritation occurred in one eye in group A. Artificial eye drops were prescribed and early tube removal was not performed. Spontaneous tube dislocation was recorded in one eye in group B. No other corneal, punctal, or canalicular complications were found. At six months, irrigation of intact canaliculus was patent in all eyes. Mucoid discharge, conjunctival hyperemia, and chronic conjunctivitis were also resolved. Postoperative Munk scores were 1.11 ± 0.9 in group A and 0.86 ± 0.9 in group B. Of note, preoperative and postoperative Munk scores were significantly different in both groups (group A, p = 0.006; group B, p = 0.017). The postoperative Munk scores were not statistically different between the two groups (p = 0.606). CONCLUSIONS: In patients with nasolacrimal duct obstruction and a total of one canaliculus obstruction, external DCR and monocanalicular intubation of the intact canaliculus is an effective surgical option.


Subject(s)
Conjunctivitis , Dacryocystitis , Dacryocystorhinostomy , Joint Dislocations , Eye, Artificial , Humans , Hyperemia , Intubation , Lacrimal Apparatus Diseases , Lacrimal Duct Obstruction , Nasolacrimal Duct , Retrospective Studies
10.
Arq. bras. oftalmol ; 81(6): 500-504, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-973850

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Technology Assessment, Biomedical , Dacryocystorhinostomy/statistics & numerical data , Lacrimal Duct Obstruction , Postoperative Period , Silicones/therapeutic use , Dacryocystorhinostomy/methods , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Surgeons
11.
Article in Korean | WPRIM | ID: wpr-738567

ABSTRACT

PURPOSE: We report a case of a young female patient who was diagnosed with a marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) of the lacrimal sac which mimicked dacrocystitis. CASE SUMMARY: A 23-year-old female suffered from epiphora for 3 years in the right eye. She had swelling and a painful lesion at the lacrimal sac 4 months prior and was referred to our hospital due to nasolacrimal duct obstruction and dacryocystitis. Lacrimal irrigation was performed with no passing and regurgitation with mucoid discharge. We performed orbital computed tomography and magnetic resonance imaging which showed a suspected tumor of the lacrimal sac in the right eye. We then performed excision and biopsy of the tumor through the skin approach. The patient was diagnosed with a MALT lymphoma with no systemic involvement. After six cycles of chemotherapy involving rituximab with cyclophosphamide, vincristine, and prednisone, the lesion of the mass and the painful symptoms decreased, which was regarded as a complete response. However, epiphora and eye discharge persisted, showing a nasolacrimal duct obstruction, so we performed endoscopic dacryocystorhinostomy with a lacrimal sac biopsy. The histological examination showed chronic inflammation, but not lymphoma. There was no recurrence of lymphoma at one year postoperatively. CONCLUSIONS: If there is an epiphora and palpable lesion in the lacrimal sac area, MALT lymphoma mimicking dacyocystitis may be suspected. After the lymphoma is first diagnosed by excision and biopsy, systemic chemotherapy with dacryocystorhinostomy could be an effective treatment.


Subject(s)
Biopsy , Cyclophosphamide , Dacryocystitis , Dacryocystorhinostomy , Drug Therapy , Female , Humans , Inflammation , Lacrimal Apparatus Diseases , Lymphoid Tissue , Lymphoma , Lymphoma, B-Cell, Marginal Zone , Magnetic Resonance Imaging , Nasolacrimal Duct , Orbit , Prednisone , Recurrence , Rituximab , Skin , Vincristine , Young Adult
12.
Article in English | WPRIM | ID: wpr-719171

ABSTRACT

PURPOSE: Various absorbable anti-adhesion agents have been used to prevent postoperative synechia formation after endonasal surgery. The purpose of this study was to evaluate the anti-adhesion effects of HyFence and Mediclore after endonasal dacryocystorhinostomy (DCR) compared to a mixed solution of hyaluronic acid and sodium carboxymethylcellulose (Guardix-Sol). METHODS: In this retrospective study, endonasal DCR and silicone tube intubation were performed on 198 eyes of 151 patients. Three different anti-adhesion adjuvants were applied to the osteotomy site in the nasal cavity after standard endonasal DCR procedures. The subjects were classified into three respective groups: group A (71 eyes, Guardix-Sol 1.5 g), group B (89 eyes, HyFence 1.5 mL), and group C (38 eyes, Mediclore 1 cc). The three groups were evaluated by asking patients about subjective symptoms and by performing lacrimal irrigation tests and endoscopic examinations. RESULTS: There were no statistically significant differences in age, sex, timing of tube removal, or follow-up period among the three groups. There were no statistically significant differences in success rates among the three groups (p = 0.990, 91.5% [65 / 71], 92.1% [82 / 89], and 92.1% [35 / 38], respectively). CONCLUSIONS: HyFence and Mediclore are safe and effective adjunctive modalities following endonasal DCR compared to Guardix-Sol. Therefore, these agents can be considered good alternatives to Guardix-Sol to increase the success rate of endonasal DCR in treating patients with poor prognosis.


Subject(s)
Carboxymethylcellulose Sodium , Dacryocystorhinostomy , Follow-Up Studies , Humans , Hyaluronic Acid , Intubation , Nasal Cavity , Osteotomy , Prognosis , Retrospective Studies , Silicon , Silicones
13.
Article in English | WPRIM | ID: wpr-716898

ABSTRACT

We evaluated the effect of silicone stent use during endoscopic dacryocystorhinostomy on postoperative morbidities in comparison with versus without a silicone stent. Two authors independently searched six databases (PubMed, Embase, Scopus, the Web of Science, the Cochrane library, and Google Scholar) from inception of article collection to July 2017. The analysis included prospective randomized studies that compared intraoperative silicone stent insertion (silicone group) with no application of a silicone stent (control group), in which the outcomes of interest were success rate (lacrimal passage patent check with syringing, symptom relief, or endoscopic confirmation of fluorescein dye from the opening of Hasner's valve) and morbidities (e.g., postoperative bleeding, rhinostomy closure, granulation tissue, synechia, and eyelid problems) after certain follow-up periods (over 10 weeks). Nine studies involving a total of 587 participants were included. Functional success rates tended to be higher in the silicone group than in the control, but there was no statistically significant difference in success rates (odds ratio, 1.45; 95% confidence interval, 0.77 to 2.73). According to the surgical type such as mucosal removal and mucosal flap surgery, the results from types didn't demonstrate any significant effect, but the mucosal flap technique seemed to be more beneficial. Regarding postoperative morbidities, although the outcomes of the groups did not present any statistically significant difference, eyelid problems and postoperative bleeding tended to occur more frequently in the silicone group, but rhinostomy closure tended to occur more frequently in the control group. Success and morbidity rates showed no difference between the silicone stent group and control group in the meta-analysis. However, additional analyses revealed that the success rate of endonasal dacryocystorhinostomy using silicone intubation with mucosal flap has shown an improving trend, and morbidities such as granulation and synechia showed decreasing trends compared with the group without silicone intubation.


Subject(s)
Dacryocystorhinostomy , Eyelids , Fluorescein , Follow-Up Studies , Granulation Tissue , Hemorrhage , Intubation , Prospective Studies , Silicon , Silicones , Stents , Treatment Outcome
14.
Article in English | WPRIM | ID: wpr-715304

ABSTRACT

OBJECTIVES: Insertion of a silicone stent during endoscopic dacryocystorhinostomy (DCR) is the most common procedure to prevent rhinostomy closure. It has been claimed that silicone intubation improves the surgical outcomes of endoscopic DCR. However, many reports have documented an equally high success rate for surgery without silicone intubation. Accordingly, we conducted a systematic review and meta-analysis to clarify the outcomes of endoscopic DCR with and without silicone intubation and determine whether silicone intubation is actually beneficial for patients. METHODS: PubMed, Embase, and Cochrane Library databases were searched to identify relevant controlled trials evaluating endoscopic DCR with and without silicone intubation. The search was restricted to English articles published between January 2007 and December 2016. Relevant articles were reviewed to obtain information pertaining to interventions and outcomes. We also performed a meta-analysis of the relevant literature. RESULTS: In total, 1,216 patients included in 12 randomized controlled trials were pooled. A total of 1,239 endoscopic DCR procedures were performed, and silicone stents were used in 533 procedures. The overall success rate for endoscopic DCR was 91.9% (1,139/1,239), while the success rates with and without silicone intubation were 92.9% (495/533) and 91.2% (644/706), respectively. There was no statistically significant heterogeneity among the included studies. A meta-analysis using a fixed-effects models showed no significant difference in the success rate between endoscopic DCR with silicone intubation and that without silicone intubation (OR, 1.38; 95% CI, 0.89 to 2.12; P=0.148; z=1.45). Furthermore, there were no significant differences with regard to surgical complications such as synechia, granulation, and postoperative bleeding. CONCLUSION: The findings of our meta-analysis suggest that the success rate and postoperative complication rate for endoscopic DCR is not influenced by the use of silicone intubation during the procedure.


Subject(s)
Dacryocystorhinostomy , Endoscopy , Hemorrhage , Humans , Intubation , Population Characteristics , Postoperative Complications , Silicon , Silicones , Stents
15.
Acta otorrinolaringol. cir. cabeza cuello ; 45(4): 267-270, 2017. ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-970518

ABSTRACT

Desde hace muchos años la vía lagrimal la han compartido dos disciplinas: la otorrinolaringología y la oftalmología. Con el paso del tiempo se han desarrollado diferentes técnicas encaminadas al manejo de la patología de la vía nasolagrimal desde la tradicional vía externa hasta los procedimientos asistidos con Láser. La DCR (dacriocistorrinostomia) endoscópica es al día de hoy el procedimiento ideal para el manejo de la insuficiencia y la estenosis de la vía lagrimal, derivado de traumas, dacriocistitis o disfunción de la vía nasolagrimal. Presentamos el reporte de nuestra experiencia en el manejo de estos trastornos en conjunto con el servicio de oftalmología en el Hospital de Ecopetrol de Barrancabermeja, dando especial relevancia a la técnica quirúrgica y a los resultados posoperatorios evitando la morbilidad de la dacriocistorrinostomia externa.


During long time, the lacrimal pathway has been studied and treated by two specialties. Otolaryngology and ophthalmology. As time has gone by, different techniques for treating the lacrimal pathway have been developed, such as the traditional external approach and the laser assisted procedures. Nowadays, endoscopic DCR (dacryocystorhinostomy) is the ideal procedure for treating the lacrimal pathway insufficiency and stenosis secondary to trauma, dacryocystitis or dysfunction of the nasolacrimal pathway. We report our experience in the management of these disorders with the Ecopetrol Hospital in Barrancabermeja's Ophthalmology service, giving special relevance to the surgical technique and the postoperative results avoiding the morbidity of the external dacryocystorhinostomy.


Subject(s)
Humans , Dacryocystorhinostomy , Lacrimal Apparatus , Lacrimal Apparatus Diseases
16.
Article in Korean | WPRIM | ID: wpr-648867

ABSTRACT

Epiphora is an overflow of tears onto the face and mainly occurs secondary to abnormal excretory system such as nasolacrimal duct obstruction (NLDO), which could be congenital or acquired. In past years, patients with NLDO have been usually managed by ophthalmologists using external dacryocystorhinostomy (EX-DCR) which has been considered the gold standard of treatment. Recently, the advancement of nasal endoscope and endoscopic sinus surgery has contributed to perform endoscopic DCR (EN-DCR), which now offers comparable success rate to EX-DCR with many advantages. ENT surgeons are familiar with intranasal anatomy and nasal endoscope handling rather than ophthalmologists. Therefore, these advantages lead to more ENT surgeons performing endoscopic DCR. However, the learning curves exist to reach a favorable success rate because surgical technique should be delicate in the narrow nasal cavity. This paper attempts to describe management of epiphora from ENT perspective, focus on surgical anatomy, evaluation modalities and update on endoscopic technique and surgical outcome compared with EX-DCR. This present review would serve as a guide for beginners and increase their confidence with endoscopic anatomy and correct management of epiphora including EN-DCR procedures.


Subject(s)
Dacryocystorhinostomy , Endoscopes , Endoscopy , Humans , Lacrimal Apparatus Diseases , Learning Curve , Nasal Cavity , Nasolacrimal Duct , Otolaryngology , Surgeons , Tears
17.
Chinese Medical Journal ; (24): 698-702, 2017.
Article in English | WPRIM | ID: wpr-266924

ABSTRACT

<p><b>BACKGROUND</b>Rupture of the medial canthal ligament can be caused by many events. It remains a challenge to rebuild the drainage system and restore the function. The aim of this study was to evaluate the clinical efficacy of medial canthoplasty combined with conjunctivodacryocystorhinostomy (CDCR) in patients with medial telecanthal deformities and lacrimal drainage system damage.</p><p><b>METHODS</b>Twenty-two patients (22 eyes) treated with medial canthoplasty and CDCR during June 2012 to June 2014 were included in this retrospective study. For all patients, a self-tapping, titanium, low-profile head microscrew was drilled into the solid bone on the posterior aspect of the anterior lacrimal crest at the attachment position of the medial canthal ligament. Medpor-coated tear drainage tubes were applied. Distance of patient's lateral displacement before and after operation was recorded and compared. The complications of CDCR were described.</p><p><b>RESULTS</b>Before the surgery, distance of patient's canthal displacement was 4-6 mm. The canthal distance between two eyes of patients with surgery was 1 mm or less. Among patients with CDCR, four patients had proximal obstruction and two patients had distal obstruction. Five patients had tube malposition, for example, tube extrusion 1-3 months after surgery.</p><p><b>CONCLUSIONS</b>Medial canthoplasty combined with CDCR is an effective surgical method for treatment of patients with medial telecanthal deformity and lacrimal drainage system obstruction. The study indicates that medial canthoplasty combined with CDCR surgery rebuilds normal appearance of eyelid and contour of the medial canthus and successfully repairs the function of the lacrimal drainage system.</p>


Subject(s)
Adult , Aged , Blepharoplasty , Methods , Conjunctiva , Pathology , General Surgery , Dacryocystorhinostomy , Methods , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
18.
Article in Korean | WPRIM | ID: wpr-183620

ABSTRACT

PURPOSE: We report a case of fungal ball after Endoscopic Dacryocystorhinostomy (DCR) in a 40-year-old female patient. CASE SUMMARY: A 40-year-old female patient was admitted to our hospital for left lower eyelid tenderness and bloody discharge from the lacrimal punctum. During a planned endoscopic DCR, the sac was opened after the osteotomy, and 2 fungal balls were found in the lacrimal sac. The masses were 7 × 5 mm and, 9 × 5 mm sized, irregularly shaped, and red in color. Aspergillus fumigatus was diagnosed pathologically. Postoperative paranasal sinus magnetic resonance imaging showed no residual fungal ball. During follow-up, the patient showed patent rhinostomy opening, and there was no evidence of fungal infection on nasal endoscopic finding. CONCLUSIONS: Although Aspergillus fumigatus is a rare cause of canalicular obstruction, fungal ball development in the lacrimal sac can cause acute dacryocystitis.


Subject(s)
Adult , Aspergillus fumigatus , Dacryocystitis , Dacryocystorhinostomy , Eyelids , Female , Follow-Up Studies , Humans , Lacrimal Apparatus , Magnetic Resonance Imaging , Nasolacrimal Duct , Osteotomy
19.
Article in Korean | WPRIM | ID: wpr-128319

ABSTRACT

PURPOSE: This article analyzes the microorganisms and antibiotics susceptibility in dacryocystitis. METHODS: In this study, patients who were diagnosed with acute and chronic dacryocystitis with nasolacrimal duct obstruction were selected and underwent endoscopic endonasal dacryocystorhinostomy. Cultures were obtained from the lacrimal sac during operation from January 2008 to January 2016, and were used to analyze the microorganisms and antibiotics susceptibility. RESULTS: The 67 patients, 9 were diagnosed with acute dacryocystitis and 58 were diagnosed with chronic dacryocystitis. Among them, 64 cases showed bacterial growth (95.5%). The most frequently detected bacteria was Staphylococcus epidermidis (S. epidermidis) (33.8%), followed by Staphylococcus aureus (S. aureus) (25.4%) and Enterobacter aerogenes (18.3%). S. epidermidis had the most powerful resistance to ciprofloxacin compared to the other bacteria (58.3%, p = 0.02). Except for S. epidermidis and S. aureus, the other bacteria responded to ciprofloxacin and gentamycin. CONCLUSIONS: As a causative microorganism of dacryocystitis, S. epidermidis is becoming more prominent, and it is thought that S. epidermidis may be resistant to quinolones (i.e., broad-spectrum antibiotics). This resistance might be increasing the percentage of present S. epidermidis when viewed as a causal pathogen in dacryocystitis.


Subject(s)
Anti-Bacterial Agents , Bacteria , Ciprofloxacin , Dacryocystitis , Dacryocystorhinostomy , Enterobacter aerogenes , Gentamicins , Humans , Nasolacrimal Duct , Quinolones , Staphylococcus aureus , Staphylococcus epidermidis
20.
Article in Korean | WPRIM | ID: wpr-127899

ABSTRACT

Epiphora is one of the most common problems in ophthalmological practice, and is caused by dysfunction of the lacrimal pathway. The lacrimal drainage system is a continuous anatomical structure consisting of the lacrimal punctum, inferior and superior canaliculi, common canaliculus, lacrimal sac, and nasolacrimal duct. Lacrimal disease can be medically treated in case of acute inflammation or partial obstruction at the beginning of treatment, but surgical treatment is necessary in most cases. This paper discusses the etiology, clinical features, diagnosis, and surgical treatment of various lacrimal diseases through a selective review of the relevant literature. Advances in lacrimal duct surgery can now be performed in such a way that the structural integrity and normal physiological function of the entire efferent lacrimal pathway is preserved.


Subject(s)
Dacryocystorhinostomy , Diagnosis , Drainage , Inflammation , Lacrimal Apparatus , Lacrimal Apparatus Diseases , Lacrimal Duct Obstruction , Nasolacrimal Duct
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