Chronic Dacryocystitis Patients Research Articles

Outcome of External Dacryocystorhinostomy Operation with and without Posterior Nasal Mucosal Flap Suturing Technique in Combined Military Hospitals of Bangladesh

Introduction: External Dacryocystorhinostomy is an anastomosing operation which creates a fistula between the medial wall of lacrimal sac and lateral wall of nasal cavity. Objectives: To compare the success rate by suturing both the anterior and posterior nasal mucosal flaps and without suturing the posterior nasal mucosal flap in External DCR surgery of 50 cases in different Combined Military Hospitals (CMH) of Bangladesh. Methods: The study included 50 cases of Chronic Dacryocystitis patients with symptoms of epiphora and blocked Sac Patency Test (SPT). External Dacryocysto- rhinostomy (DCR) surgery was done by same surgeon in different CMH over the period of 02 years extending from January 2016 to December 2017. Total 50 patients were divided into equal 02 groups. Group A underwent External DCR with silicone tube intubation and both anterior and posterior nasal mucosal flaps were sutured. Group B underwent similar DCR surgery where only anterior nasal mucosal flaps were sutured with lacrimal sac flap and posterior mucosal flap was excised completely. Results: External DCR surgery success rate was evaluated by a patent SPT at 03 months, 06 months and 12 months post operatively in both groups. SPT was successful in 92% cases in group A and 96% in group B at 3 months follow up after silicone tube removal. At 6 months reduction of epiphora occurred in 90% cases in Group A and 96% cases in Group B with unchanged SPT percentage. At 12 months follow up result remained unchanged as found at 6 months. There was significant difference in success rate of two different surgical technique. Quality of surgery improved with less intraoperative complications with shorter surgical time when only anterior nasal mucosal flap was sutured with excision of posterior nasal flap. Conclusion: This study suggested that comparing both the techniques of with and without suturing anterior and posterior nasal mucosal flaps in external DCR surgery, the later one makes considerable improvement in success rate of DCR. Excising the posterior nasal mucosal flaps can reduce operation time, improve operation technique and reduced epiphora post surgically. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 31-33

Comparison of the surgical outcomes of endoscopic dacryocystorhinostomy in chronic dacryocystitis with or without previous bicanalicular silicone tube intubation

AimsTo compare the outcomes of endoscopic dacryocystorhinostomy (En-DCR) in chronic dacryocystitis (CD) with or without previous bicanalicular silicone tube intubation (BSTI), and investigate whether previous BSTI influenced postoperative outcomes. MethodsWe conducted a retrospective review of medical records of CD patients (group A) who had previously undergone BSTI for nasolacrimal duct stenosis and an age- and sex-matched control group of CD patients (group B) without previous intubation receiving En-DCR from November 2017 to January 2022. Sixty-one patients (61 eyes) were included in group A and age- and sex-matched 122 patients (122 eyes) in group B. Dacryocystic parameters were measured by computed tomography-dacryocystography and surgical findings were recorded during surgeries. The surgical success rates of the two groups were compared at 12 months post-operation. ResultsThe mean horizontal, sagittal, and vertical lengths were 6.06 ± 1.24, 6.03 ± 1.44, and 8.05 ± 2.00 mm, respectively, in group A and 6.33 ± 1.25, 6.26 ± 1.19, and 10.40 ± 2.45 mm, respectively, in group B. There were no differences in the horizontal or sagittal parameters between the two groups. The vertical parameter in group A was significantly lower than that in group B. Scar formation in the sac was observed in 54 patients in group A but was absent in group B. At 12 months postoperatively, the anatomical and functional success rates were 88.52 % and 85.25 %, respectively, in group A and 92.62 % and 89.34 %, respectively, in group B, with no difference between the two groups. ConclusionPrevious BSTI reduced dacryocyst vertical parameter and caused dacryocyst scar formation but did not affect postoperative En-DCR efficacy.

Wider Inner Intercanthal Distance is a Predisposing Factor for Chronic Dacryocystitis in Adults

Background: Many adult women of low socio-economic condition have been suffering from chronic dacryocystitis (CDC). Wider inner intercanthal distance (IICD) is a proposed risk factor for developing chronic dacryocystitis. A few studies have been undertaken in this regard. Objective: To find out the relationship between wider inner intercanthal distance and chronic dacryocystitis in adults. Materials and Methods: This cross-sectional comparative study was conducted in the Department of Anatomy, Rajshshi Medical College, Rajshshi, Bangladesh from July 2016 to June 2017. A total number of 460 subjects were enrolled for this study. Among them, 154 were patients of chronic dacryocystitis (CDC) and 306 were healthy controls. Their IICD was measured. Results: The mean IICD of CDC group was 30.71 ± 2.26 mm whereas the mean IICD of the control group was 29.20 ± 2.08 mm. The IICD of CDC patients was observed to be higher (p<0.001) compared to healthy controls. Conclusion: Those who had wider inner intercanthal distance were more predisposed to develop chronic dacryocystitis. So, wider IICD can be regarded as a risk factor for developing chronic dacryocystitis.KYAMC Journal Vol. 14, No. 02, July 2023: 83-86.

Endoscopic dacryocystorhinostomy with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent incarceration.

To investigate the feasibility of endoscopic dacryocystorhinostomy (En-DCR) with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent (NDS) incarceration. En-DCRs were performed on 44 chronic dacryocystitis patients (46 eyes) secondary to NDS incarceration from April 2016 to October 2022. The granuloma and scar tissues were separated, and the removal of NDS incarceration was achieved during the surgery; the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal, a bicanalicular silicone tube was implanted, and lacrimal size and condition were assessed. The tube was removed 3mo after surgery. During the final follow-up of 12mo when the surgery was completed, the complications and the rates of surgical success were assessed. This study covered 40 patients (42 eyes). Intraoperatively, it was found that the lacrimal sac became small, and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes. At 12mo after surgery completed, the rates of the functional and anatomical success reached 80.95% (34/42) and 83.33% (35/42), respectively. Under the effect of intranasal ostial closure, seven eyes failed to achieve anatomical success. No serious complications (e.g., visual impairment, sinusitis, and orbital fat prolapse) was observed. With the success rate over 80% and no serious complications, En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.

Surgical Outcome of Endoscopic Dacryocystorhinostomy with and Without Prolene Stent in Chronic Dacryocystitis: A Randomized Controlled Trial.

Popularity of Endoscopic dacryocystorhinostomy is rising over a conventional external dacryocystorhinostomy. One of the most frequent reasons for procedure failure is the closing of neo-ostium. To compare the surgical results of endoscopic Dacryocystitis operations with and without Prolene stents in terms of procedure success rates and postoperative complications. A randomized controlled trial of 2years was carried out including 100 patients of chronic dacryocystitis. The cases were randomly split into two groups with 50 cases each in Endoscopic DCR with stent and without stent groups. The results, both the subjective and objective were noted. At the end of 3months, the overall success rate was 88% and 90% in group with and without stent respectively with no significant statistical difference. 12% subjects had wound infection, 8% had granulations around the rhinostoma, 6% had synechiae, 10% had discomfort from the tube in stent group. In Group B (without stent), 16% had wound infection, 4% had granulations around the rhinostoma. As Endoscopic DCR without stent has equally good results and less complications as compared to with stent, we recommend endoscopic DCR without stent. Use of Stent should be reserved for special conditions like revision cases, common canalicular block, fibrosed lacrimal sac.

Microbial distributions in the conjunctiva and lacrimal sacs of patients with chronic dacryocystitis in a tertiary hospital.

The aim was to clarify the distributions of bacteria in the conjunctival sac and lacrimal sac in patients with chronic dacryocystitis. In total, 297 (322 eyes) chronic dacryocystitis patients who underwent nasal endoscopic dacryocystorhinostomy (EN-DCR) were included. Conjunctival sac secretions from the affected eye were collected preoperatively, and lacrimal sac retention fluid from the affected side in the same patient was collected intraoperatively. Bacterial culture and drug sensitivity testing were performed to determine bacterial distributions. In total, 127 bacterial isolates (49 species) were detected in 123 eyes in the conjunctival group, with a positivity rate of 38.2% (123/322); 85 bacterial isolates (30 species) were detected in 85 eyes in the lacrimal sac group, with a positivity rate of 26.4% (85/322). The positivity rates were significantly different (P = 0.001) between two groups. The gram-negative bacilli proportion in the lacrimal sac group (36/85, 42.4%) was significantly higher than that in the conjunctival sac group (37/127, 29.2%) ( P = 0.047). Positive conjunctival sac secretion culture (123/322) was significantly associated with increased ocular secretion (281/322, 87.3%) (P = 0.002). Among the culture-positive bacteria in the conjunctival sac group and the lacrimal sac group, 30/127, 23.6% and 43/127, 26.7% and 21/85, 24.7% and 20/85, 23.5% were resistant to levofloxacin and tobramycin, respectively. This study illustrated differences in bacterial distributions between conjunctival sac secretions and retained lacrimal sac fluid in chronic dacryocystitis patients, with a higher proportion of gram-negative bacilli in lacrimal sac secretions. The ocular surface flora in chronic dacryocystitis patients is partially resistant to levofloxacin and tobramycin, which need to be considered by ophthalmologists.

Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses.

To evaluate the outcome of endoscopic dacryocystorhinostomy (En-DCR) with mucosal anastomosis in chronic dacryocystitis patients, with various categories of ethmoid sinuses. Between July 2015 and September 2019, 1439 adult patients, representing 1623 affected eyes, presented with chronic dacryocystitis and were scheduled for En-DCR. The categories of ethmoid sinuses were preoperatively determined, using computed tomography-dacryocystography (CT-DCG), and were classified as category 1 (C1), category 2 (C2), and category 3 (C3). No sinuses anterior to the posterior lacrimal crest defined as C1. Sinuses found between the anterior edge of the lacrimal bone and the posterior lacrimal crest defined as C2. Sinuses found anterior to the lacrimal bone suture defined as C3. At the end of surgery, the dacryocyst and nasal mucosa were anastomosed in C1, and the dacryocyst mucosa and anterior ethmoid sinus were anastomosed in C2 and C3 ethmoid sinus patients. The surgical success rate and related complications, in patients with 3 categories of ethmoid cells, were monitored and documented. Postoperative data was obtained for 179 C1 affected eyes, 878 C2 affected eyes, and 432 C3 affected eyes. The overall success rate of En-DCR was 93.0% (1385/1489). Additionally, the success rates were comparable among the different ethmoid categories at 12mo post operation. We demonstrated that the major reason for surgical failure was intranasal ostial closure, due to granulation or scar tissue. En-DCR is a feasible and highly effective primary treatment for chronic dacryocystitis. To ensure surgical success, the surgery protocol must be designed in accordance with the category of ethmoid sinuses present in individual patient.

Differently Expressed Circular RNAs in Lacrimal Sacs From Patients With Chronic Dacryocystitis.

This study was designed to identify differently expressed circular RNAs (circRNAs) and investigate their potential roles in lacrimal sacs from patients with chronic dacryocystitis. The lacrimal sac samples of three chronic dacryocystitis patients and three control subjects were collected for RNA sequencing after ribosomal RNA was depleted. Differently expressed circRNAs and messenger RNAs (mRNAs) were used for co-expression analysis. CircRNA-microRNA (miRNA)-mRNA interaction network were also established by miRanda software. Meanwhile, pathway and functional enrichment analysis were conducted for the down- and up-regulated mRNAs in the circRNA-mRNA co-expression network. The expression levels of circRNAs and mRNAs in chronic dacryocystitis and control samples were validated by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). In all the 3,909 circRNAs predicted through RNA sequencing, 25 circRNAs (20 up-regulated and 5 down-regulated) expressed differently in chronic dacryocystitis samples. Besides, there identified 1,486 differentially expressed mRNAs. Of these differently expressed circRNAs and mRNAs, eight were validated by qRT-PCR, including MYH2, DSP, CD27, CCL5, FN1, has_circ_0004792, has_circ_0001062, and has_circ_0115476. Gene Ontology (GO) analysis indicated that the majority of altered mRNAs in this co-expression network were involved in immune system processes and meanwhile Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that these altered expressed mRNAs were also amplified in bacterial invasion of epithelial cells, both of which were thought to be involved in the pathogenesis of chronic dacryocystitis. In the circRNA-miRNA-mRNA interaction network, six circRNAs were found to be related to Th1 and Th2 cell differentiation, which was closely associated with the development of chronic dacryocystitis. This study identified statistically significant differences between circRNAs and mRNAs of lacrimal sac samples of chronic dacryocystitis patients and control individuals and provides novel insight into the regulatory mechanism of circRNAs, miRNAs, and mRNAs in the pathogenesis of chronic dacryocystitis.

Results of endoscopic endonasal dacryocystorhinostomy: A prospective cohort study.

To evaluate the success rate of endoscopic endonasal dacryocystorhinostomy. The prospective cohort study was conducted at the Ophthalmology and Otorhinolaryngology departments, Shifa Foundation Community Health Centre, Islamabad, Pakistan, from October 2017 to September 2019, and comprised chronic dacryocystitis patients who underwent endoscopic endonasal dacryocystorhinostomy. Endoscopic dacryocystorhinostomy with or without lacrimal intubation was performed under general anaesthesia. The patients were followed up post-operative at 1 week, 1 month, 6 months and 12 months. Data was analysed using SPSS 20. Of the 47 patients, 41(87.2%) were females. The overall mean age was 40.70±10.84 years (range: 25-66 years). Lacrimal intubation was performed in 31(66%) patients. Surgical success was achieved in 46(97.9%) patients. Of them, 37(78.7%) patients were completely symptom-free, while 9(19.1%) were partially symptomatic and were managed conservatively. Treatment failure requiring repeat surgical procedure was the case with 1(2.1%) patient. Procedure failure was more likely in patients with previous attacks of acute dacryocystitis (p=0.003). Endoscopic dacryocystorhinostomy was found to be a safe procedure with good anatomical and functional outcomes in chronic dacryocystitis patients.

A Comparative study of external dacryocystorhinostomy versus endonasal Dacryocystorhinostomy

Background: Surgical treatment of dacryocystitis dates back to nearly 2000 years ago described as creating an artificial passageway into the nose using hot cautery to puncture through the lacrimal bone. Better understanding of lacrimal physiology and nasal and lacrimal anatomy through the centuries led to development of a procedure that would resemble a modern external DCR surgery in the 18th century. Intranasal approach operations had also been described in the 20th century. Advancements in methods of DCR surgery have been procured in view of cosmesis, amount of bleeding, duration of surgery, and outcome of the procedure.Aim/Objective: The aim of this study is to compare endonasal DCR and external DCR in the following prospect Methods: This was a hospital based, interventional, prospective, non-randomized study of a total of 100 randomly selected patients of chronic dacryocystitis from OPD. 50 patients underwent external DCR and 50 patients underwent endonasal DCR. Young patients with good nasal space and without any nasal abnormality were operated for endonasal DCR, and old patients or those with nasal abnormalities were operated for external DCR. Preoperative assessment included an ENT evaluation, blood pressure, sac syringing, and blood investigations. Surgery was performed and post-operative assessments were conducted in the aspects of complications of surgery, intraoperative bleeding, surgical time and outcome of surgery.Results: From a total of 100 patients, 59% were females of which 54% were operated by endonasal DCR, with 30% of the population of total persons operated aging 60-70 years. There is more prevalence of dacryocystitis in females and in old aged patients in this study due to more chances of lacrimal pump failure in old age, and hormonal factors, smaller skull size and application on local cosmesis for females. Punctum patency after 6 months comparing endonasal and external DCR surgery using chi square formula proved a P value of 0.0008 which is highly significant showing that external DCR has significantly higher success rate than endonasal DCR. In the aspect of complications, the study proved a greater chance of recurrence of epiphora in external DCR, also the presence of a skin scar and wound dehiscence persists as a complication in external DCR due to the external skin incision which is not made in endonasal DCR.Conclusion: DCR is the treatment of choice for nasolacrimal duct obstruction, and it can be performed by external or endoscopic approach. Both approaches have minimal complications and comparable surgical outcome, hence the choice of surgery should depend upon the patient’s preference, availability of resources and surgeon’s expertise.

External dacryocystorhinostomy for patients of chronic dacryocystitis with chronic rhinosinusitis

Introduction: Dacryocystitis is characterized as an inflammatory state of the nasolacrimal sac. It is typically caused by an obstruction within the nasolacrimal duct and subsequent stagnation of tears in the lacrimal sac. Stagnation of tears will provide a favorable environment for infectious organisms to propagate and proteinaceous debris to form. Materials and Methods: In this prospective, observational study conducted over a 5-year period (March 2011 to February 2016) in a tertiary eye care center and department of Ophthalmology and otorhinolaryngology, consecutive subjects (60 chronic sinusitis patients) were recruited with primary obstruction of the lower lacrimal drainage system due to chronic dacryocystitis who underwent external dacryocystorhinostomy (EDCR) by a single surgeon. Results: A total of 60 patients were included in this study, concerning the gender, there was a predominance of the female with 39 out of 60 patients (64.1%) and males were 21 patients. Age groups of 1-20 years are 3 patients (4.61%) and predominant age in the study was elderly more than 61 years old patients 40%. The clinical characteristics of chronic dacryocystitis are shown in table 3, epiphora was found in 51 patients (78.4%) and absent in 14 patients (21.5%). The discharge by the digital expression of the lacrimal sac was attained in 45 patients (69.2%) and not attained in 20 patients (30.8%). The previous history of exacerbation of chronic dacryocystitis identified as purulent discharge occurred in 5 patients (7.7%) and non-occurrence in 60 patients (92.3%). Conclusion: The physiopathology of the CDC is not fully known. This study reveals a possible influence of CRS on the CDC, emphasizing its action on the exacerbation of the symptoms.

Study of patient outcome in endoscopic dacrocystorhinosomy using a microdebrider in chronic dacryocystitis patients

Background: Endoscopic dacryocystorhinostomy (DCR) has become accepted as a suitable treatment for patients with chronic dacryocystitis. In this study authors did endoscopic dacrocystorhinosomy using a microdebrider, which is a recent advancement tool being used successfully in other endoscopic sinus surgeries also. Limited studies are available as of now on this topic.Methods: A total number of 33 patients (with 40 affected eyes) presenting with complains of epiphora having nasolacrimal duct obstruction were selected. They underwent an endoscopic DCR in which dissection of some nasal mucosa and widening of bony ostium was done using a microdebrider. Silicone stent was passed into the nasolacrimal duct through both punctum. Patient outcome was assessed by using both objective (endoscopy and dye test) and subjective (improved symptoms) criteria. Standard follow up time for clinical course was kept 3 months with weekly visits.Results: Patients which got relief from epiphora in 37 eyes (92.5% cases) had no obstruction on endoscopy and positive dye test. Rest (7.5 % cases) had presence of granulation tissue at rhinostoma site and negative dye test, which was cited as the cause of failure.Conclusions: The use of microdebrider is potentially beneficial in endoscopic endonasal dacryocystorhinostomy. By using such an instrument, the minimal amount of tissue damage occurs, a large fistula is formed, and the recurrence due to the formation of adhesions/synechiae/granulations is prevented/reduced thus reducing the time of surgery, complications and failure rate.

A clinical study of dacryocystitis

A clinical study of dacryocystitis - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.067, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

Microbial study of the lacrimal sac and its contents in patients of chronic dacryocystitis of the adult and the paediatric age group in a tertiary care hospital, Kishanganj, Bihar, India

Microbial study of the lacrimal sac and its contents in patients of chronic dacryocystitis of the adult and the paediatric age group in a tertiary care hospital, Kishanganj, Bihar, India

Surgical results of transcaruncular dacryocystorhinostomy

Purpose: The objective of the study is to evaluate the effectiveness of the transcaruncular approach of dacryocystorhinostomy (DCR) in the management of the cases of chronic dacryocystitis. Materials and Methods: A prospective study was conducted on 30 patients presenting in the outpatient department with chronic dacryocystitis at a tertiary eye care center. Intraoperative parameters were observed and noted at the time of surgery. Patients were followed up for a minimum period of 6 weeks and interviewed for subjective improvement of symptoms. Outcome measures were anatomical patency, epiphora, esthetic outcome, and presence of any complications. Results: Thirty patients of chronic dacryocystitis with nasolacrimal duct obstruction comprising 22 females and 8 males with a mean age of 43.8 years were operated by transcaruncular modification of external DCR. The surgical success rate of 90% was achieved after a follow-up period of 6 weeks. Postoperative complications included periorbital edema, mild nasal bleeding, and section leak which resolved by day 7 postoperatively. The procedure was associated with minimal intraoperative complications. One patient (3%) had significant intraoperative bleeding, and two patients (7%) had canalicular injury and both the patients were managed with canalicular intubation. Conclusions: Transcaruncular DCR is a cost-effective and esthetic approach not requiring the use of any endoscope or lasers and provides the benefits of external approach without a skin incision. It is associated with minimal intraoperative and postoperative complications. The surgical success rate of the procedure is comparable to the other conventional methods of DCR.

Endoscopic DCR with and without prolene stent in rural area: a prospective randomized study

<p class="abstract"><strong>Background:</strong> The objective of the study was<strong> </strong>to compare the results of endoscopic DCR with and without prolene stenting and to assess subjective and anatomical success in patients undergoing prolene stenting.</p><p class="abstract"><strong>Methods:</strong> The surgical outcomes of endoscopic endonasal DCR was compared in 100 patients of chronic dacryocystitis with nasolacrimal duct obstruction from June 2013 to May 2018. The successful outcome of surgery was defined by subjective improvement of symptoms and anatomical patency of the neo-ostium on syringing by nasal endoscopy. </p><p class="abstract"><strong>Results:</strong> In our study females were predominant in both groups with around 60% being females in group with stenting and 64% in group without stenting. Male to female ratio was 1:1.5 and 1:1.77 in group with stenting and without stenting. The symptomatic success rate of the surgery at the end of 3 months was 92% in group without stenting and 88% in group with stenting. There was no statistical difference in the results of two groups.</p><p><strong>Conclusions:</strong> We recommend that stenting is not routinely required for endoscopic DCR surgeries. A selective stenting approach may be advocated using prolene 3-0, using stenting for specific indications. With proper surgical technique and good follow up, endoscopic DCR without stenting is treatment of choice for chronic nasolacrimal duct obstruction.</p>

Study of Bacterial Spectrum in Patients of Chronic Dacryocystitis, At a Tertiary Care Centre in Northern India

Purpose: To ascertain the current pattern of microbial isolates and their antibiotic sensitivity patterns in patients of chronic dacryocystitis seen at a tertiary care centre in North India. Methods: A case record analysis was conducted on computerized data of 400 immune competent patients of chronic dacryocystitis in KGMC, Lucknow between Jan 2011-Dec 2015. The sample for purpose of microbiological isolate was collected from patients who ROPLAS +ve. The sample was collected under strict sterile control and culture was done on 5% sheep blood agar. Antibiotic sensitivity was done by Kirby Bauer disc diffusion method on Mueller Hinton agar. Results: 400 samples were collected for bacterial culture and antibiotic sensitivity. 61% of these samples were sterile at 24 hrs and 72 hrs of culture. 39% were positive for microbial Agents. Staphylococcus aureus (54.6%) was the most common gram positive cocci followed by coagulase negative Staphylococcus epidermidis (19.4%), followed by Streptococcus pneumoniae (14%). Gram negative organisms in both group A and group B included Pseudomonas aeruginosa (6%) followed by Klebsiella pneumoniae (3%) and Hemophilus influenzae (3%). High sensitivity was seen towards vancomycin and fluoroquinolones in Gram positive bacteria and for Piperacillin/ Tazobactum in gram negative cases. Conclusion: It is important to have knowledge of the microbial agent responsible for chronic dacryocystitis in a particular area to the choose the most appropriate antibiotic for the implicated organism.

Our experience with transcanalicular laser-assisted endoscopic dacryocystorhinostomy (TCLADCR) in patients of chronic dacryocystitis with deviated nasal septum.

The purpose of this study is to study the operative difficulties and success rate of transcanalicular laser-assisted endoscopic dacryocystorhinostomy in patients of chronic dacryocystitis with deviated nasal septum (DNS). A prospective interventional clinical study of 36 consecutive patients suffering from chronic dacryocystitis with nasolacrimal duct obstruction with DNS undergoing primary TCLADCR from March to June 2011 was carried out. Diode laser was used to create a 16-mm(2) ostium which was enlarged to 64 mm(2) using Blakesley's forceps. Success was defined as anatomical patency and absence of symptoms at 12 months of follow-up. Out of the 36 patients, 25 were females with ages 20-72 years, and 19 were left sided. There were 12 high, 12 mid and 12 basal DNS towards the side of surgery, mild to moderate in severity. Intraoperatively there was difficulty in visualising the aiming beam in the nose, tedious manipulation of endoscope and excessive bleeding in 3 patients. Increased bleeding and failures were significantly higher in high DNS (Fisher exact test-2 tailed: 0.0045). The procedure was successful in 94.4 % cases with average ostium size of 21.94 mm(2) at 12 months and no statistically significant difference in success rates between mild and moderate DNS (Fisher exact test-2 tailed: 1.000). Also there was no difference in the complication rate between mild and moderate DNS (Fisher exact test-2 tailed: 0.0841). TCLADCR is an effective procedure in patients with mild to moderate mid and basal DNS and obviates the need for multiple procedures and a cutaneous scar.

N-butyl-2-cyanoacrylate tissue adhesive versus subcuticular skin closure in external dacryocystorhinostomy

Purpose The aim of this study was to compare the surgical efficacy and aesthetic outcome of using tissue adhesive N-butyl-2-cyanoacrylate 'Histoacryl' with subcuticular suture closure of skin incision in external dacryocystorhinostomy (DCR). Design The present study was conducted as an interventional study. Patients and methods A total of 60 chronic dacryocystitis patients undergoing DCR procedures at the Research Institute of Ophthalmology were included. The patients were randomly selected, irrespective of age, sex or race, and were divided into two groups of 30 patients each. A classic external DCR was done for all the patients. At the completion of the surgery, the skin incisions in group 'A' were closed with vicryl 6/0 subcuticular suture, whereas in group 'B' N-butyl-2-cyanoacrylate 'Histoacryl' (FDA approved) tissue adhesive was used to close the skin incisions. No subcutaneous sutures were placed to approximate the wound edges. After 20 s of drying time the adhesive was applied for the second time. All the patients were followed up on the first day, fourth day, first week, second week, first month, and then monthly thereafter for 6 months. The time of suturing the wound and the time of application of the tissue adhesive was recorded for all the patients in both groups. During follow-up the wound was examined for evidence of infection, pain and discharge, and an inquiry was carried out for patient satisfaction. Photographs of the wounds were taken at every visit. The photographs were then shown to a senior surgeon, who was oblivious of the method of closing the wound, and rated the quality of skin incision according to 'WES scale'. Results No intraoperative wound complications were encountered in any patient. Statistical analysis of the data available, at 1 month, showed no statistically significant differences between the two groups as regards duration of healing, inflammation or final incision appearance as rated by the senior surgeon. Skin closure time averaged 61 s in subcuticular suture and 52 s in N-butyl-2-cyanoacrylate skin glue, which was statistically insignificant. Conclusion Using N-butyl-2-cyanoacrylate glue is an effective and a reliable method for skin closure, yielding similar aesthetic results as skin closure with subcuticular sutures in clean incision for external DCR surgery. It is safe, quick, does not compromise wound integrity, is adequately tolerated by the patients and could be considered an excellent alternative and an improvement on the traditional method of wound closure, providing high level of satisfaction for both patient and surgeon.

改良泪囊鼻腔吻合术治疗高龄慢性泪囊炎的疗效观察

目的：探讨改良泪囊鼻腔吻合术治疗高龄慢性泪囊炎的临床疗效。方法：对47例(47眼)高龄慢性泪囊炎患者采用改良泪囊鼻腔吻合术，术中填入明胶海棉压平后瓣，只缝合前瓣，同时吻合腔置入导尿管支撑；术后定期冲洗，术后7 d拔除导尿管。结果：拔管后行泪道冲洗全部通畅，总有效率100%。术后随访2年，总有效率为100%。结论：改良泪囊鼻腔吻合术治疗高龄慢性泪囊炎，手术时间短，手术成功率高，是安全可行的。Objective: To explore the clinical effect of modified dacryocystorhinostomy (DCR) on the treatment of elderly chronic dacryocystitis patients. Method: 47 cases (47 eyes) of chronic dacryocystitis patients were treated with modified dacryocystorhinostomy; the gelatin sponge was filled with flat after flap, and only the front flap was just sutured during operation. At the same time, the catheter was put in and supported the anastomosis cavity, which was pulled out 7 days after operation, and the cavity was flushed periodically. Result: All of the lacrimal ducts were unobstructed after withdrawal of the catheter; the total effectiveness was 100%. During 2-year follow-up, the total effectiveness was 100%. Conclusion: The operation time of modified dacryocystorhinostomy on the treatment of elderly chronic dacryocystitis is short; it has a high operation success rate, and it is safe and feasible.