Long-term outcomes of modified transcanalicular diode laser dacryocystorhinostomy.

PURPOSE: The purpose of this study is to assess the long-term outcomes of modified transcanalicular diode laser dacryocystorhinostomy in a large cohort of patients affected by primary acquired nasolacrimal duct obstruction. METHODS: This study, conducted from January 17 to June 2022, encompassed 141 patients (159 procedures) who underwent modified transcanalicular diode laser dacryocystorhinostomy (MT-DCR). The procedure employed an 810-nm diode laser. Patients were monitored for at least a year after the intervention. Anatomical success was determined by ostium patency upon irrigation, while functional success referred to epiphora resolution. Parameters studied included patient demographics, procedure duration, complications, and both anatomical and functional success. Statistical analysis was performed using the Statistical Package for the Social Sciences software, with results considered significant at a 95% confidence interval (p≤0.05). RESULTS: A total of 159 lacrimal drainage systems (141 patients: 112 women and 29 men) were included in this study. Among them, 18 underwent bilateral procedures. The average patient age was 58 years (range: 34-91 years), and the average surgical duration was 24 minutes (range: 18-35 minutes). One year after the surgery, MT-DCR exhibited anatomical and functional success rates of 84.9% (135/159) and 83% (132/159), respectively. CONCLUSION: MT-DCR achieved an anatomical success rate of 84.9%, reflecting an excellent outcome. However, further extensive studies with larger sample sizes and longer follow-up periods are necessary to substantiate these findings.

Anatomy of the nasolacrimal duct in Persian cats determined by computed tomographic dacryocystography.

OBJECTIVE: This study sought to describe the anatomical characteristics of the nasolacrimal duct of Persian cats as observed by computed tomographic dacryocystography. ANIMAL STUDIED: Ten cats weighing 3-6 kg (three live cats and seven cadaveric specimens). PROCEDURES: The animals were submitted to bilateral computed tomographic dacryocystography, totaling 20 nasolacrimal ducts. Dorsal, sagittal, and transverse planes were studied. Two additional skulls were also dissected following latex injection into the nasolacrimal duct. The length and width of the nasolacrimal duct and lacrimal canaliculi, and the distance between the nasolacrimal duct and the root of the upper canine tooth at the point of closest proximity were measured. RESULTS: The nasolacrimal duct followed a convoluted course, particularly in the middle and rostral portions. Duct stenosis (width reduction equal to or >75%) and dilations (width increase equal to or >50%) were also detected, particularly in the rostral portion. Nasolacrimal duct length and width ranged from 1.3 to 1.5 cm and 1.5 to 2.3 mm, respectively. Mean lacrimal canaliculus length and width corresponded to 3.1 mm and 0.4 mm, respectively. Mean distance from the nasolacrimal duct to the canine tooth was 2.4 mm. The root of this tooth interfered with the course of the nasolacrimal duct. CONCLUSION: This study provided anatomical information for clinical assessment of the nasolacrimal drainage system in Persian cats.

Endoscopic endonasal dacryocystorhinostomy learning curve.

PURPOSE: To compare the learning curves of the specialists in two different fields without previous endoscopic endonasal dacryocystorhinostomy experience as well as to reveal the related complications with surgical success rates. METHODS: We retrospectively investigated 90 patients who received consecutive endoscopic endonasal dacryocystorhinostomy with mucosa preservation by an ophthalmologist (Group 1, n=45) and an otorhinolaryngologist (Group 2, n=45) between October 2017 and October 2019. Patients who were admitted with epiphora complaints and diagnosed with primary acquired nasolacrimal duct obstruction through lacrimal irrigation test and aged >18 years with at least 6 months of follow-up were included in the study. In all cases, additional pathologies such as septum deviation were evaluated by performing maxillofacial imaging. Patients' medical records were evaluated in terms of surgery duration, complications, and functional achievements. RESULTS: The mean surgical duration of the patients in Group-2 was 36.27 ± 11.61 min, while it was 43.62 ± 16.89 min in Group-1; the difference was statistically significant (p=0.018). Functional achievements in Group 1 was 84.4% (73.3% in the first set of 15 cases, 93.3% in the last set of 15 cases) in Group 2; this rate was 88.9% (80% in the first set of 15 cases, 93.3% in the last set of 15 cases), and the difference was not statistically significant (p=0.53). Septum intervention in addition to endoscopic surgery in both the groups (p=0.03, p=0.005, respectively) and intense bleeding during surgery (for both the groups, p<0.0001) significantly decreased the functional success. CONCLUSION: Endoscopic endonasal dacryocystorhinostomy, performed after the necessary training, can provide high success and low complication rates when even conducted by ophthalmologists who are unfamiliar with endoscopic surgery after an experience of 30 cases.

Acute dacryocystitis retention: a case report and literature review.

Acute dacryocystitis retention (ADR) is an unusual entity that contributes to an incorrect diagnosis and treatment. We describe a case of acute dacryocystitis retention occurring in a 61-year-old diabetic male who presented with severe pain, swelling, and inflammatory signs above the left medial canthal ligament tendon. He had no previous history of epiphora. Computed tomography scan indicated acute dacryocystitis. Clinical treatment resulted in complete resolution of the condition. Syringing one month after the acute episode indicated a patent lacrimal excretory system. The temporary obstruction that evolved to an acute dacryocystitis retention was probably secondary to nasal alteration or supposed dacryoliths. Timely, conservative clinical treatment can lead to complete resolution of acute dacryocystitis retention with no further treatments.

The role of the rhinostomy ostium size on functional success in dacryocystorhinostomy.

INTRODUCTION: Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors. OBJECTIVE: To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. METHODS: The charts of the patients operated in our hospital between May 2017 and January 2019 were analyzed retrospectively (ethical approval number: 2018-12.04). The patients that were operated in the ophthalmology and otolaryngology departments were included in the study. Endoscopic rhinostomy ostium measurements, punctum lavage findings and complications were recorded at 8 weeks postoperative at the earliest. RESULTS: When the 64 patient charts were reviewed (76 operations), the mean ostium width was 1.85±1.11mm in the endonasal approach group and 3.60±2.24mm in the external approach group. The mean ostium areas in endonasal and external group were 14.61±16.66mm2 and 56.05±60.41mm2, respectively. The ostium was anatomically patent and punctum lavages were negative in 11 patients (6 patients in the endonasal approach group and 5 patients in the external approach group) and these cases were considered as functional failures. The rhinostomy ostium was significantly wider in the external approach group, but this was considered ineffective on functional outcomes. CONCLUSION: Lacrimal duct stenosis can be successfully treated with endonasal and external methods. Tear drainage may be insufficient even in the presence of a patent ostium. Therefore, functional success should also be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is definitely required, while it is believed that ostium size does not affect functional surgical success.

Obstrução lacrimal pós-tratamento oncológico: revisão de literatura / Lacrimal drainage system obstruction after cancer treatment: a literature review

RESUMO A obstrução de via lacrimal é uma possível complicação decorrente de tratamentos oncológicos sistêmicos e locais. A epífora crônica gera grande impacto na qualidade de vida desses pacientes, e, como a fibrose terminal da via lacrimal pode necessitar de procedimentos complexos para sua resolução, é importante estarmos atentos a esse efeito adverso, com o objetivo de reconhecê-lo e tratá-lo precocemente, ou mesmo preveni-lo. Nesta revisão da literatura, os autores analisam todos os agentes quimioterápicos e radioterápicos associados à obstrução lacrimal e descrevem os mecanismos, a frequência, os tratamentos e a profilaxia. Os tratamentos oncológicos associados à obstrução lacrimal foram: radioterapia em cabeça e pescoço (dosagem acima de 45 a 75Gy), radioiodoterapia (dosagem acima de 150mCi) e quimioterapia com 5-FU, S-1, capecitabine e docetaxel. A obstrução lacrimal pode ser irreversível, e a intubação profilática das vias lacrimais é uma possibilidade descrita de tratamento profilático em casos de radioterapia e uso do 5-FU, S-1 e docetaxel. O tratamento cirúrgico de todos os casos é a dacriocistorrinostomia.

ABSTRACT Lacrimal duct obstruction can be a side effect of systemic and/or local cancer treatments. Chronic epiphora has a great impact on the quality of life of oncological patients. Since terminal fibrosis of the lacrimal system may require complex procedures, it is important to be aware of this adverse effect in order to recognize and treat it, or even prevent it. A literature review was performed to identify all types of systemic cancer treatment associated with lacrimal obstruction and to describe the mechanisms, frequency, treatment, and prophylaxis. The oncological treatments associated with lacrimal obstruction were head and neck radiotherapy (dosage above 45-75 Gy), radioiodine therapy (dosage above 150 mCi), and chemotherapy with 5-FU, S-1, Capecitabine and Docetaxel. Depending on the dose, this complication may be irreversible. Prophylactic intubation of the lacrimal system is an option for prophylaxis in cases of radiotherapy, use of 5-FU, S-1, and Docetaxel. Final surgical treatment is dacryocystorhinostomy.

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.

Chronic unilateral tearing as a sign of lacrimal sac squamous cell carcinoma.

Tearing is a very common symptom in ophthalmic practice; however, this issue is commonly overlooked. The authors describe the case of a patient with chronic unilateral epiphora that had been neglected for 8 y; lacrimal system workup was performed for this patient only because of dacryocystitis evolvement. Following the diagnosis of nasolacrimal duct blockage, dacryocystorhinostomy was indicated. Intraoperative abnormal mucosa was subjected to biopsy, and a diagnosis of squamous cell carcinoma in the lacrimal sac was established. Extended tumor excision was performed for the patient and adjuvant radiotherapy was administered, without any recurrence till the 2-year follow-up. The present report highlights the relevance of a detailed evaluation for determining the underlying causes of tearing, especially in chronic unilateral presentation. The consideration of potential malignancy in such cases could prevent delayed diagnosis of uncommon but potentially life-threatening malignancies of the lacrimal drainage system.

Nasolacrimal obstruction concomitant to cataract: diagnosis and management in the preoperative period of cataract surgery / Obstrução lácrimo-nasal concomitante a catarata - diagnóstico e conduta no período pré-operatório da facectomia

ABSTRACT Purpose: Concomitant nasolacrimal duct obstruction can occur in cataract carriers, which increases the risk of postoperative endophthalmitis. The primary aim of this study is to evaluate the knowledge of Brazilian cataract surgeons on the diagnosis and management of cataracts associated with nasolacrimal duct obstruction. Methods: This survey was based on a questionnaire involving Brazilian cataract surgeons that was conducted from March to April 2018. Data were collected on the participant's profile, time and experience in ophthalmic practice, previous training in diagnosis and management of nasolacrimal duct obstruction, and background with endophthalmitis after cataract surgery in patients with nasolacrimal duct obstruction. All data were entered into an Excel spreadsheet and analyzed according to the frequency of occurrence. Results: Ninety-one ophthalmologists answered the questionnaire. Most (63.7%) had been performing cataract surgery for >10 years, and most (84.6%) received training to diagnose and handle nasolacrimal duct obstruction during their medical residence training. Nasolacrimal duct obstruction was investigated in the preoperative period of the cataract by lacrimal sac expression test (53.8%) or by irrigation of the tear pathways (23.1%). Nasolacrimal duct obstruction was treated with antibiotic eye drops by 47.2% of respondents. Seventy-eight percent of surgeons indicate usually performing lacrimal surgery prior to the intraocular surgery, waiting for 4 to 6 weeks to proceed with the cataract surgery. The procedure of choice for treating nasolacrimal duct obstruction prior to cataract surgery was dacryocystorhinostomy (88.4%). Most participants recognized the need for a protocol to assist in the detection and management of nasolacrimal duct obstruction in cataract carriers. Conclusion: Improvement in the diagnosis and management of nasolacrimal duct obstruction concomitant to cataract is needed, as this is a risk factor for endophthalmitis.

RESUMO Objetivo: Portadores de catarata podem apresentar concomitantemente obstrução do ducto lacrimo-nasal (DLN), com risco de desenvolver endoftalmite no pós-operatório da facectomia. O objetivo do presente estudo é apresentar as percepções dos cirurgiões de catarata sobre a propedêutica e a conduta frente a pacientes com obstrução do ducto lacrimo-nasal concomitante com catarata. Métodos: Trata-se de uma pesquisa baseada em um questionário envolvendo cirurgiões brasileiros de catarata, realizado no período de março a abril de 2018. Foram levantados dados sobre o perfil dos participantes, o tempo e a experiencia da prática oftalmológica, o treinamento prévio para diagnóstico e tratamento da obstrução do ducto lacrimo-nasal e os conhecimentos de endoftalmite após cirurgia de catarata. Todos os dados foram inseridos em planilha Excel e analisados de acordo com a frequência de ocorrência. Resultados: Noventa e um oftalmologistas responderam ao questionário. A maioria (63,7%) deles realiza cirurgias de catarata há mais de 10 anos e a maioria (84,6%) recebeu treinamento para diagnóstico e tratamento da obstrução do ducto lacrimo-nasal durante o curso de residência médica. A pesquisa da obstrução crônica do ducto lacrimo-nasal no pré-operatório da catarata é feita pelo teste do refluxo de secreção pelos pontos lacrimais (53,8%) ou por irrigação das vias lacrimais (23,1%). A obstrução do ducto lacrimo-nasal é tratada com colírios antibióticos por 47,2% dos respondentes. Para os portadores de obstrução do ducto lacrimo-nasal , 78% indicam a desobstrução das vias lacrimais previamente à facectoma, aguardando de 4 a 6 semanas para tal. O procedimento de escolha para tratar a obstrução do ducto lacrimo-nasal antes da facectomia é a dacriocistorrinostomia (88,4%). A necessidade de um protocolo para auxiliar na detecção e tratamento da obstrução do ducto lacrimo-nasal em portadores de catarata é reconhecida pela maioria dos participantes deste estudo. Conclusão: É necessário melhorar a propedêutica e o manejo da catarata em portador de obstrução do ducto lacrimo-nasal porque esse é um fator de risco para endoftalmite.

Efficacy of probing for congenital nasolacrimal duct obstruction in a private tertiary hospital: 10-year experience / Eficácia de sondagem para obstrução congênita de ducto nasolacrimal em hospital terciário privado: 10 anos de experiência

ABSTRACT Objetive: To evaluate the success rate of initial and repeated probing as treatment approach for congenital nasolacrimal duct obstruction (CNLDO) in children between 2 and 46 months. Methods: A restrospective review of 73 children diagnosed with CNLDO who underwent probing of the NLD from March 2010 to 2020 was conducted. Data were colected from Hospital Oftalmológico de Anápolis in Anápolis, Goiás. Results: The procedure was performed in 90 eyes. The study sample was constituted of 36 males and 37 females. Bilateral involvement occurred in 18 (24.6%) children whereas 55 (75.3%) of them were unilaterally affected. The age ranges of the patients were divided into 4 groups: A - up to 6 months old (5.5% of the eyes), B - 7 to 12 months (27.5%), group C - 13 to 24 months (39.5%) and group D - older than 24 months (26.4%). The mean age of the sample was 18.6 months. Initial probing obtained an overall success rate of 88.8% and group B showed the best percentage (96%) from all age ranges. The second intervention had a lower outcome, successfuly in 55.5% of the cases. Conclusion: All age ranges showed high success rates for initial probing, although there was a decrease in subsequent procedures outcomes. Our results demonstrate that the success rate for primary probing is not affected by age.

RESUMO Objetivo: avaliar a taxa de sucesso de sondagem inicial e de repetição como abordagem de tratamento para obstrução congênita do ducto nasolacrimal em crianças entre 2 e 46 meses. Métodos: conduziu-se uma revisão retrospectiva de 73 crianças diagnosticadas com obstrução congênita do ducto nasolacrimal que se submeteram à sondagem do ducto nasolacrimal de março de 2010 a 2020. Os dados foram coletados no Hospital Oftalmológico de Anápolis em Anápolis, Goiás. Resultados: o procedimento foi realizado em 90 olhos. A amostra do estudo constitui-se em 36 pacientes do sexo masculino e 37 do sexo feminino. O acometimento foi bilateral em 18 crianças, enquanto 55 (75,3%) delas foram afetadas de forma unilateral. Os pacientes foram divididos em 4 grupos, de acordo com a faixa etária: A- até 6 meses de vida (5,5% dos olhos); B- 7 a 12 meses (27,5%); grupo C- 13 a 24 meses (39,5%) e grupo D- mais que 24 meses (26,4). A média de idade de amostra foi de 18,6 meses. A sondagem inicial teve uma taxa de sucesso global de 88,8%, e o grupo B mostrou a melhor porcentagem (96%) de todas as faixas etárias. A segunda intervenção teve uma taxa de sucesso menor, de 55,5% dos casos. Conclusão: todas as faixas etárias mostraram altas taxas de sucesso na sondagem, embora tenha havido um decréscimo nos resultados dos procedimentos subsequentes. Nossos resultados demonstram que a taxa de sucesso na sondagem primária não é afetada pela idade

Nasolacrimal obstruction concomitant to cataract: diagnosis and management in the preoperative period of cataract surgery.

PURPOSE: Concomitant nasolacrimal duct obstruction can occur in cataract carriers, which increases the risk of postoperative endophthalmitis. The primary aim of this study is to evaluate the knowledge of Brazilian cataract surgeons on the diagnosis and management of cataracts associated with nasolacrimal duct obstruction. METHODS: This survey was based on a questionnaire involving Brazilian cataract surgeons that was conducted from March to April 2018. Data were collected on the participant's profile, time and experience in ophthalmic practice, previous training in diagnosis and management of nasolacrimal duct obstruction, and background with endophthalmitis after cataract surgery in patients with nasolacrimal duct obstruction. All data were entered into an Excel spreadsheet and analyzed according to the frequency of occurrence. RESULTS: Ninety-one ophthalmologists answered the questionnaire. Most (63.7%) had been performing cataract surgery for >10 years, and most (84.6%) received training to diagnose and handle nasolacrimal duct obstruction during their medical residence training. Nasolacrimal duct obstruction was investigated in the preoperative period of the cataract by lacrimal sac expression test (53.8%) or by irrigation of the tear pathways (23.1%). Nasolacrimal duct obstruction was treated with antibiotic eye drops by 47.2% of respondents. Seventy-eight percent of surgeons indicate usually performing lacrimal surgery prior to the intraocular surgery, waiting for 4 to 6 weeks to proceed with the cataract surgery. The procedure of choice for treating nasolacrimal duct obstruction prior to cataract surgery was dacryocystorhinostomy (88.4%). Most participants recognized the need for a protocol to assist in the detection and management of nasolacrimal duct obstruction in cataract carriers. CONCLUSION: Improvement in the diagnosis and management of nasolacrimal duct obstruction concomitant to cataract is needed, as this is a risk factor for endophthalmitis.

Probing for congenital nasolacrimal duct obstruction: a systematic review and meta-analysis of randomized clinical trials.

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.

Probing for congenital nasolacrimal duct obstruction: a systematic review and meta-analysis of randomized clinical trials / Sondagem no tratamento da obstrução lacrimonasal congênita: revisão sistemática de ensaios clínicos randomizados e metanálise

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.

Ophthalmological abnormalities in Down syndrome among Brazilian patients.

Down syndrome is the most common chromosomal disorder, affecting 1/700 live births. Among the clinical findings, one constant concern is the high prevalence of visual disorders that, if left untreated, can negatively affect child development. The aim of this study was to determine the prevalence of ophthalmological findings among patients who attended an outpatient clinic for patients with Down syndrome in southern Brazil between 2005 and 2016. A cross-sectional study including 1,207 patients medical records were done, which 492 (40.8%) had some ophthalmological disorder. These data were subjected to descriptive analysis using Statistica software. Among the 492 patients with any ophthalmological disease, the need for glasses was found in 434 (36%) patients, keratoconus in 254 (42.1%), congenital cataract in 27 (15.1%), nasolacrimal duct obstruction in 25 (2.0%), strabismus in 22 (1.9%), nystagmus in four (0.3%), and juvenile cataract in two (0.2%). Two young adults with keratoconus underwent corneal transplantation. Although the prevalence of an ophthalmological disease among the present sample (40.8%) was lower than described in the current literature, it still reinforced the importance of routine and early evaluations in infants. These should begin at 6 months of age and be repeated half-year until 2 years old, annually until 7 years old, biennial in adolescents, and triennial in adults and elderly. Our findings of a high frequency of keratoconus support a detailed corneal study in such patients for early detection and treatment.

Aplicación transoperatoria de mitomicina-C en la dacriocistorrinostomía externa: acuerdos y desacuerdos / Intraoperative application of Mitomycin-C in external dacryocystorhinostomy: agreements and disagreements

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.

Congenital dacryocystocele diagnosed by antenatal ultrasonography with spontaneous resolution.

Dacryocystocele is a rare benign facial abnormality of the nasolacrimal system, which may be detected at the antenatal workup during the third trimester of pregnancy. Ultrasound is the method of choice for this examination. However, magnetic resonance imaging may also be used in selected cases. Dacryocystocele is mostly a transient finding; it may resolve spontaneously in utero or postnatally. When the defect is bilateral and persists in neonatal life, it may lead to respiratory complications. We report a case of a fetus with bilateral dacryocystocele diagnosed by prenatal ultrasound at the beginning of the third trimester of pregnancy with spontaneous postpartum resorption.

Congenital dacryocystocele diagnosed by antenatal ultrasonography with spontaneous resolution / Dacriocistocele congênita diagnosticada por ultrassonografia pré-natal com resolução espontânea

ABSTRACT Dacryocystocele is a rare benign facial abnormality of the nasolacrimal system, which may be detected at the antenatal workup during the third trimester of pregnancy. Ultrasound is the method of choice for this examination. However, magnetic resonance imaging may also be used in selected cases. Dacryocystocele is mostly a transient finding; it may resolve spontaneously in utero or postnatally. When the defect is bilateral and persists in neonatal life, it may lead to respiratory complications. We report a case of a fetus with bilateral dacryocystocele diagnosed by prenatal ultrasound at the beginning of the third trimester of pregnancy with spontaneous postpartum resorption.

RESUMO A dacriocistocele é uma anormalidade facial benigna rara do sistema nasolacrimal, que pode ser detectada na rotina pré-natal durante o terceiro trimestre da gravidez. O ultrassom é o método de escolha, mas a ressonância magnética também pode ser usada em casos específicos. Na maioria das vezes, a dacriocistocele é um achado temporário, que pode se resolver espontâneamente ainda no útero ou após o nascimento. Quando a anormalidade é bilateral e persiste na vida neonatal, pode levar a complicações respiratórias. Este é o relato do caso de um feto com dacriocistocele bilateral diagnosticada por ultrassom pré-natal no início do terceiro trimestre da gravidez, com reabsorção espontânea após o nascimento.

Topical mitomycin in endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction in older children.

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.

Double puncta canaliculi may exhibit different clinical presentations.

In this paper, we describe two adult patients who presented with double lacrimal puncta: one of them was asymptomatic and incidentally diagnosed, and the other complained of epiphora. In both patients, unilaterality, preference for the lower lid, and location medial to the normal punctum were common features of the accessory punctum. In the asymptomatic patient, irrigation revealed no obstruction in the punctum or the nasolacrimal drainage system. By contrast, the other patient's nasolacrimal drainage system exhibited obstruction. Therefore, dacryocystorhinostomy surgery and silicone tube intubation were successfully performed. Double lacrimal puncta may be associated with epiphora or dry eye. These manifestations can easily be missed in a routine examination. This report was written to emphasize that unilateral epiphora of dry eye symptoms may be related to supernumerary punctum or canalicular systems and can easily be diagnosed with lid eversion.