Endonasal Dacryocystorhinostomy Research Articles

Endoscopic endonasal dacryocystorhinostomy learning curve.

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. 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. 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. 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.

The effects of accompanying sinonasal pathologies on the success of primary dacryocystorhinostomy

Objectives: In this study, the results of patients who underwent primary endoscopic endonasal dacryocystorhinostomy surgery and nasolacrimal silicone tube intubation (PEEDCR + NSTI) due to chronic dacryostenosis were evaluated retrospectively. The sinonasal pathologies accompanying these cases and their results were reviewed in the light of the literature. Materials and Methods: The medical records of 55 patients who admitted to State Hospital Ear Nose and Throat Clinics between January 1, 2015 and December 31, 2019, were diagnosed with chronic dacryostenosis and underwent PEEDCR + NSTI surgery were retrospectively examined. Results: Fifty-five patients were included in the study. Thirty-three of the patients (60%) were female and 22 were male (40%). Endoscopic endonasal DCR and nasolacrimal silicon tube intubation were applied to a total of 55 patients, 21 (38.18%) right eye and 34 (61.82%) left eye. Simultaneously, sinonasal pathology surgery was performed on 32 patients. 47 patients (85.5%) achieved complete recovery, while the complaint of eight patients (14.5%) continued. In our study, we found the success rate as 85.5% in primary cases. Nasal revision surgery and EEDCR + NSTI were applied to 8 patients with recurrence. While 7 of these are fully recovered, 1 patient relapsed again. Success rate after revision surgery increased to 98.2%. All of the 8 patients with recurrence were those who underwent sinonasal pathology surgery simultaneously. Conclusion: PEEDCR + NSTI surgery is a functional treatment method that is well-tolerated and with high success in patients with lacrimal stenosis. Sinonasal pathologies were responsible for recurrences. Simultaneously, intranasal pathologies must be treated effectively.

Особливості післяопераційного періоду у хворих на хронічний дакріоцистит та цукровий діабет 2-го типу після проведення ендоскопічної ендоназальної дакріоцисториностомії залежно від ступеня компенсації цукрового діабету

The aim. To identify the features of the postoperative period in patients with chronic dacryocystitis and type 2 diabetes mellitus (DM2) after endoscopic endonasal dacryocystorhinostomy (DCR), depending on the degree of compensation of DM. Materials and methods. The study involved 30 DM2 patients with chronic dacryocystitis who underwent endoscopic endonasal DCR according to standard methods. The patients were divided into groups according to the degree of compensation of DM2: 6 patients with compensated, 7 patients with subcompensated and 17 patients with decompensated DM2. The results of the operation were evaluated after 2 months, 6 months and 2 years. In addition to standard methods, ophthalmic examination included nasolacrimal duct probing, lacrimal duct lavage, and endoscopic examination of the nasal cavity. Results and discussion. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months (58.8 ± 11.9 % of patients) on average was 1.4 times, and after 6 months (52.9 ± 12.1 % of patients) and 2 years (41.2 ± 11,9 % of patients) – it was 1.5 times less than that in subcompensated and compensated DM2 (p &lt; 0.05). In patients with decompensated DM2, tearing was observed in 41.2 ± 11.9 % of patients after 2 months, in 47.1 ± 12.1 % of patients after 6 months and in 58.8 ± 11.9 % of patients after 2 years post-op, which was, on average, 2.7 times, 2.1 times and 1.5 times more often than that in subcompensated and compensated DM2, respectively (p &lt; 0.05); there were no significant differences between the values (p &gt; 0.05). Conclusions. Features of the postoperative period in patients with chronic dacryocystitis after endoscopic endonasal DCR depend on the degree of compensation of DM2. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months is on average 1.4 times, and after 6 months and 2 years it is 1.5 times less than that in subcompensated and compensated DM2. Keywords: type 2 diabetes mellitus, degree of compensation of diabetes mellitus, chronic dacryocystitis, efficiency of endoscopic endonasal dacryocystorhinostomy, features of postoperative period.

An Evaluation of Success Rate of Endoscopic Endonasal Dacryocystorhinostomy at Tertiary Care Hospital

Objective: To evaluate the success rate of endoscopic endonasal dacryocystorhinostomy at tertiary care hospital. Material and methods: Between July 2020 to December 2020, total 50 patients having age between 20-60 years, both gender, cases of epiphora, cases with evidence of obstruction were recruited from Department of ENT, DG Khan Medical Collge, DG Khan. Success of DCR was evaluated. Results: Fifty cases were selected for this study. Age range was 20-40 years with mean age 38.80 ± 8.74 years. DCR was successful in 47 (94%) patients while in 3 (6%) patients surgery was not successful. Male patients were 35 (70%) while female patients were 15 (30%). Surgical success was noted in 33 (94.29%) male patients and 14 (93.33%) female patients. Insignificant (P = 1.00) association between surgical success and gender was noted. Conclusion: In this study high success rate of DCR was noted. Males were prominent. Most of the patients were between 20-40 years and no association of success of surgery with age group and gender found. Keywords: Dacryocystorhinostomy, Epiphora, Intubation, Chronic dacryocystitis

Endoscopic endonasal dacryocystorhinostomy vs nasolacrimal duct intubation in pediatric nasolacrimal duct obstruction - a comparative study

Abstract Study design; Pilot randomized controlled study. Objective To compare success rates of endoscopic endonasal dacryocystorhinostomy and nasolacrimal duct intubation in congenital nasolacrimal duct obstruction (NLDO) in a trial to define the superiority of either technique. Patients &amp; Methods Sixty-six eyes of 61 patients were diagnosed as having epiphora and mucopurulent discharge due to congenital NLDO. The patients were randomly divided into two groups; Group A; 33 eyes of 28 patients (treated by probing and silicone intubation only (NLDI)) and Group B; 33 eyes of 33 patients (treated by endoscopic endonasal dacryocystorhinostomy and silicone tube intubation (EDCR). All tubes were removed 6 months after the operation. Results The success rate, defined as complete resolution of clinical symptoms and signs after 6 months of follow up, was 72.7 % in Group A and 81.8% in Group B. Although the success rate was higher in Group B, yet the difference was shown to be statistically nonsignificant. Preoperative symptoms were assessed postoperatively after tube removal. Complete cure had a higher rate of occurrence in Group B than in Group A (27eyes (81.8%) versus 25 eyes of 22 patients (75.8%) respectively). Postoperative positive fluorescein dye disappearance test (FDDT) after tube removal was more in Group B than in Group A (27 eyes (81.8) versus 24 eyes of 21 patients (72.7 %) respectively). In Group A, silicone tubes had to be repositioned due to prolapse in 3 eyes of 3 patients (9.1%) and had to be removed early in 3 eyes of 3 patients (9.1%) due to failure of repositioning. In Group B, silicone tubes did not require early tube extraction before the date of removal in any of the patients. Intraoperative, there was only one case (3.0%) of fat prolapse during EDCR in Group B with no subsequent postoperative complications. Hemostasis did not represent a problem in any of the patients. Postoperative complications occurred more in Group B than Group A (21 eyes (63.6%) versus 13 eyes of 13 patients (39.4 %) respectively). Late complications occurred more in Group B than Group A (18 eyes (54.5%) versus 12 eyes of 12 patients (36.4%) respectively) in the form of persistent epiphora and tube prolapse. Conclusion The success rate of pediatric EDCR was higher than that of pediatric NLDI. The difference was statistically non-significant. Complications were comparable between the two groups. The study, being pilot in its comparative aspect between endoscopy and intubation, opens the horizon for further study on a larger group that probably will expand this difference.

Изучение этиологических факторов рецидива после эндоназальной эндоскопической дакриоцисториностомии

The aim of this work is to study the etiological factors of failures after endonasal endoscopic dacryocystorhinostomy (EEDCR). We retrospectively studied the case reports of 485 patients (521 cases) with a relapse after EEDCR performed for primary dacryocystitis. The obtained data allowed us to reveal that the largest number of cases of relapse after EEDCR was a consequence of partial or complete obliteration of dacryocystorhinostomy (DCR) ostium (278 cases), which amounted to 53.3% of all analyzed cases. In 127 cases, the reason of recurrence after EEDCR was stenosis or obliteration of the common canaliculus ostium (24.4%). In 116 cases (22.3%), relapse after EEDCR was caused by a combination of several etiological factors. Of these, in 86 cases, synechiae and granulation in the area of dacryostomy were revealed. The retrospective analysis carried out within the framework of this work, based on the study of the results of the applied diagnostic methods, including multislice computed tomography with contrast enhancement of lacrimal drainage system, made it possible to determine and systematize the etiological factors of the development of repeated obstruction of the lacrimal drainage system after EEDCR. Key words: relapse, dacryocystitis, DCR, common canaliculus ostium, DCR ostium, synechiae.

Endoscopic endonasal dacryocystorhinostomy-an experience in a tertiary care hospital

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Dacryocystorhinostomy is a surgical procedure by which the lacrimal flow is diverted into the nasal cavity by making an opening in the lacrimal sac when the nasolacrimal duct gets blocked. The operation can be carried out using either an external or endonasal surgical approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a clinical observational study done on 50 patients with chronic dacryocystitis with obstruction at the level of sac or nasolacrimal duct. This study was conducted at Dr. Shankarrao Chavan government medical college, Nanded, during the period of 2 years (2018-2020). Patients were evaluated and operated for endoscopic endonasal dacryocystorhinostomy.&lt;/p&gt;&lt;p class="Default"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of studied cases was 33.92±12.13 years. The M:F ratio was 0.78. Epiphora was the predominant complaint in all cases 100%. Swelling of lacrimal sac was present in 24% cases and Pain on affected side was present in 18% cases. 6% patients had fistula on the side of block. 12% patients had mucocele and 14% patients had pyocele on the affected side. Left and right side was involved in 54% and 40% cases respectively. The disease presented bilaterally in 06% cases. 80% patients had no complications after endonasal endoscopic dacryocystorhinostomy (EEDCR) surgery. Rate of surgical success was 92%.&lt;/p&gt;&lt;p class="Default"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Nasolacrimal duct obstruction is more common among females and in middle aged persons. EEDCR is treatment which provides patients relief from the symptoms without any scar and also preserves nasolacrimal pump system with high success rate. It may prove better surgical technique in chronic dacryocystitis.&lt;/p&gt;

Dacryolithiasis diagnosis and treatment: a 25-year experience using nasal endoscopy

BackgroundDacryolith-induced epiphora is caused by a chronic obstruction of the nasolacrimal duct whose aetiology is often specified peroperatively. Dacryocystorhinostomy (DCR) has been often regarded as the gold standard to treat...

Effect of Silver Nitrate Application on the Success of Endoscopic Dacryocystorhinostomy.

To compare the clinical outcomes of patients undergoing additional procedures in endoscopic endonasal dacryocystorhinostomy (End-DCR) surgery and discuss the factors affecting the success of End-DCR surgery in light of relevant literature. The study included 155 patients who underwent End-DCR surgery in our clinic due to epiphora. This was a prospective randomized, single-blind, controlled trial. Group I (control) included 54 patients who did not undergo silicone stent insertion or silver nitrate application, group II included 51 patients who underwent silicone stent insertion only, and group III included 50 patients who underwent silver nitrate application only. Statistical analysis was performed on follow-up data regarding anatomic and functional success rates. Revision surgery was performed in 16 patients who developed persistent epiphora in the postoperative period, including 6 in group I, 7 in group II, and 3 in group III (P = .4). The most common reason for revision surgery was stenosis of the neo-ostium (n = 8), followed by granulation tissue formation (n = 5) and synechia formation (n = 3). Granuloma formation was the most common postoperative complication, and a significant difference was found among the groups with regard to granuloma formation (P = .04). At postoperative month 12, the functional success rate was estimated to be 88%, 86%, and 94%, and the anatomic success rate was estimated to be 94%, 92%, and 96% in groups I, II, and III, respectively, with no significant difference, found among the 3 groups with regard to both rates (P = .79 and P = .76, respectively). The results indicated that stenting and silver nitrate application did not affect surgical success. Our preliminary results on silver nitrate cauterization showed that it is an effective, inexpensive, and practical method to reduce granulation formation in the postoperative period.

Results and clinical aspects of primary endonasal endoscopic dacryocystorhinostomy with silicone tube.

Endonasal endoscopic dacryocystorhinostomy (DCR) is a common treatment for saccal and post-saccal stenosis of the lacrimal pathway or chronic dacryocystitis (DC). The main symptom is chronic epiphora (tearing) and dacryocystitis (infection). The objective of this study is to assess the short-term surgical result of this treatment based on possible prognostic factors; such as gender, age, the pathogen spectrum and the histopathological result as well as the influence of these parameters on hospital stay. It is a retrospective analysis, which includes 197 cases in 177 patients, who received an endonasal endoscopic DCR with a silicone tube between January 2009 and December 2016, as primary procedure. The follow-up was carried out 3months after the surgery, with the silicone tube being removed as part of the last examination including a flushing of the tear ducts with saline. This procedure is part of determining to measure the short-term success of the intervention. The definition of success of the surgery is an absence of epiphora or an acute infection of the nasolacrimal duct system, as well as an absent reflux in case of flushing the tear duct. The success rate was 86.3% (N = 170). Higher incidence was seen in females (N = 146; 74.1%) and patients with a mean age of 65.4 (± 17.2). The presence of pathogens as well as the histopathological result do not have an impact on the short-term surgical success. Patients diagnosed with rheumatic diseases appear to have a worse prognosis with relation to procedure success. Also, the length of hospital stay was related to possible prognostic factors. Type II diabetes and glaucoma had a significant influence on a longer hospital stay. The endonasal endoscopic DCR is a surgical procedure with high success rate. Patients with rheumaticdiseases should be aware of increased failure rates. Patients with glaucoma and Type II diabetes might need a more intense aftercare.

Использование современных энергетических методов удаления костных тканей при проведении эндоскопической дакриоцисториностомии

The article presents the results of surgical treatment of 22 patients with chronic dacryocystitis accompanied by proximal obstruction of the nasolacrimal duct. A new method of nasolacrimal anastomosis bone window during endonasal endoscopic dacryocystorhinostomy using ultrasound bone dissection is described. The questions of operation technique using SONOCA 185 ultrasound bone dissector and specific features of postoperative treatment are discussed. The obtained data allow to conclude that low temperature process of bone dissection with ultrasound cavitation gives a possibility of adequate bone window formation, reduces surgical trauma of bone structures, surrounding soft tissues and nasal cavity vessels as well as reduces the risk of bleeding and operation time needed for its stopping. It also enables better healing of soft tissues in shorter terms, provides anatomical and functional success of operation in 91 % of cases. Key words: chronic dacryocystitis; endonasal endoscopic dacryocystorhinostomy; ultrasound bone dissection; dacryostoma.

Outcome of Endonasal Dacryocystorhinostomy with Nasal and Lacrimal Sac Mucosal Flaps

Purpose: In patients with nasolacrimal duct obstruction, the outcomes of surgery were evaluated according to the type or presence of flaps. Methods: In total, 509 eyes were compared retrospectively: 178 eyes in patients treated without flaps, 126 eyes in patients treated using nasal mucosa flaps, and 205 eyes in the patient group using nasal and lacrimal sac mucosal flap were compared retrospectively. We analyzed the factors of success according to the surgical method by comparing granulation and bony ostium obstruction at 1, 3, and 6 months after surgery in each group. Results: At 6 months after surgery, granulation was found in 6 eyes (2.93%) in the nasal and lacrimal sac mucosal flap group, 5 eyes (3.96%) in the nasal mucosal flap group, and 15 eyes (8.42%) in the group treated without flaps. Bony ostium obstruction was found in 3 eyes (1.46%) in the nasal and lacrimal sac mucosal flap group, 4 eyes (2.38%) in the nasal mucosal flap group, and 6 eyes (2.81%) in the group treated without flaps. The anatomical surgical success rate of patients treated with nasal and lacrimal sac mucosal flaps was 95.61%, which was higher than those of patients treated with nasal mucosal flaps (92.86%) and without flaps (88.20%). The functional and anatomical surgical success rate was 94.15% in the group treated with nasal and lacrimal sac mucosal flaps, 88.89% in the group treated with nasal mucosal flaps, and 84.83% in the group treated without flaps. Conclusions: Endonasal dacryocystorhinostomy using the nasal and lacrimal sac mucosal flap is an effective method that minimizes the risk of granulation and bony ostium obstruction.

Endonasal Dacryocystorhinostomy; the learning curve and our experience

Amac:Bu arastirma sirasinda elde edilen sonuclar ile bir kulak burun bogaz uzmaninin gozetimi altinda bir oftalmik cerrah tarafindan gerceklestirilen endonazal dakriyosistorinostomi operasyonunun ogrenme egrisi hakkinda bilgi verilmesi amaclandi. Hastalar ve Yontem:Bu retrospektif calismada, endonazal dakriyosistorinostomi ameliyati olan ardisik olgular, tek bir oftalmik cerrah tarafindan ikinci bir kulak burun bogaz uzmani gozetiminde gerceklestirildi. 23 hastaya toplam 29 ameliyat yapildi. Tam nazolakrimal kanal tikanikligi tanisi konulan hastalar degerlendirildi ve ameliyat edildi. Tum cerrahi vakalar intraoperatif olarak kaydedildi ve her vaka icin kayit suresi belirlendi. Postoperatif donemde veya sonrasinda meydana gelen komplikasyonlarin tumu kaydedildi. Bulgular:23 hastanin yas ortalamasi 55.25 ± 18.6 yil (15 yas-80 yas) idi; bunlardan 20\'si (% 87) kadindi. Sol taraf tikanikligi vakalarin% 69\'unda (20/29) yer aldi. Ortalama 12,4 aylik takip sonunda,% 89 (26/29) olguda anatomik ve fonksiyonel basari elde edildi. Ameliyathanede harcanan ortalama sure 84 ± 17,2 dakika idi (aralik, 40-110 dakika). Sadece 3 basarisiz ameliyatin ilk 5 ameliyat arasinda oldugu tespit edildi, geri kalan 24 vakada basarisizlik saptanmadi. Sonuc:Endonazal dakriyosistorinostomi, nazolakrimal kanal tikanikliginin tedavisi icin guvenli, etkili ve kozmetik acidan kabul edilen bir ameliyattir. Bazi ameliyatlardan biraz daha uzun bir ogrenme egrisine sahip olmasina ragmen, endoskopun kullanimi ustalastiktan ve cerrahi alanin asinaligi gelistirildikten sonra, ameliyat suresi onemli olcude azalacaktir. Multidisipliner koordinasyonun potansiyel komplikasyon oranlarinin azaltilmasinda ve teknigin mukemmellestirilmesinde onemli bir rol oynadigina inaniyoruz.

COMPARISON OF SURGICAL OUTCOME OF ENDOSCOPIC DACRYOCYSTORHINOSTOMY WITH OR WITHOUT FLAP

The goals of this study were to evaluate the results of endoscopic endonasal dacryocystorhinostomy (DCR) and to compare the surgical success rates of the different procedures (with or without mucosal flap) in patients with nasolacrimal duct obstruction. This prospective study investigated the results of 39 patients, they were 36 females (92.3%) and 3 males (7.7%). Endoscopic endonasal DCR was performed at the Basrah Teaching Hospital, Department of Otolaryngology in the period between July 2018 to July 2019. The patients were divided into two groups; with or without flap. During surgery, the mucosal flap was preserved in 13 patients (group B) and removed in 26 patients (group A). For all patients, silicone stents were put at the end of surgery. The silicone tube was removed within 6 months after surgery. After six months follow-up, the results were; patent ostium reported in 17 patients (81%) in group A and in 10 patients (90.9%) in group B. There was no statistically significant difference between the groups (P-Value 0.461). The overall incidence of crustation and adhesion is more in group A than in group B but it was also statistically not significant.In conclusion, endoscopic endonasal DCR carries no significant difference of success ratewhether it is with or without mucosal flap.Key words: Endoscopy, Dacryocyctorhinostomy, flap, Surgery.

Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation.

To establish the necessity of silicone tube intubation in acute dacryocystitis (AD) patients undergoing endonasal endoscopic dacryocystorhinostomy (En-DCR). Patients presenting with unilateral AD were randomly assigned to two treatment groups. En-DCR procedures were performed following lacrimal abscess formation, with the operation being performed with silicone intubation for patients in group B but not group A. Functional success was defined by an absence of additional AD episodes, no epiphora, and ostium patency as established via endoscopic evaluation or fluorescein irrigation. Operative success rates and demographic variables were compared between treatment groups. In total, 66 patients were analyzed in the present study (33 per group), with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B, respectively. All patients exhibited complete resolution of acute inflammation. Upon follow-up, granulation tissue was detected around the ostium at higher rates in group B (9/22, 40.9%) relative to group A (4/27, 14.8%). At the 12-month follow-up time point, patients in group A exhibited higher success rates (25/27, 92.6%) relative to patients in group B (20/22, 90.9%), but this difference was not significant. Cases of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ostium. Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation, cost, and operative duration, these data do not support the routine silicone intubation of AD patients following En-DCR surgery.

English

BACKGROUND Epiphora is a common annoying symptom, embarrassing the patient both socially and functionally and may even endanger the eye. Chronic Dacryocystitis is the most common cause of epiphora which arises from nasolacrimal duct occlusion. Dacryocystorhinostomy (DCR) is the procedure of choice in the management of Dacryocystitis. We wanted to study the final outcome following endonasal DCR for chronic dacryocystitis with or without using silicon stent, evaluate the causes of persistence of epiphora in patients with or without the use of lacrimal stents and identify the methods of overcoming them postoperatively. METHODS A case control study to compare the results of Endonasal DCR with and without stent was conducted among 96 patients of both genders aged above 20 years with symptoms and signs suggestive of nasolacrimal duct blockage. All the cases and controls were randomly selected and included as group A and group B. RESULTS 96 patients were included in this study and they were divided into two groups (Group A and Group B) with 48 patients in each group. More than 75 % of the patients were between 31 and 60 years of age with a mean age of 44.36 ± 3.15 years. In Group B, 72.91 % of the cases were between 31 and 60 years of age with a mean age of 45.50 ± 4.10 years. There was no statistically significant difference in both groups. In group A (DCR with stent) success rate or relief of symptoms was 96 % whereas in group B (DCR without stent) success rate or symptomatic relief was 80 %. CONCLUSIONS Endoscopic endonasal DCR with stent is a safe and minimally invasive procedure and is an effective treatment for patients who have failed primary endoscopic DCR without stent and also in cases of mucocele and pyocele of the sac. KEYWORDS Chronic Dacryocystitis, Dacryocysto-Rhinostomy, Nasolacrimal Duct and Endoscopic Dacryocysto-Rhinostomy

Endonasal Endoscopic Dacryocystorhinostomy with and Without Stents-A Comparative Study.

The study aims to compare the outcomes of endonasal endoscopic dacryocystorhinostomy (DCR) with and without nasolacrimal stents. A prospective randomized comparative study involving fifty patients, divided into two groups of 25 patients each. Group A consists of patients who underwent endoscopic DCR with silicon stent and group B consists of patients who underwent endoscopic DCR without stent. Patients were regularly followed up at 1st week, 6th week, 10th week and at the end of 5th month postoperatively. The silicone stents were removed at 6th postoperative week. Using statistical analysis results between the two groups were compared. Post-operative improvement in nasolacrimal duct obstruction and epiphora was seen in both the groups. Age of the patients ranged from 18 to 69years with most of the patients in the age group of 40 to 49years (46% N = 23, 12 in group A and 11 in group B). 88% of the patients were females. (N = 44, 21 in group A and 23 in group B) and 12% were males (N = 6, 4 in group A and 2 in group B). The disease was more commonly observed on the left side with 72% of the cases (N = 36, 19 in group A and 17 in group B) and 28% (N = 14, 6 in group A and 8 in group B) on the right side. In group A, (En DCR with silicone stent) 96% of the cases were successful while 4% resulted in failure whereas in group B (En DCR without stent) 92% of the cases were successful while 8% resulted in failure. Endoscopic DCR is simple and safe method. It is minimally invasive procedure as it is a direct approach to the sac. Cosmetically it is acceptable as there is no external scar. Endoscopic dacryocystorhinostomy with canalicular silicone intubation for shorter duration (6weeks) is a safe and successful procedure for the treatment of nasolacrimal duct obstruction. Close follow up immediately after surgery is needed to reduce the failure rate. Regular post-operative follow up is necessary and any defect like synechia and granulation tissue formation can be released at follow up period thus increasing the success rate. En DCR has a good success rate with and without stenting of 96% and 92% respectively.

Diplopia Following the Insertion of a Canalicular Bypass Tube: Etiology, Risk Factors, Management, and Outcomes.

To report the etiology, management, and possible risk factors for diplopia after canalicular bypass surgery. A multicenter retrospective, noncomparative case series of patients who developed diplopia following canalicular bypass surgery were assessed. Twenty-four cases of diplopia were identified across 12 institutions. Tubes were inserted as a primary procedure with external dacryocystorhinostomy (DCR) (1; 4%) or without DCR (10; 42%) or as a secondary procedure after external (8; 33%) or endonasal (5; 21%) DCR. Factors predisposing to local damage were noted in 17 (71%): these factors included preexisting autoimmune/inflammatory condition (7 cases), medial canthal tumor resection (5 cases), preoperative radiotherapy (2 cases), 2 drug treatments (topical and systemic), and 1 local surgery. Horizontal diplopia was due to restriction of abduction and first noted at a median of 3.5 months (mean: 17.8 months, range: 1 day to 112 months) and persisted in 23 (96%) cases with a mean restriction of -2, affecting primary gaze in 4 patients and activities of daily living in 13 (42%). Seventeen patients received various treatments: 10 were operated on resulting in cure in 1 and improvement in 9. A stable degree of diplopia persisted in all but one patient. Restriction of abduction causing horizontal diplopia is a rare complication with canalicular bypass surgery and a notably high proportion occurred after tube placement without DCR; carunculectomy was not ubiquitous. Although in some the diplopia may be improved with intervention, the chance of cure is low. This complication should probably be included during informed consent for canalicular bypass tubes.

Comparison of Endonasal Endoscopic Dacryocystorhinostomy with External Dacryocystorhinostomy

Purpose: To compare anatomical and functional success of Endonasal Dacryocystorhinostomy (DCR) with that of External Dacryocystorhinostomy.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Ophthalmology and Otolaryngology, District Headquarter Teaching Hospital, Sahiwal, from July 2018 to July 2019.&#x0D; Methods: Sixty patients with nasolacrimal duct obstruction were selected by convenient sampling technique and were divided into two groups. Group 1 underwent endonasal DCR while group 2 underwent external DCR. Detailed history with regard to symptoms and duration of the obstruction was taken. Detailed ophthalmological and otolaryngological examination was performed. Patients were followed up for three months. Chi-square test was used to compare the success between two groups. Confidence level of 95% was used and p value of less than 0.05 was considered significant.&#x0D; Results: Male to female ratio was 4:11. The most common presenting symptoms was epiphora that was present in all patients. Regurgitation of lacrimal sac was present in 75%, conjunctivitis was present in 53.33% and dacryocystitis was present in 41.66% patients. Anatomical success rate for endonasal DCR was 25 (83.33%) and for external DCR was 27 (90%). Functional success rate for endonasal DCR was 23 (76.67%) and for external DCR was 22 (73.33%). There was no statistically significant difference in the short term success of surgery between the two groups.&#x0D; Conclusion: Endonasal DCR offers minimal invasive approach with comparable anatomical and functional results to the external DCR.&#x0D; Key Words: Conjunctivitis, Dacryocystorhinostomy, Dacryocystitis, Epiphora.

Lacrimal sac diverticulum: clinical presentation and endoscopic management.

To describe the clinical presentation, surgical intervention and clinical outcomes of patients with a lacrimal sac diverticulum. Retrospective chart review of all patients who underwent endonasal endoscopic dacryocystorhinostomy (DCR) in a single medical center from January 2010 to October 2020. The diagnosis of a lacrimal sac diverticulum was based upon intraoperative findings. In total, 406 patients underwent endonasal endoscopic DCR during the study period. Eight female patients (mean age 35years) were diagnosed with a lacrimal diverticulum and underwent DCR by an endonasal endoscopic approach. The mean follow-up period was 11.5months. All eight patients had cystic findings at the lacrimal fossa on imaging studies prior to surgery. Five patients had a history of dacryocystitis. The main presenting symptoms were epiphora and/or medial canthal swelling. The diverticulum was identified on the inferior wall in seven cases. A dacryolith in the lacrimal sac was identified intraoperatively in two patients. All patients showed full resolution of symptoms after surgery. There were no intraoperative or postoperative complications. Lacrimal sac diverticulum is a rare entity with female predominance. It may be the underlying etiology of epiphora and/or dacryocystitis. The diagnosis is based upon identifying the presence of a diverticulum intraoperatively. Endoscopic DCR is an effective approach for integrating both the lacrimal sac and diverticulum cavities into a single space, leading to resolution of symptoms.