Endonasal Dacryocystorhinostomy Research Articles

Comparison of endoscopic and external dacryocystorhinostomy in terms of operation success and patient satisfaction; A prospective study

Aim: To compare the results of endoscopic endonasal dacryocystorhinostomy (endonasal-DCR) and external dacryocystorhinostomy (external-DCR) and to evaluate patient satisfaction after the procedures. Materials and Methods: Patients who underwent dacryocystorhinostomy (DCR) were examined prospectively. Demographic data, follow-up periods, success rates and complications were recorded. A patient satisfaction questionnaire was used for subjective evaluation.Results: The mean age of external-DCR patients was 53.14± 3.41 while it was 52.05 ± 2.15 years years in patients who underwent endonasal-DCR procedure (p=0.074). The follow-up period ranged from 6 to 30 months. The success rates in the endonasal-DCR and external-DCR operations were 91.1% and 92.3%, respectively. The patient satisfaction was better in the endonasal-DCR as compared to external-DCR. Compared to external-DCR (17%), none of the endonasal-DCR patients had visible scars. The time it takes patients to return to daily routine was 12.4 ± 2.71 days in external-DCR and, 5.10 ± 0.99 days in endonasal-DCR (p0.001).Conclusion: Although the success rates are better in external-DCR, the patient satisfaction was significantly higher, and the recovery times were significantly lower in endonasal-DCR.

Evaluation of ostium size following endoscopic dacryocystorhinostomy as a predictive factor of outcome: A prospective study

Endonasal dacryocystorhinostomy (DCR) is a surgical procedure that aims to increase tear drainage to treat epiphora caused by nasolacrimal obstruction by creating a bypass through the bone between the lacrimal sac and the nasal cavity. A silicone stent is temporarily put in place for 2 months to avoid early obstruction of the rhinostomy. One of the causes of surgical failure is related to progressive stenosis of intranasal ostium, due to fibrosis and new bone growth, inducing a relapse of epiphora and/or dacryocystitis. Few studies have described changes in the size of the intranasal ostium on direct post-DCR measurement or kinetics of its shrinkage. The purpose of this study is to determine whether changes in the size of intranasal ostium might be a predictor of final functional efficacy. A prospective cohort of eighteen consecutive patients undergoing endonasal DCR for chronic epiphora or chronic dacryocystitis between January 2017 and April 2018 was analyzed. Eight patients who underwent bilateral DCR, and twenty-six intranasal ostia were finally analyzed. Follow-up took place every two months for 1 year, with the silicone tube removed at 2 months. Functional success was defined as absence of recurrent epiphora or dacryocystitis. Ostium size was systematically measured on photos taken during intranasal endoscopy performed every 2 months for 1 year. At 2 months after endonasal DCR, 23 of the 26 ostia (88.5%) were functional, but only 19 (73.1%) of them were directly measurable. The mean horizontal diameter at 2 months was 1.44 (SD 0.61) mm, and the mean vertical diameter was 0.86 (SD 0.37) mm, which corresponded to a mean area of 10 (SD 0.84)mm2. We noted a statistically significant decrease in ostium size and area between 2 and 4 months after the procedure (P -0.001), followed by a stabilization period with no statistical correlation between the size of the ostium and its final functional efficacy. At 6 months after DCR, of the 7 ostia that were not initially measurable, 3 were immediately non-functional at 2 months, 3 had a relapse of epiphora at 4 months, and 1 had a relapse of dacryocystitis at 6 months, i.e., 100% clinical failures at 6 months. The other procedures all remained functional after 1 year of follow-up. The intranasal ostium of an endonasal DCR shrinks significantly within the 2 months after removal of the silicone tube and remains stable thereafter. There is no correlation between the size or area of intranasal ostium and its final functional efficacy. However, when the ostium is not measurable at the time of 2-month stent removal, all patients experienced a relapse of epiphora or dacryocystitis within 6 months.

COMPLICATIONS IN SURGICAL TREATMENT OF PATIENTS WITH CHRONIC DACRYOCYSTITIS

Relevance. Effective treatment of chronic dacryocystitis (CD) remains an urgent problem of modern ophthalmology and rhinology. When studying this issue, not enough attention is always paid to complications.
 Objective – to analyze the existing complications in the surgical treatment of patients with СD.
 Material and methods. The study group (1st group) consisted of 45 patients with CD, who underwent endonasal endoscopic dacryocystorhinostomy (EEDCR) according to the developed own method, the comparison group (2nd group) included 36 patients who after performing the developed EEDCR a polyvinyl chloride (PVC) conductor was installed in the area of the dacryorhinostoma. The control group (3rd group) included 28 patients who underwent EEDCR according to the traditional method: with the preservation and plastic placement of mucous flaps and with the installation of PVC-conductor. Patients of the 1st and 2nd groups were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography (CT) of the lacrimal ducts in the preoperative period according to the developed method and patients of subgroups 1B and 2B – according to the traditional algorithm. Statistical analysis was performed using the licensed program MedCalc (MedCalc Software bvba, Ostend, Belgium; 2017).
 Results. In patients of subgroups 2A, 2B, and group 3 in the period of 1.5 months after surgery, local complications of the eyeball were recorded: epiphora during implant wearing, severe conjunctivitis, prolapse and displacement of the implant, granulation in the lower lacrimal duct, ectopia of the lower lacrimal point. No such complications were observed in patients of subgroups 1A and 1B. In patients of subgroups 1B, 2B, and group 3 in the early postoperative period were recorded varying degrees of swelling of the lower eyelid, as well as nosebleeds after removal of tampons. No such complications were observed in patients of subgroups 1A and 2A, and the difference between the groups was statistically significant (p <0.05).
 Conclusion. CT of the lacrimal ducts and EEDCR according to the developed methods are effective and allow their combined use to avoid local complications from the nasal cavity and eyeball.

Эндоназальная дакриоцисториностомия как способ лечения острого абсцедирующего дакриоцистита

Aim. Estimation of acute abscessed dacryocystitis endosurgery treatment long term results. Methods. A retrospective analysis of a group including 16 patients with acute dacryocystitis and lacrimal sac abscess in whom endonasal dacryocystorhinostomy was performed as a primary procedure. Mean age was 57 years. All operations were performed under general anesthesia. To remove the mucous membrane of the lateral wall of the nose and the medial wall of the lacrimal sac, we used the Coblator® II radio wave cold plasma ablator (RF8000E) (USA). The bone window was formed using a SONOCA 185 ultrasonic bone dissector from Soring (Germany) with an oscillation frequency of 35 kHz. The operation was completed by bicanalicular intubation with FCI’s Bika silicone system. Results. Mean post-op follow-up period was 6 months. Lacrimal ducts passability was achieved in 13 of 16 patients (81,25 %). Three patients (18,75 %) had recurrent epiphora after surgery and underwent reoperations. In one of them (6,25 %) granuloma formation around the dacryostoma was found and in two (12,5 %) membranous obstruction of the anastomosis occurred. In all the patients pain has ceased within 3 days post-oр. Medial eyelids edema and erythema have gradually ceased in 2 days and completely resolved in 7–10 days. Conclusions. Success rate (81,25 %) in long-term functional results of endonasal dacryocystorhinostomy operations shows high efficacy of our methods of nasolacrimal anastomosis formation in the treatment of patients with acute dacryocystitis and lacrimal sac abscess. Key words: endonasal dacryocystorhinostomy; lacrimal sac abscess; ultrasound bone dissection; cold plasma ablation.

ПЕРЕДОПЕРАЦІЙНЕ РЕНТГЕНОЛОГІЧНЕ ОБСТЕЖЕННЯ ХВОРИХ З ХРОНІЧНИМ ДАКРІОЦИСТИТОМ

Метою дослідження було розробити спосіб визначення топографо-анатомічного взаємозв’язку слізного мішка з оточуючими структурами та оцінити його ефективність при плануванні та виконанні ендоназальної ендоскопічної дакріоцисториностомії (ЕЕДЦРС). Досліджувану групу (1-а група) склали 45 пацієнтів з хронічним дакріоциститом (ХД), яким ЕЕДЦРС була здійснена за розробленою методикою, до групи порівняння (2-а група) було включено 36 хворих, яким після виконання ЕЕДЦРС за розробленою методикою в зону дакріориностоми встановлювали полівінілхлоридний провідник. До контрольної (3-ї) групи увійшли 28 пацієнтів, яким ЕЕДЦРС виконувалась за загальноприйнятою методикою. Для оцінки інформативності методик проведення комп’ютерної томографії (КТ) СВШ і можливості ефективного застосування отриманих КТ-даних, пацієнти 1-ї та 2-ї груп були розподілені на 2 підгрупи: до 1А і 2А були включені пацієнти, яким КТ СВШ проводили за розробленою методикою, а хворим підгруп 1В і 2В – за традиційним алгоритмом. Гіперпневматизація клітин agger nasi виявлена у 14,7% обстежених, запальна патологія в навколоносових пазухах – у 38,5% (p>0,05). Слізна ямка розташовувалась на рівні переднього кінця середньої носової раковини (СНР) в 39,4 % випадках, допереду від нього – у 32,1%, а дозаду – в 14,7 %. У 13,8 % спостереженнях визначити відношення слізної ямки до СНР було утрудненим, ці випадки були в підгрупах 1В, 2В та в 3-й групі (p<0,05). Візуалізація хірургічного поля 1-2 ступеня в групах 1А та 2А була у понад 90 % пацієнтів, у групах 1В та 2В – менш ніж у 50 %, а в групі 3 – у 25 % хворих (p<0,05). Таким чином, анатомо-топографічні особливості СВШ необхідно визначати та враховувати при хірургічному лікуванні та спостереженні хворих з ХД. Розроблена методика проведення КТ із контрастуванням СВШ є ефективнішою в порівнянні з традиційною, а виконання хірургічного втручання при її застосуванні – ощадливим.

Анализ причин рецидива после эндоназальной эндоскопической дакриоцисториностомии

Анализ причин рецидива после эндоназальной эндоскопической дакриоцисториностомии

Influence of Surgical Techniques on Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-analysis.

Endoscopic endonasal dacryocystorhinostomy (END-DCR) has increased as a valid alternative to the classic external approach to treat distal lacrimal obstruction. Different surgical varieties of the END-DCR approach have been proposed with no clear understanding of the best surgical technique. A comprehensive research was performed in PubMed, Embase, SCOPUS, and Cochrane databases with a final search on March 2020. The aim of this search was to identify relevant END-DCR procedures performed with mechanical (Mecn-END-DCR) and powered (Pow-END-DCR) approaches to compare their functional success rate. In addition, the influence of mucosal flaps was evaluated. Articles were selected only if they were published later than 2000 and had at least 50 single-clinician surgical procedures performed. Excluded articles included acute infections, cancers, mixed cohort study, and revision cases. A total of 11,445 publications were identified and 2741 reviewed after screening; 15 articles were included after full-text review (0.6% of the initial articles reviewed). The mean success rate was 91.34% (95% CI, 87.1%-94.3%) for Pow-END-DCR and 89.5% (95% CI, 86.5%-91.9%) for Mecn-END-DCR with no significant difference between the surgical approaches (P = .43). For mucosal flaps performed during END-DCR, the mean success rate was 89% (95% CI, 86%-91%) if mucosal flaps were used and 92% (95% CI, 88%-95%) if they were not used, with no statistical difference present (P = .14). Our analyses suggest that there are no differences in outcomes between mechanical and powered approaches in END-DCR and that mucosal flap preservation is not essential to achieve a superior END-DCR outcome.

Silicone Tube Intubation with Lacrimal Endoscopy and Endonasal Dacryocystorhinostomy in Adult Nasolacrimal Duct Obstruction

ëª©ì  눈물소관폐쇄가 없는 성인 후천코눈물관막힘 환자에서 눈물길미세내시경 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ ì„ 시행한 경우와 ì½”ê²½ìœ ëˆˆë¬¼ì£¼ë¨¸ë‹ˆì½”ì•ˆì—°ê²°ìˆ ì„ 시행한 경우 간의 치료 효과를 ë¹„êµí•˜ê³ ìž 하였다. 대상과 방법 눈물소관폐쇄가 없는 성인 후천코눈물관막힘 환자로 ì „ì²´ 50ëª (68안) 중 눈물길미세내시경 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ ì„ 받은 경우(21ëª , 31안)와 ì½”ê²½ìœ ëˆˆë¬¼ì£¼ë¨¸ë‹ˆì½”ì•ˆì—°ê²°ìˆ ì„ 받은 경우(29ëª , 37안)를 í›„í–¥ì ìœ¼ë¡œ 비교하였다. ê²°ê³¼ 눈물길미세내시경 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ ì„ 시행한 경우 ìˆ í›„ 3개월 및 6개월의 ì„±ê³µë¥ ì€ ì „ì²´ 31안 중 27안(87.1%), 22안(71.0%)을 보였다. ì½”ê²½ìœ ëˆˆë¬¼ì£¼ë¨¸ë‹ˆì½”ì•ˆì—°ê²°ìˆ í™˜ìžêµ°ì—ì„œëŠ” ìˆ í›„ 3개월 및 6개월의 ì„±ê³µë¥ ì€ ì „ì²´ 37안 중 34안(91.9%), 30안(81.1%)을 보였다. ìˆ í›„ 3개월 및 6개월의 ì„±ê³µë¥ ëª¨ë‘ ìœ ì˜í•œ 차이가 없었으나(p=0.517, p=0.327), ìˆ ì „ 눈물소관관류검사에서 ì™„ì „íì‡„ë¥¼ 보이는 경우 ìˆ í›„ 6개월 ì½”ê²½ìœ ëˆˆë¬¼ì£¼ë¨¸ë‹ˆì½”ì•ˆì—°ê²°ìˆ (81.8%)이 눈물길미세내시경 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ (33.3%)보다 ìœ ì˜í•˜ê²Œ 높은 ì„±ê³µë¥ ì„ 보였다(p=0.028). ê²°ë¡ ëˆˆë¬¼ì†Œê´€ë§‰íž˜ì´ 없는 후천코눈물관막힘 환자에서 눈물길미세내시경을 이용한 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ ì€ 환자에서 ì½”ê²½ìœ ëˆˆë¬¼ì£¼ë¨¸ë‹ˆì½”ì•ˆì—°ê²°ìˆ ê³¼ 동등한 ì„±ê³µë¥ ì„ 보였으나, 코눈물관의 ì™„ì „íì‡„ê°€ 있는 환자의 경우에는 낮은 ì„±ê³µë¥ ì„ 보였다. 눈물길미세내시경 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ ì„ 이용하여 불필요한 ì¹¨ìŠµì  ìˆ˜ìˆ ê³¼ ì „ì‹ ë§ˆì·¨ 및 합병증을 줄일 수 있을 것으로 보인다. Keywords: Acquired nasolacrimal duct obstruction, Endonasal dacryocystorhinostomy, Lacrimal micro-endoscope, Silicone tube intubation, Success rate

Comparative Analysis of Dacryo Cysto-Rhinostomy: External Versus Endoscopic

Dacryocystorhinostomy (DCR) is a surgical procedure that restores communication between the tear sac and the adjacent nasal cavity. Our work consists of a comparative study of the results of external dacryocystorhinostomy (EX-DCR) versus endoscopic endonasal dacryocystorhinostomy (EN-DCR), whose rate of therapeutic failure by endoscopic route estimated at 20% against only 7% in the case of external surgery.

A Case of Primary Tuberculosis of the Lacrimal Sac Presenting as Epiphora

Extra-pulmonary tuberculosis usually progresses as a secondary infection from pulmonary tuberculosis, and tuberculosis of the head and neck region. Tuberculosis of ocular and periocular areas, however, is a rare disease. Among ocular tuberculosis involving the adnexal structures, a few lacrimal sac tuberculosis has been reported. We recently experienced a case of lacrimal sac tuberculosis presenting as epiphora. Examination revealed bilateral nasolacrimal duct obstruction and the patient underwent endoscopic endonasal dacryocystorhinostomy. During the operation, a biopsy taken from the unhealthy looking lacrimal sac filled with caseous necrotic tissue was suggestive of tuberculosis. Histopathological features and further systemic evaluation confirmed tuberculosis. She was treated medically with anti-tubercular agents. The new opening of the lacrimal sac was patent and epiphora was resolved successfully at a year follow up. This report highlights the requirement of high suspicion of tuberculosis, even in the nasolacrimal drainage system.

Ethmoid Sinus Mucosal and Lacrimal Sac Flap Anastomosing in Patients With Failed Dacryocystorhinostomy.

The aim of this work is to demonstrate the outcomes of endonasal dacryocystorhinostomy (En-DCR) with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing in patients with previous failed DCR. The clinical data of patients who suffered from recurrent epiphora after failed DCR between September 2014 and March 2018 were reviewed retrospectively. Among them, those who received the second En-DCR procedure were enrolled in this study. During the surgery, anterior ethmoidectomy was performed. Posterior lacrimal sac flap was apposed closely to the mucosal of anterior ethmoid sinus instead of nasal flap at end of the surgery. Patients were followed up more than 12 months were included, the success rate and complications were recorded. Sixty-one eyes of 61 patients were enrolled in the study. The success rate of our modified En-DCR was 83.6% (51/61). Among 10 eyes with postoperative obstruction, 4 eyes caused by granuloma, 2 eyes caused by scar synechia, 2 eyes caused by membranous obstruction, and 2 eyes caused by common canalicular stenosis. No serious complications such as orbital fat prolapse, cerebrospinal fluid leak, sinusitis, or visual impairment were occurred in this study. Endoscopic approach with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing is a good choice for patients with recurrent epiphora after previous failed DCR.

Study of transcanalicular endonasal laser DCR: Our experience

Surgical classical DCR with external approach is considered as mainstay treatment with higher success rates for nasolacrimal duct obstructions. But In certain conditions, Transcanalicular endonasal laser DCR is proven more advantageous than classical DCR due to less complications like bleeding and low morbidity with acceptable success rate. The purpose of this study is to study the success rate and complications of Transcanalicular laser-assisted endoscopic dacryocystorhinostomy. We present our experience of transcanalicular enonasal laser DCR done in 50 patients with 6 month follow-up period. Diode laser was used to create ostium in all cases. Success rate of surgery is defined by patent sac syringing at each follow-up visit in most cases. Complications observed like bleeding, lid edema and pain are minor and easily manageable. At the end of our study, the final success rate is around 60% which is acceptable and comparable to other studies. Transcanalicular laser-assisted DCR, is a newer approach for nasolacrimal duct obstruction with good success rate and minimal complications with Shorter surgical time, faster recovery and better cosmesis than external classical DCR.

Lithuanian version of nasolacrimal duct obstruction symptom scoring questionnaire. Cross-cultural adaptation and validation. Short- and long-term results.

The objective of this study was to perform translation, cross-cultural adaptation and validation of the Lithuanian version of specific nasolacrimal duct obstruction symptom scoring (NLDO-SS) questionnaire and to evaluate short- and long-term results of endoscopic endonasal dacryocystorhinostomy (EN-DCRS) procedure. Permission for questionnaire translation, cross-cultural adaptation and validation was obtained from the authors of the original questionnaire. Translation, validation and cross-cultural adaptation were carried out according to generally accepted methodology. Validation study of the Lithuanian version of NLDO-SS (L-NLDO-SS) was performed, and short- and long-term results of EN-DCRS procedure were evaluated according to symptoms. In total, 44 patients were evaluated 2weeks before the surgical intervention, a day before the surgery and 41 patients 2months after the surgery, and again 10months later. We analysed the internal consistency and test-retest reliability of the L-NLDO-SS questionnaire. Cronbach's alpha was used to represent and evaluate internal consistency for ordinal responses. Validity was assessed by comparing scores between a control group of volunteers without NLDO and the NLDO group using Mann-Whitney test. To test the limiting score on which the sensitivity and specificity curves cross in identifying patients with NLDO, receiver operating characteristic (ROC) curve analysis was used. The pre- and post-operative scores were compared using the paired t-test. The results showed an acceptable internal consistency of L-NLDO-SS questionnaire, with Cronbach's alpha-.73 in the initial test group and .71 in the retest group. Pearson's correlation coefficient was .94 (P<.001), revealing good correlation between the initial scores and the retest scores. Our sample of healthy individuals had a mean L-NLDO-SS score of 11.42 (±12.69) points, and patients being scheduled for EN-DCRS had a mean L-NLDO-SS score of 27.45 (±9.81) points. Post-operatively mean L-NLDO-SS scores improved from 27.45 (±9.81) points to 4.45 (±6.29) points in the short term and to 5.83 (±4.17) in the long term, demonstrating the statistically significant responsiveness of the instrument over both timescales. Lithuanian version of NLDO-SS questionnaire is a valid instrument for assessing patients with NLDO in the Lithuanian population. It demonstrated good internal consistency, reproducibility, validity and responsiveness.

A Prospective Longitudinal Study to Evaluate the Outcomes of Success of Endoscopic DCR in Pediatric Age Group.

Children with nasolacrimal duct obstruction (NLDO) have different therapeutic approach from that used in adults. Dacryocystorhinostomy (DCR) is the most common procedure in adults but it is less frequently carried out in children, indicated in children which are refractory to probing. The objective of the study is to report a series of 30 cases of paediatric epiphora who underwent endoscopic endonasal dacryocystorhinostomy surgery, for primary obstruction of nasolacrimal duct and results, outcomes of success are evaluated. This is a prospective and non-comparative review of 30 cases of epiphora aged between 3 and 9years from April 2018 to March 2019. The main outcome measures assessed were determined by the resolution of symptoms and the patency of the lacrimal anatomy confirmed by syringing or irrigating the nasolacrimal duct. Secondary outcomes included the presence of such complications as bleeding, scarring, and/or persistent epiphora and infection. In our study 30 patients underwent unilateral DCR surgery in NLDO. Out of 30 patients males were 17 and females were 13. The overall success rate of endoscopic DCR was 90%, and failed cases were mainly due to pre-saccal obstruction. No major complications were reported, minor complications occurred in about 60% of cases. Analysis of the results indicated that EDCR was safe and an effective therapeutic approach for treating nasolacrimal duct obstruction in pediatric age group patients having NLDO. It's considered as an alternative procedure to external dacryocystorhinostomy after a failed conservative treatment.

Conditions for improving the effectiveness of surgical treatment of patients with chronic dacryocystitis in endonasal endoscopic procedures

Introduction. Surgical treatment of patients with chronic dacryocystitis is a complex interdisciplinary problem. Lacrimal sac can be reached externally and internally (endonasally). The effectiveness of the treatment largely depends on the results of complete diagnosis and choice of a treatment method.&#x0D; Purpose. To analyze the effectiveness of surgical treatment of patients with chronic dacryocystitis in endonasal access.&#x0D; Materials and methods. The study of 225 patients consisted in the analysis of two groups of patients (20152019) with chronic dacryocystitis: the first group (110 patients) underwent an endonasal endoscopic dacryocystorhinostomy in the form of monooperation, the second underwent endonasal endoscopic dacryocystorhinostomy with additional intranasal interventions (115 patients). All patients underwent endoscopic examination of the nasal cavity and midface multispiral computed tomography (MSCT).&#x0D; Results. The results of the obtained data convincingly showed a higher efficiency of treatment in the group of patients with combined operations with the pathological processes revealed in intranasal localization in comparison with the group of monoperations.&#x0D; Conclusion. According to the study data, patients with chronic dacryocystitis should undergo full ophthalmologic and endonasal diagnostics, including multispiral computed tomography-dacryocystorhinography of the middle facial zone according to the described algorithm. When detecting pathological processes hindering the standard endonasal endoscopic dacryocystorhinostomy, it is necessary to perform an expanded scope of surgical interventions which will contribute to the efficiency of treatment of patients with chronic dacryocystitis up to 91.3%.

Treatment for Functional Failure after Primary Endonasal Dacryocystorhinostomy

ëª©ì  눈물길 폐쇄 환자에서 ì½”ê²½ìœ ëˆˆë¬¼ì£¼ë¨¸ë‹ˆì½”ì•ˆì—°ê²°ìˆ ì„ 시행하여 í•´ë¶€í•™ì ì¸ 성공은 달성했지만 ì§€ì†ì ì¸ 눈물흘림을 호소하여 실리콘관을 ì‚½ìž í•œ 환자들을 대상으로 한 결과를 ë¶„ì„í•˜ê³ ìž 한다. 대상과 방법 2006ë „ 12월부터 2018ë „ 4월까지 본원에서 ì½”ê²½ìœ ëˆˆë¬¼ì£¼ë¨¸ë‹ˆì½”ì•ˆì—°ê²°ìˆ ì„ ë°›ê³ í•´ë¶€í•™ì ì¸ 눈물길 개통은 확보하였으나, ê¸°ëŠ¥ì ìœ¼ë¡œ ì—¬ì „ížˆ 눈물흘림을 호소하였던 23ëª (37안)의 환자들을 대상으로 ì´ì°¨ì ìœ¼ë¡œ 실리콘관을 ì‚½ìž í•˜ê³ ê·¸ 결과를 í›„í–¥ì ìœ¼ë¡œ 조사하였다. ê²°ê³¼ 이차 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ ì„ 시행 받을 때 환자들의 í‰ê· ì—°ë ¹ì€ 59.8세, í‰ê· ì¶”ì  기간은 14.8개월이었다. 일차 ì½”ê²½ìœ ëˆˆë¬¼ì£¼ë¨¸ë‹ˆì½”ì•ˆì—°ê²°ìˆ í›„ 이차 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ ì„ 시행 받을 때까지 í‰ê· ê¸°ê°„ì€ 24.5개월이었다. ê¸°ëŠ¥ì  실패에 대한 이차 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ ì˜ ê²°ê³¼, 총 37안 중 33안에서 ì™„ì „í•œ 성공을 ë³´ì˜€ê³ 4안에서 ë¶€ë¶„ì  성공을 확인하였다. 환자들의 ì£¼ê´€ì ì¸ 증상 í˜¸ì „ì— 근거하였을 때 실패한 환자는 없었다. ê²°ë¡ ì½”ê²½ìœ ëˆˆë¬¼ì£¼ë¨¸ë‹ˆì½”ì•ˆì—°ê²°ìˆ í›„ í•´ë¶€í•™ì  ë¬¸ì œê°€ 없음에도 ë¶ˆêµ¬í•˜ê³ ëˆˆë¬¼í˜ë¦¼ì´ ì§€ì†ë ë•Œ, 이차 ì‹¤ë¦¬ì½˜ê´€ì‚½ìž ìˆ ì´ 외래에서 간단하게 ì‹œí–‰í• ìˆ˜ 있는 ì•ˆì „í•˜ê³ íš¨ê³¼ì ì¸ ì‹œìˆ ë¡œ 사료된다. Keywords: Endonasal dacryocystorhinostomy, Functional failure, Re-silicone tube insertion, Munk score

Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis.

Epiphora is a common ophthalmologic sign that is most commonly caused by distal acquired lacrimal obstruction. Recent data have demonstrated that external dacryocystorhinostomy (EXT-DCR) and endoscopic endonasal dacryocystorhinostomy (END-DCR) can be considered the treatments of choice. However, different post-surgical medical therapies are available and are currently used to improve surgical outcomes, although no direct comparison has been performed. To analyse the influence of post-surgical medical treatments on END-DCR and EXT-DCR outcomes. A structured search was conducted using the U.S. National Library of Medicine (PubMed), EMBASE, SCOPUS, and Cochrane databases with a final search performed in May 2020. The research identified papers published later than 2000 with at least 50 single clinician procedures performed in EXT-DCR and END-DCR. Articles that studied acute infections, revision cases, mixed cohort studies of acquired and congenital obstruction, and tumour were excluded. The influence of systemic antibiotic/steroids, local application of mitomycin C, nasal/ocular antibiotic, nasal/ocular steroids and nasal decongestants was analysed. In total, 11,445 papers were selected, 2,741 of which were reviewed after screening, and 18 included after full text review (0.6% of the initial articles reviewed) which involved 3,590 procedures. Considering the low number of publications on EXT-DCR, statistical analysis of post-surgical therapy was not feasible. In END-DCR, the analyses were performed only for nasal steroids (p = 0.58), oral antibiotics (p = 0.45) and nasal decongestant (p = 0.27), which demonstrated no meaningful influence. Given the variable association between adjunctive medical therapies, pharmacologic molecular heterogeneity and modality/concentration of application, these results should be considered critically. Additionally, no differences were seen for application of silicone stenting, whereas, no statistical analysis was performed for mitomycin C. Given the high success rate of EXT-DCR and END-DCR and the heterogeneity of literature data, the effective influence of post-surgical medical therapy is difficult to identify. Future large prospective randomized studies could help in detecting the optimal adjunctive therapy for these surgeries.

Применение трансканаликулярного баллона при рецидиве после эндоназальной эндоскопической дакриоцисториностомии

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

Assessment of Rhinostomy Parameters in Endonasal Dacryocystorhinostomy.

Epiphora is a bothersome condition seen in chronic dacryocystitis. The mainstay of treatment is surgical, that is creating an opening to establish a drainage pathway. With the advent of endoscope, endonasal DCR has gained popularity. Use of silicone stent in endonasal DCR has added advantage in improving the surgical outcome. And the use of DOS system in improving the success rates of endonasal DCR: (Mohammad et al. in Clin Ophthalmol 8:2491-2499, 2014) a total of 35 patients with chronic dacryocystitis were subjected for endonasal DCR with silicone bicanalicular stent. Patients were followed up at an interval of 1week, 3weeks, 6weeks and 6months post surgery. DCR ostium parameters were evaluated using DOS system. Silicone stent removal was done at sixth week and evaluated for success. The success rate in our study was 89%. The DOS score of the patient with successful surgery had a score of more than 30 and in the failed cases the score was between 22 and 28. The success rate of the procedure primarily depends on the ostium parameters and the position of the silicone stent. The DOS scoring system can be suitable tool in evaluating the same.

Intra-Operative Mitomycin-C as Adjuvant Therapy in External and Endonasal Dacryocystorhinostomy: Systematic Review and Meta-Analysis.

PurposeTo evaluate the effect of mitomycin-C (MMC) on the success of external (Ex-DCR) or endoscopic dacryocystorhinostomy (En-DCR).MethodA systematic review of randomized clinical trials of Ex- or En-DCR with and without the use of MMC to treat primary acquired nasolacrimal duct obstruction (NLDO) was done. Two authors independently searched six databases from 1990 to 2019, using the terms “dacryocystorhinostomy” and “mitomycin-C.” Statistical and meta-analyses were performed using RevMan 5.3 software.ResultsTwenty-seven studies involving 2158 surgeries were included in this systematic review. The Ex-DCR group comprised 14 studies [odds ratio (OR): 2.74; 95% confidence intervals (CI) 1.54–4.87; I2 = 30%], while the En-DCR group 13 studies (OR: 1.69; 95% CI 1.21–2.37; I2 = 0%). The use of MMC slightly increased the success rate of Ex- or En-DCR (OR: 2.1; 95% CI 1.52–2.9; I2 = 14%).ConclusionThe intraoperative use of MMC is safe and slightly improves the success rate of Ex- or En-DCR. However, the evidence was very weak.