Dacriocistorrinostomía endonasal: participación del oftalmólogo / Endoscopic dacryocystorhinostomy: Role of the ophthalmologist

OBJETIVO: Evaluar los resultados de la dacriocistorrinostomía (DCR) endoscópica con o sin apoyo del oftalmólogo. MATERIAL Y MÉTODOS: Estudio retrospectivo de 100 casos operados de DCR endoscópica por un otorrinolaringólogo entre junio de 2008 y diciembre de 2009. De las 100, 50 fueron intervenidas con apoyo quirúrgico de un oftalmólogo, que canalizaba los canalículos superior e inferior con sondas de Bowman, mientras que en los otros 50 casos fue el propio otorrinolaringólogo quién realizó esta canalización, sin apoyo del oftalmólogo. La evaluación de los resultados a 2 años incluyó la percepción subjetiva, la permeabilidad de la vía lagrimal tras lavado y la permeabilidad funcional de la vía lagrimal tras test de Jones modificado. RESULTADOS: De las 100 DCR revisadas, en más del 50% se realizó algún tratamiento complementario por el otorrinolaringólogo, sobre todo septoplastias. En cuanto a la resolución de la epífora, cuando no hubo oftalmólogo presente en el quirófano, los pacientes referían mejoría subjetiva total en 75%; sin embargo, en el grupo cuya canalización quirúrgica era realizada por el oftalmólogo, los resultados satisfactorios llegaban al 92% de forma subjetiva, diferencia estadísticamente significativa. CONCLUSIONES: La DCR endoscópica es efectiva en el tratamiento de la epífora, pero sus resultados mejoran cuando el oftalmólogo colabora en el procedimiento quirúrgico, canalizando la vía lagrimal

OBJECTIVE: To evaluate the results of endoscopic dacryocystorhinostomy (DCR) with or without support of the ophthalmologist. MATERIAL AND METHODS: A retrospective study of 100 cases of endoscopic DCR surgery conducted by an otolaryngologist between June 2008 and December 2009. Of the 100 cases, 50 were operated with surgical support of the ophthalmologist, who inserted Bowman probes in the upper and lower canaliculi, while in the other 50 cases it was the otolaryngologist who performed this, without support of the ophthalmologist. The evaluation of the results after 2 years included the subjective perception, the lacrimal patency after lacrimal syringing, and lacrimal functional test after modified Jones test. RESULTS: Of the 100 DCR reviewed, more than 50% required complementary treatment by the otolaryngologist, mainly septoplasty. As for the resolution of epiphora, without support of the ophthalmologist, 75% the patients reported an overall subjective improvement, but this reached 92% in the surgical group with support of the ophthalmologist, which was a statistically significant difference. CONCLUSIONS: Endoscopic DCR is effective in the treatment of epiphora, but its results improve when the ophthalmologist inserts the probes in the lacrimal canaliculi during the surgical procedure

[Endoscopic dacryocystorhinostomy: role of the ophthalmologist]. / Dacriocistorrinostomía endonasal: participación del oftalmólogo.

OBJECTIVE: To evaluate the results of endoscopic dacryocystorhinostomy (DCR) with or without support of the ophthalmologist. MATERIAL AND METHODS: A retrospective study of 100 cases of endoscopic DCR surgery conducted by an otolaryngologist between June 2008 and December 2009. Of the 100 cases, 50 were operated with surgical support of the ophthalmologist, who inserted Bowman probes in the upper and lower canaliculi, while in the other 50 cases it was the otolaryngologist who performed this, without support of the ophthalmologist. The evaluation of the results after 2 years included the subjective perception, the lacrimal patency after lacrimal syringing, and lacrimal functional test after modified Jones test. RESULTS: Of the 100 DCR reviewed, more than 50% required complementary treatment by the otolaryngologist, mainly septoplasty. As for the resolution of epiphora, without support of the ophthalmologist, 75% the patients reported an overall subjective improvement, but this reached 92% in the surgical group with support of the ophthalmologist, which was a statistically significant difference. CONCLUSIONS: Endoscopic DCR is effective in the treatment of epiphora, but its results improve when the ophthalmologist inserts the probes in the lacrimal canaliculi during the surgical procedure.

[Meningocele, glioma and optic nerve meningioma: differential diagnosis and treatment]. / Meningocele, glioma y meningioma del nervio óptico: diagnóstico diferencial y tratamiento.

PURPOSE: After studying 3 clinical cases, we have reviewed the clinical and radiological characteristics of meningocele, meningioma and optic nerve glioma. The differential diagnosis and therapeutic management are also discussed. METHODS: Review of three clinical reports of three patients seen in our unit and a bibliographic search concerning the diagnosis and therapeutic management of these three entities at the present time. RESULTS: Differential diagnosis has to be based on a wide range of parameters: epidemiologic (age, race, sex, prevalence of the tumors), clinical (visual acuity, perimetry, Hertel exophthalmometry and funduscopy) and radiologic (computed tomography and magnetic resonance). Anatomopathologic study is required only rarely. The therapeutic options are: observation, surgery and radiotherapy. CONCLUSION: A correct differential diagnosis is mandatory to be able to individualize the treatment for each entity (Arch Soc Esp Oftalmol 2009; 84: 563-568).

Meningocele, glioma y meningioma del nervio óptico: diagnóstico diferencial y tratamiento / Meningocele, glioma and optic nerve meningioma: differential diagnosis and treatment

Objetivo: Estudiar a partir de 3 casos las característicasclínicas y radiológicas del meningocele,meningioma y glioma del nervio óptico (NO) paradiscutir su diagnóstico diferencial así como su enfoqueterapéutico.Método: Se revisaron las historias clínicas de trespacientes afectos de las patologías anteriormentemencionadas que fueron estudiados en nuestro servicio,y se realizó una revisión bibliográfica sobre eldiagnóstico y tratamiento actual de estas entidades.Resultados: El diagnóstico diferencial debe basarseen un amplio abanico de aspectos: edad, raza,sexo y frecuencia de la tumoración como factoresepidemiológicos a tener en cuenta. Clínicamentelos pilares fundamentales son: agudeza visual (AV),campimetría, exoftalmometría Hertel y funduscopia,que nos servirán para controlar la evolución delproceso. Las características radiológicas que nosaportan la resonancia magnética (RM) y la tomografíacomputerizada (TC) como técnicas de elecciónnos ayudan a diferenciar un cuadro de otro. Enraras ocasiones hay que recurrir al estudio anatomopatológicopara confirmar la entidad. Las opcionesterapéuticas son observación, cirugía, quimioterapiay radioterapia en función de las características del caso.Conclusión: El diagnóstico diferencial de estaspatologías es difícil, y hay que basarse en sus característicasclínicas y radiológicas para así orientarcorrectamente su tratamiento, individualizandocada caso y teniendo en cuenta el comportamientorelativamente benigno de estos tumores para evitaruna decisión terapéutica precipitada(AU)

Purpose: After studying 3 clinical cases, we havereviewed the clinical and radiological characteristicsof meningocele, meningioma and optic nerveglioma. The differential diagnosis and therapeuticmanagement are also discussed.Methods: Review of three clinical reports of threepatients seen in our unit and a bibliographic searchconcerning the diagnosis and therapeutic managementof these three entities at the present time.Results: Differential diagnosis has to be based on awide range of parameters: epidemiologic (age, race,sex, prevalence of the tumors), clinical (visualacuity, perimetry, Hertel exophthalmometry andfunduscopy) and radiologic (computed tomographyand magnetic resonance). Anatomopathologicstudy is required only rarely. The therapeuticoptions are: observation, surgery and radiotherapy.Conclusion: A correct differential diagnosis ismandatory to be able to individualize the treatmentfor each entity(AU)

[Sebaceous carcinoma. Study of two cases]. / Carcinoma de glándulas sebáceas: presentación de dos casos clínicos.

CLINICAL CASES: A 94-year-old woman, who had had a chalazion for a period of 8 months, presented because of thickening of the eyelid with necrosis, madarosis and adenopathy. A 67-year-old woman, previously operated on for a sebaceous carcinoma, presented because of reddening of the conjunctiva and eyelid. Clinical evaluation revealed inflammation of the eyelid and an irregular and erythematous superior bulbar conjunctiva with disruption of the limbal architecture. DISCUSSION: A sebaceous carcinoma is a tumour which is difficult to diagnose and treat, because it can be patchy and has a tendency to pagetoid dissemination. Diagnosis requires a biopsy of the lesion and mapping of biopsies from the conjunctiva of the eyelid and eyebrow. The subsequent treatment depends on the extent of the tumour, and may involve simple cleavage, topical mitomycin C, radiotherapy or exenteration of the eyebrow.

Carcinoma de glándulas sebáceas: presentación de dos casos clínicos / Sebaceous carcinoma. Study of two cases

Casos clínicos: Mujer de 94 años que consulta por chalazión de 8 meses de evolución. Presenta engrosamiento palpebral con necrosis y madarosis, y una adenopatía preauricular. Mujer de 67 años operada de un carcinoma de glándulas sebáceas que acude por enrojecimiento conjuntival y palpebral. La biomicroscopía manifestaba inflamación del párpado y presencia de una conjuntiva bulbar superior irregular y muy eritematosa con desestructuración de la arquitectura limbar. Discusión: El carcinoma de glándulas sebáceas es un tumor de diagnóstico y manejo difícil ya que puede presentarse de manera parcheada y tiene tendencia a la diseminación pagetoide. Para su diagnóstico se debe realizar biopsia escisional y mapa de biopsias de conjuntiva palpebral y bulbar. El tratamiento posterior dependerá de la extensión del tumor, bien escisión simple, Mitomicina C tópica, radioterapia o exenteración orbitaria

Clinical cases: A 94-year-old woman, who had had a chalazion for a period of 8 months, presented because of thickening of the eyelid with necrosis, madarosis and adenopathy. A 67-year-old woman, previously operated on for a sebaceous carcinoma, presented because of reddening of the conjunctiva and eyelid. Clinical evaluation revealed inflammation of the eyelid and an irregular and erythematous superior bulbar conjunctiva with disruption of the limbal architecture. Discussion: A sebaceous carcinoma is a tumour which is difficult to diagnose and treat, because it can be patchy and has a tendency to pagetoid dissemination. Diagnosis requires a biopsy of the lesion and mapping of biopsies from the conjunctiva of the eyelid and eyebrow. The subsequent treatment depends on the extent of the tumour, and may involve simple cleavage, topical mitomycin C, radiotherapy or exenteration of the eyebrow