Does Bicanalicular Intubation Improve the Outcome of Endoscopic Dacryocystorhinostomy?

The aim of this study was to compare the success of endoscopic dacryocystorinostomy with and without bicanalicular intubation in the treatment of distal nasolacrimal duct obstruction. METHODS: In a prospective, randomized, comparative study, endoscopic dacryocystorinostomy without bicanalicular silicone intubation (Group I) and endoscopic dacryocystorinostomy with intubation (Group II) were performed in patients with distal nasolacrimal duct obstructions. The tubes were removed 3 months after surgery in Group II, and the patients were followed up for 6 months after surgery. Therapeutic success was defined as the fluorescein dye disappearance test grade 0-1 corresponding with a complete resolution of symptoms. RESULTS: Thirty patients, aged 23-86 years, were included in the study. The success rate was 13/15 (86.67%) in Group I and in 14/15 (93.33%) in Group II. The difference between the two groups was not statistically significant (p = 0.483). Most common complications were granulations that occurred in 1/15 (6.67%) patient in Group I and in 2/15 (13.33%) patients in Group II. Adhesions in rhinostomy with epiphora and persistent secretion were observed in 1/15 (6.67%) patient in Group II. CONCLUSIONS: Bicanalicular intubation does not significantly increase the success rate of EDCR in distal nasolacrimal obstruction in adults.

Lacrimal sac dacryolith (76 cases): a predictive factor for successful endonasal dacryocystorhinostomy?

To evaluate whether the presence of dacryolith is a predictive factor for successful dacryocystorhinostomy. The success rate of endonasal dacryocystorhinostomy (EDCR) performed to relieve obstruction of the nasolacrimal duct was evaluated according to the presence of dacryolithiasis. The surgical results of patients with (group I) and without dacryoliths (group II) were analysed and compared 1-year post surgery. A total of 771 EDCRs performed from 1994 to 2010 were evaluated. Dacryolith was found in 76/771 procedures (9.9%). Complete improvement was achieved significantly more frequently in group I (76/76; 100.0%) than in group II (633/695; 91.1%; p < 0.001). EDCRs were performed significantly more frequently in people aged 31-50-years, the average age of the group I was 41.1 years (range 18-72 years), of the group II 53.3 years (range 3 months-86 years; p < 0.001). There was no significant difference in the female-to-male ratio in the two groups. The presence of dacryoliths is a predictive factor for successful endonasal dacryocystorhinostomy.

Lacrimal sac dacryoliths (86 samples): chemical and mineralogic analyses.

BACKGROUND: Because dacryoliths occur at low frequency, few studies have focused on their composition. We aimed to present findings from morphological, chemical, and mineralogic analysis of 86 dacryoliths. METHODS: We studied 86 dacryoliths obtained during 832 dacryocystorhinostomies (DCR) performed for postsaccal obstruction. We examined the samples with atomic infrared spectrometry (80 samples), amino acid analysis (17 samples), scanning electron microscopy, and an electron microprobe with an energy dispersive detector (seven samples). RESULTS: Dacryoliths were found in 86/832 DCRs (10.3 %), mostly in patients with primary acquired nasolacrimal duct obstruction. All the dacryoliths were soft, composed of organic material, including proteins and mucoproteins, with approximately 20 % amino acid content. There were no "hard" dacryoliths composed of calcium phosphate. The stones were composed of lobes and lobules built on an amorphous core material with small cavities, probably as a result of various chemical processes that produced a gaseous product. The most frequent elements found in inorganic inclusions were silicon, magnesium, sulfur, potassium, calcium, sodium, and chlorine. Also, some particles had high contents of bismuth, titanium, iron, and organic fibers. The fibers found in the core of dacryoliths suggested a potential origin from cotton swabs used in cosmetics. CONCLUSION: Dacryoliths are composed almost exclusively of organic material, including proteins and mucoproteins, with approximately 20 % amino acid content.

Monocanalicular versus bicanalicular intubation in the treatment of congenital nasolacrimal duct obstruction.

BACKGROUND: To compare the success rate of monocanalicular intubation (MCI) compared with bicanalicular silicone intubation (BCI) in congenital nasolacrimal duct obstruction (CNLDO) in infants and toddlers. METHODS: In a prospective, nonrandomized, comparative study, MCI (n = 35 eyes) through the inferior canaliculus or BCI (n = 35 eyes) were performed under general anaesthesia in children aged 10 to 36 months with CNLDO. The tubes were removed 3-4 months after tube placement, and the children were followed up for 6 months after the removal of tubes. Therapeutic success was defined as the fluorescein dye disappearance test grade 0-1, corresponding with a complete resolution of previous symptoms. Partial success was defined as improvement with some residual symptoms. RESULTS: Complete and partial improvement was achieved in 31/35 (88.57%) in the BCI group and 34/35 (97.14%) in the MCI group. The difference between the two groups was not significant (p = 0.584). Complications occurred in both groups. Dislodgement of the tube and premature removal was observed in four BCI cases, and loss of the tube was observed twice in the MCI group. Canalicular slitting was observed in five eyes in the BCI group. Granuloma pyogenicum observed in 2 cases with MCI revealed a few weeks after the tube removal. Corneal erosion in the inferior medial quadrant was observed in one MCI eye and revealed in a few days after the local treatment without tube removal. CONCLUSIONS: Both MCI and the BCI are effective methods for treating CNLDO. MCI has the advantage of a lower incidence of canalicular slit and easy placement.

Conjunctivocystorhinostomy with Jones tube--is it the surgery for children?

BACKGROUND: To present experience with conjunctivocystorhinostomies (CDCR) at pediatric age. METHODS: Operative and postoperative data were collected for 15 pediatric CDCRs (aged 9 to 14.5 years) performed endonasally. Four procedures were performed bilaterally, seven unilaterally. The follow-up examinations were made every 3 months in the first year, every 6 months in the second year, and every 12 months afterwards. The patient s satisfaction with the surgery, lacrimal drainage function, and complications were evaluated. The drainage function of the lacrimal system was assessed on the basis of the history, clinical examinations, and the fluorescein dye disappearance test. The data were taken from the medical records and written questionnaires. RESULTS: After the surgery, 12 children were very satisfied, two children partially satisfied, and one child was not satisfied (due to the loss of the tube). Full or partial functional success was found in 14 cases (93.3%); no functional success was observed in one case. The number of complications was higher than in other studies concerning adult patients. A total of 37 complications were observed in our study; most of the complications occurred in more than one of the children, and were observed in some children several times. The most frequent complications were lateral or medial malposition (25 times) and the extrusion of the tube (eight times). It was necessary to re-insert the tube in seven cases under general anaesthesia. The complications mostly occurred within the first 3 months after the surgery (seven complications during the first week, 12 complications between the 2nd and the 4th week, eight complications between the 5th and the 12th week, and three complications between the 9th and the 12th postoperative week). CONCLUSIONS: CDCR appears to be a reasonable procedure in children over 10 years old. Experience in lacrimal surgery (pediatric dacryocystorhinostomy, CDCR in adults), and good cooperation and compliance of children are a fundamental assumption for successful pediatric CDCR.

Primary pediatric endonasal dacryocystorhinostomy--a review of 58 procedures.

OBJECTIVES: The objectives of this study are to report the outcomes of pediatric patients with lacrimal system obstruction who underwent primary endoscopic dacryocystorhinostomy (EDCR). STUDY DESIGN: The authors conducted a retrospective noncomparative case series. METHODS: The operative and postoperative data have been collected in 58 children aged between 3 months and 13 years (mean 4.1 years). The total of 58 primary EDCRs has been performed by two surgeons using a standardized surgical technique. The EDCRs were performed 52 times on one eye, 6 times on both eyes (3 times simultaneously, 3 times at the separate sitting with an interval of 4-6 months). The follow-up evaluations include taking history, clinical examinations including a fluorescein disappearance test. RESULTS: The follow-up interval ranged from 12 to 36 months (mean 17 months, median 15 months). The success rate was 51/58 (87.9%) in all 58 EDCRs. The success rate was 47/51 (92.2%) in the group of postsaccal obstructions, 3/5 (60.0%) in the group of postsaccal and suprasaccal obstrutcions and 1/2 (50.0%) in presaccal obstructions. The procedures were successful in all eight children aged under 1 year old (100%) and in 14 of 15 children between 1 and 2 years old (93.3%). The silicone intubation was used in 54 EDCRs. CONCLUSIONS: The endoscopic DCR is a safe and effective procedure for most children with the success rate comparable to that achieved in the external DCR and in adults. The success rate of the postsaccal obstructions is significantly higher than in presaccal or combined pre- and postsaccal obstructions.

Does the length of intubation affect the success of treatment for congenital nasolacrimal duct obstruction?

PURPOSE: To compare success rates of intubation for 2 versus 5 months in congenital nasolacrimal duct obstruction in children between 15 and 30 months of age. METHODS: This prospective, randomized study evaluated drainage function in 145 eyes of children aged between 15 and 30 months and treated for congenital nasolacrimal duct obstruction using silicone stents with the fluorescein dye disappearance test. The tubes were removed 2 months (group I, 48 eyes) and 5 months (group II, 47 eyes) after stent placement. Thereafter, the children were followed for 6 months after tube removal. Fifty eyes were excluded from the study because of incomplete follow-up. RESULTS: The full resolution of symptoms (fluorescein test 0-1) was 33 of 48 in group I and 33 of 47 in group II at the time of tube removal (2 vs. 5 months). Six months after tube removal, the success rate was 43 of 48 (89.6%) in group I and 43 of 47 (91.5%) in group II. After the stents were removed, no relapses were observed in children having a fluorescein test 0-1 with the tubes remaining in the lacrimal system. CONCLUSIONS: The effects of intubation for 2 versus 5 months on the function of the nasolacrimal duct during and after intubation in children between 15 and 30 months of age are comparable. The fluorescein dye disappearance test is the test of choice for monitoring lacrimal drainage function.

Pediatric endonasal dacryocystorhinostomy: a report of 34 cases.

OBJECTIVES: To present experience with the endoscopic dacryocystorhinostomies (EDCR) at the pediatric age. STUDY DESIGN: Case series, clinical study. METHODS: The operative and postoperative data have been collected in 34 pediatric EDCRs (mean age 4.5 years; range 4 months to 13 years). The total of 34 primary and 5 revision procedures have been performed by the same surgeon using a standardized surgical technique. The follow-up evaluations include symptom evaluations and the endoscopic assessment of the newly created ostium with fluorescein testing. RESULTS: The 28 of 34 primary EDCRs (82.3%) were patent after a mean follow-up of 12 to 36 months: 24 of 27 (88.9%) procedures with subsaccal obstructions, 3 of 5 (60.0%) with combined subsaccal and suprasaccal obstructions, and 1 of 2 (50.0%) with suprasaccal obstructions. Intubation was used in 30 primary EDCRs. We found no differences in the success rate between the group with operative intranasal debridement and the group without it in the follow-up period. EDCRs failed in six patients, five of whom were revised endoscopically with success. CONCLUSIONS: EDCRs in children appear to provide a safe and successful procedure with the success rate comparable with those achieved with external DCRs and those in adults.

Conjunctivodacryocystorhinostomy tube placement with a urologic catheter.

In an endoscopically performed conjunctivodacryocystorhinostomy, insertion of a Jones glass tube can be difficult if the nasal end of the tube draws soft tissue around the tunnel in front of the tube. A urologic Tiemann catheter has been used for Jones tube placement in 44 cases since 2001. The tube is put in the lumen end of the catheter, the tip of which is bulbous and gradually tapered in its diameter. The catheter can be easily inserted into the tunnel and pulled out of the nose with forceps, leaving the glass tube in the tunnel.