Lacrimal Irrigation Research Articles

Изучение антифибротической активности пирфенидона при дакриоцисториностомии (экспериментальное исследование)

One of the main reasons of failure in surgical treatment of dacryocystitis is cicatrical closure of the ostium. Considering controversial data on efficacy and safety of antifibrotic methods currently employed during dacrycystorhinostomy, searching for new ways to prevent fibrosis remains one of the main directions of research in dacryology. Pirfenidone, a small-molecule agent, was demonstrated to have a pronounced antifibrotic effect in experiments both in the eye and various other organs. Aim. To experimentally evaluate the antifibrotic effect of pirfenidone in dacryocystorhinostomy. Material and methods. 18 shinshilla rabbits were used in the current study. Subjects underwent modified dacryocystorhinostomy followed by 0,15 or 0,3 mg/ml pirfenidone injection circumostially. Animals were divided into groups based on pirfenidone dosage used. Control group animals received no injection. Rabbits were killed on the 7th (6 rabbits), 14th (6 rabbits) and 28th day (6 rabbits) following surgery. Ostium patency was evaluated using lacrimal irrigation and morphologically once the animal was killed. Ostium tissue samples were analyzed histologically. Results. Cicatrical closure of the ostium was observed in 4 subjects from control group on days 14 and 28 following surgery. The most pronounced fibrotic changes were also noted in tissue specimens obtained from these rabbits. Fibrotic changes in groups 1 and 2 were notably less severe than in control group. Conclusion. Data obtained in the current study evidences high antifibrotic efficacy of pirfenidone. This necessitates further research of pirfenidone use in dacryocystorhinostomy. Key words: dacryocystorhinostomy, ostium closure, dacryostoma, pirfenidone, antifibrotic therapy.

Surgical Site Reassessment: An Important Step in Improving Clinical Outcomes Following Pediatric Endoscopic Dacryocystorhinostomy

Purpose: To report the authors' experience with endoscopic unpowered dacryocystorhinostomy in the treatment of pediatric nasolacrimal duct obstruction, and to evaluate whether surgical site reassessment (after the appropriate healing period) affects clinical outcomes. Methods: This retrospective study included 47 children aged between 1.5 and 17.0 years (mean age: 6.9 years) who underwent endoscopic unpowered dacryocystorhinostomy between 2014 and 2019 at one tertiary care hospital. Twenty-six patients required unilateral and 21 required bilateral endoscopic dacryocystorhinostomy. The main outcome measures were duct patency on lacrimal irrigation (“anatomical success”) and resolution of symptoms (“clinical success”) over 6 months of postoperative follow-up. Results: Sixty-eight dacryocystorhinostomy procedures were performed. Surgical site reassessment during tube removal was performed in 52 of 68 cases. Five cases (9.6%) required treatment of local pathologies, only after which was symptomatic relief achieved. Overall anatomical success was observed in 49 (94.2%) of the 52 cases in which nasal endoscopy was performed, including the 5 cases treated during reevaluation. Clinical success was observed in 63 (92.6%) cases. Conclusions: Pediatric endoscopic dacryocystorhinostomy is an effective surgical procedure used to correct nasolacrimal system obstruction resistant to conservative measures. The unpowered endoscopic dacryocystorhinostomy technique is practical and safe in the pediatric population. Surgical site reassessment allows treating local pathologies threatening ostium patency and increases clinical success rates. [ J Pediatr Ophthalmol Strabismus . 2021;58(3):168–173.]

Transcanalicular Multidiode Laser Versus External Dacryocystorhinostomy in the Treatment of Acquired Nasolacrimal Duct Obstruction.

Objectives:This study was a comparison of the outcomes of transcanalicular multidiode laser dacryocystorhinostomy (TCLDCR) and external dacryocystorhinostomy (EXDCR) treatment for patients with acquired nasolacrimal duct obstruction.Methods:Thirty-one consecutive patients who underwent TCLDCR (TCLDCR group) and 68 consecutive patients who underwent EXDCR (EXDCR group) due to acquired nasolacrimal duct obstruction were enrolled in the study. Follow-up visits were performed on the first day, and at the first week, first month, third month, sixth month, and every six months thereafter. Surgical success was defined as achievement of a patent osteotomy and a successful bicanalicular silicone intubation during the procedure. Anatomical success was defined by observation of a patent osteotomy on lacrimal irrigation, regardless of epiphora. The surgery time and intra- and postoperative complications were noted for each patient.Results:The TCLDCR group had a significantly shorter mean surgery time (27.9±5.5 minutes) compared with the EXDCR group (58.5±12.0 minutes) (p<0.001). However, the mean anatomical and functional rates of TCLDCR (58.0% and 54.8%, respectively) were significantly lower than those of the EXDCR group (94.1% and 91.1%, respectively) (both p<0.001). Two patients had “cheese wiring” damage of the lower canaliculus and 1 patient in the TCLDCR group had a full-thickness skin defect in the medial canthal region. No serious intra- or postoperative complication occurred in the EXDCR group.Conclusion:Although a TCLDCR procedure decreased the surgical time, it had a significantly lower success rate in the treatment of acquired nasolacrimal duct obstruction compared to EXDCR. The decision of the type of surgery should be made based on the cosmetic and success expectations of the patients and the presence of systemic problems.

Impact of Epiphora on Modified Ocular Surface Disease Index Questionnaire

Epiphora (excessive tear production) is a major ocular disturbance, especially among middle aged and older patients. It can be due to lacrimal drainage malfunction of any kind. The aim of this study was to evaluate the effects of epiphora with good passage on lacrimal irrigation on a modified Ocular Surface Disease Index (OSDI) questionnaire. A total of 101 patients (53 males/ 48 females) were included in the study. The modified OSDI questionnaire had 11 items concerning ocular symptoms that affects daily activities. The relationships between the questionnaire score for each question and the clinical features included age, gender and previous cataract surgery. The most affected activities according to modified OSDI were watching television, windy conditions and cold weather (average means of 3.36 + 0.82, 3.42 +±0.86 and 3.40 +±0.88, respectively). Epiphora was found to have a statistically significant effect on daily life, all except with regard to interpersonal relations (p=0.493) with increasing age. Women were found to be experiencing more eye grittiness (p=0.0001), getting more affected during reading (p=0.027), at hot/dry climates (p=0.0001) and believed epiphora has an important impact on interpersonal relations and general happiness (p&lt;0.0001). Pseudophakic patients also showed statistically significant increase of discomfort in daily life questions in 7 of the 11 questions (p&lt;0.0001). This study showed the subjective epiphora related symptoms impact on a modified OSDI. This questionnaire was easy to manage and quick to complete while showing similar results to those that were specifically designed for epiphora with nasolacrimal obstruction. We believe that the results could help to improve overall therapeutic management of patients with epiphora

Developing the rabbit canalicular injury model: Biophysical changes of masterkaR stents and implications for future research

BackgroundTo describe the preparation of a rabbit lacrimal canalicular injury model, assess the canalicular healing, and determine the suitability of this model to study the biophysical changes of mono-canalicular stents. MethodsTwelve canaliculi of twelve eyes of six healthy New Zealand white rabbits were included in the study. A canalicular injury model was prepared under general anesthesia. The injury was then repaired using modified MasterkaR stents and peri-canalicular wound closure. The stents were extubated at eight weeks, and specific surgical techniques used to obtain the healed canaliculi. Histopathological analysis was carried out on the canaliculi samples, and the stents were examined ultra-structurally using the scanning electron microscopy (SEM). ResultsAt eight weeks, the canaliculus maintained its integrity and demonstrated good healing with epithelium continuity. However, the area of incision and suture showed hyperplastic epithelium with significant sub-epithelial fibrosis. Lacrimal irrigation following stent extubation confirmed patency of all the canalicular systems studied. SEM study revealed the biofilm formation and physical deposits over the external, luminal, and adluminal surfaces of all MasterkaR stents with intervening skip areas. Although these changes were seen all over the stent, the most preferential site for physical deposits and biofilm aggregates was the ampullary portion of the stent’s head. None of the rabbits showed any evidence of a post-operative ocular infection or local inflammation. ConclusionRabbits are good candidates for the preparation of a lacrimal canalicular injury model. The canalicular tissues demonstrate changes following repair. The biophysical changes on the extubated stents resembled those obtained from the humans.

Comparison of Hasner valvulotomy outcomes in pediatric and adult patients: does age matter?

BackgroundHasner valve incision has been recently introduced as a new treatment for ophthalmic patients with epiphora symptoms. The aim of this study was to examine whether surgical outcomes of Hasner valve incision for inferior nasolacrimal duct obstruction were different between pediatric and adult patients.MethodsA total of 53 eyes of 52 patients who underwent Hasner valve incision in the Beijing Tongren Hospital from October 2016 to November 2019 were retrospectively observed. Patients were divided into two groups, including pediatric group (23 eyes of 22 patients, <18 years old) and adult group (30 eyes of 30 patients, ≥18 years old). Success rate of surgery was determined by both subjective measure (complete resolution of epiphora) and objective measure (lacrimal passage irrigation and tear meniscus height). Fisher exact test was conducted.ResultsBy conducting Fisher exact test and comparing complete resolution of epiphora (P = 0.627), lacrimal passage irrigation (P = 0.663), measurement of Tear Meniscus Height (P = 0.561), and appearance of complication (P = 0.339), there was no statistically significant difference of surgical outcomes between pediatric and adult patients (P > 0.05).ConclusionHasner valve incision was effective for both adult and children with inferior nasolacrimal duct obstruction, with no difference in surgical outcomes between the two groups.

A preliminary study on the clinical features of congenital lacrimal fistula

Objective: To summarize the clinical characteristics of congenital lacrimal fistula for reference in its clinical diagnosis and treatment. Methods: Retrospective case series study. The clinical data of 27 patients (32 eyes) with congenital lacrimal fistula admitted to the Lacrimal Center of Third Medical Center of PLA General Hospital from July 2011 to November 2017 were analyzed, including gender, age of diagnosis, left eye or right eye, family history, physical examination, ophthalmic examination, fistula opening location and appearance, symptoms, results of lacrimal duct irrigation, three-dimensional reconstruction of the lacrimal drainage system with CT, lacrimal endoscopy, treatment, outcomes and follow-up. Results: In the 27 patients, the male to female ratio was 1∶2. The age of diagnosis was 1 to 74 years old, and the median was 32 years old. The ratio of unilateral fistula to bilateral fistula was 4.4∶1 (22/5), and the ratio of left eyes to right eyes was 1.2∶1 (12/10). The disease was sporadic in 22 patients, and 5 patients had a family history. Genetic analysis showed that congenital lacrimal fistula presented autosomal dominant inheritance. Fistulas were found on the skin surface of the lacrimal sac area under the medial canthus in 30 eyes, on the lacrimal caruncle in one eye, and on the conjunctiva of the medial canthus in one eye. All the patients presented with epihora, and irrigation liquid outflowed from the fistulas with purulence in 18 eyes. Lacrimal CT of the 27 patients showed contrast agents were left in the lacrimal sac. Lacrimal duct fistula was found open in the common canaliculus with concretions in the lacrimal system in four patients. Eight patients with mild symptoms underwent observation. Three patients underwent lacrimal therapeutic irrigation and probing. Sixteen patients underwent fistulectomy and were cured without recurrence during the follow-up of 1 to 6 years. Conclusions: Congenital lacrimal fistula is usually unilateral, and the opening is mostly located on the skin surface of the lacrimal sac area under the inner canthus ligament. Most cases are sporadic, and some cases are of familial inheritance in an autosomal dominant condition. (Chin J Ophthalmol, 2020, 56: 688-692).

Evaluation of Lacrimal Drainage Function in the Anophthalmic Socket by Dacryoscintigraphy.

To investigate whether impaired lacrimal pump function is a possible cause of discharge in patients wearing an artificial eye compared with the remaining healthy eye. Consecutive patients wearing unilateral ocular prosthesis for ≥6 months were included in this retrospective study. Excluded were any deformities of eyelids or nasal passage, socket complications such as entropion, ectropion, ptosis, infection, pyogenic granuloma, contracted socket, obstruction of nasolacrimal duct diagnosed with lacrimal irrigation and a difference greater than 2 mm in terms of protrusion between two eyes detected by Hertel exophthalmometry. Patients were asked to score the levels of tearing and mucopurulent discharge between 0 and 5 to assess lacrimal drainage function subjectively. Furthermore, dacryoscintigraphy was performed to assess the functional status of the lacrimal system objectively. Included were 32 subjects (12 females, 20 males; aged 32.94 ± 17.62, range 13-78). Mean duration of prosthetic wearing 26.41 ± 21.30 (6-72) months. The mean subjective scores of tearing and mucopurulent discharge were 1.56 ± 1.67 and 1.94 ± 1.63, respectively. The rate of functional stenosis was significantly higher in the anophthalmic socket side as compared to the healthy side (P = 0.002). The rates of a presac, preduct, and intraduct obstruction was notes as n = 9, n = 10, n = 1 and n = 0, n = 6, n = 2 in the anophthalmic side and the companion eye, respectively (P = 0.021). Compared to paired healthy eyes, the ocular prosthesis exhibited significantly higher rates of functional lacrimal duct obstruction, especially at the presac level. The alterations in orbital volume and tear film composition in addition to reduced corneal reflex blinking may lead to the failure of lacrimal pump function in artificial eyes.

Posterior sub-tenon’s injection of triamcinolone acetonide in the treatment of optic disc vasculitis

Objective To evaluate the efficacy of posterior sub-tenon’s injection of triamcinolone acetonide in the treatment of optic disc vasculitis. Methods The clinical data of 60 eyes of 60 patients with optic disc vasculitis from May 2016 to May 2019 in the Seventh People’s Hospital of Zhengzhou were retrospectively analyzed. Triamcinolone acetonide 40 mg/0.5 ml was injected into Tenon’s capsule with a self-made gauge 6 lacrimal irrigation needle, and compound Xueshuantong and energy mixture were infused intravenously, compound anisodine injection was injected subcutaneously beside superficial temporal artery, methylcobalamin, citicoline and compound vitamin B were taken orally. All patients were followed up for 6-18 months. Results All 60 cases were cured within 6 to 18 months after treatment. The visual acuity were improved and the shape of macular fovea were restored, macular edema were alleviated. Conclusion Posterior sub-tenon’s injection of triamcinolone acetonide in the treatment of optic disc vasculitis is safe, effective, simple and inexpensive. Key words: Vasculitis, optic disc; Triamcinolone acetonide, injection, sub-tenon’s posterior; Efficacy, clinical

Annular intubation with pigtail probe for canalicular lacerations.

Purpose:Pigtail probe as a procedure of choice for canalicular laceration.Methods:Retrospective, consecutive interventional case series of patients with eyelid laceration involving the canaliculus undergoing repair. All patients were subjected to repair with pigtail probe as first choice and only if this was not possible, they were repaired by other method. Outcome was analyzed in terms of cosmetic, functional, and anatomic success.Results:A total of 35 patients (mean age, 10.88 years) underwent eyelid and canaliculus repair by a single surgeon (RM). In all, 32 (91.42%) canalicular lacerations were repaired by annular intubation using a pigtail probe, while the remaining 3 (8.58%) lacerations in which pigtail probe intubation was not possible, were repaired by an alternative method. Upper canaliculus was involved in 6 (17.14%) and lower canaliculus in 29 (82.86%) eyes. Mean follow-up was 8.2 months (range 3–13 months). Intubation tubes were removed after at least 3 months (range 12–20 weeks). None of the patients had complaints of epiphora. All the patients had good cosmesis, anatomic alignment and functional success as assessed by dye disappearance test in younger children and lacrimal irrigation in older children and adults.Conclusion:Bicanalicular annular repair with pigtail probe achieved excellent functional and cosmetic results. The loop minimizes the chances of extrusion of the tube, maintains natural anatomic alignment of the cut ends of the canaliculus and thus retains the integrity of the delicate canalicular system. Pigtail probe intubation can be considered as the first choice in canalicular lacerations.

A histopathological study of lacrimal puncta in patients with primary punctal stenosis

We investigated the etiology of punctal stenosis based on the histopathological features of puncta and clinical correlations in punctal stenosis patients. A retrospective review was conducted of 69 cases from 38 patients who were diagnosed with punctal stenosis. Slit-lamp examination, the lacrimal irrigation test, dacryocystography, and spectral domain-optical coherence tomography were performed for the evaluation of punctal occlusions. For treatment, punctoplasty using a punch biopsy with or without silicone tube insertion and histopathological examinations were performed. The pathological features of the punctal membranes were classified into two types of epithelia: squamous (95.7%, 66/69) and columnar (4.3%, 3/69). The squamous epithelial specimens were divided into three groups: fibrous tissue (66.8%, 48/69), goblet cells (21.8%, 48/69), and keratinization (4.3%, 3/69). Most of the subepithelial pathology was fibrosis (82.6%, 57/69), and inflammation was noted in 17.4% (12/69) of the patients. Subepithelial fibrosis was the most common pathological feature in patients exhibiting stenosis with a squamous epithelium, while inflammation was more strongly correlated with patients with a columnar epithelium. However, there was no correlation between the histopathological findings and treatment outcomes. Our histopathological findings suggest that primary fibrosis of the stenotic punctum was caused by intrinsic inflammation of the puncta rather than spreading from the conjunctiva or eyelid. Punctoplasty was effective in treating punctal stenosis, regardless of the epithelial type.

Clinical observation on the efficacy of silicone punctal plug for the treatment of acquired lacrimal puncta stenosis

Objective To observe the clinical efficacy of silicone punctal plug for the treatment of acquired lacrimal puncta stenosis. Methods The data of 46 eyes of 23 cases with acquired lacrimal stenosis from Apr. 2017 to Apr. 2019 were analyzed retrospectively. The observation group, 23 operative eyes, received punctum dilation followed by silicone punctal plug inserted into lacrimal punctum under surgjcal microscope and silicone punctal plug extraction after 2 months. The control group, 23 non-operative eyes, treated with lacrimal point dilator and lacrimal duct irrigation once a week for 2 months. Results No complication such as displacement or exfoliation of silicone punctual plug occurred in the observation group.The cure rate at 1, 2 and 3 months after silicone punctal plug extraction were 100%, 90.5%, 80.9%, and the apparent improvement rate was 100%.In the control group, the diameter of puncta was unchanged after treatment, and the improvement rate was only 21.7%. Conclusion Silicone punctal plug for the treatment of acquired lacrimal puncta stenosis is an effective and safe procedure. Key words: Stenosis, lacrimal punctum; Plug, punctal, silicone

Investigating the effects of inferior turbinate outfracture on the lacrimal system by evaluating the results of paranasal sinus computed tomography and nasolacrimal irrigation test.

This study aims to investigate the effects of inferior turbinate outfracture on the nasolacrimal system and tear flow. Forty-seven patients (26 males, 21 females) between the ages 18 and 52years (mean age-29.0 ± 9.6years) were included in the study. Preoperative nasal examinations and paranasal sinus computed tomography of the patients were carried out; the direction, location, nasal septum deviation classification and inferior turbinate hypertrophy size classification were evaluated. Lacrimal irrigation test was performed preoperatively and 14days postoperatively. The study included 47 patients who underwent septoplasty and inferior turbinate outfracture. The mean duration of lacrimal irrigation test was 2.9 ± 0.8s on the right side and 3.0 ± 1.1s on the left side preoperatively, and 2.1 ± 0.8s on the right side and 2.2 ± 1.0s on the left side postoperatively. No significant relationship between direction, location classification, angle nasal septum deviation classification and lacrimal irrigation test duration was found. A significant relationship between size classification of the left inferior turbinate and preoperative lacrimal irrigation test duration was noted (p = 0.030). Moreover, a significant decrease between preoperative and postoperative lacrimal irrigation test duration after inferior turbinate outfracture (p = 0.000) was noted. We concluded that outfracture of the inferior turbinate with septoplasty surgery may benefit the regulation of tear flow. In addition, we concluded that lacrimal irrigation test duration may be effective in determining the patients with subclinical nasolacrimal duct partial obstruction due to inferior turbinate pathologies.

Long-term results of maintenance of lacrimal silicone stent in patients with functional epiphora after external dacryocystorhinostomy.

To evaluate long-term outcomes of maintenance of lacrimal silicone stent for the management of functional epiphora after anatomically patent external dacryocystorhinostomy (DCR). We retrospectively reviewed the medical records of 101 eyes of 75 patients who were diagnosed to have functional epiphora after external DCR from 2005 to 2014. Functional epiphora was defined as epiphora that persisted or recurred even after patent DCR confirmed by a lacrimal irrigation test. Secondary silicone intubation was indicated when the patients wanted a further intervention. The stent was intended to be kept in situ unless there was a stent-related complication or the patient wanted removal. In total, 34 of 75 patients (45.3%, 52 eyes) who agreed to the intervention underwent secondary silicone intubation. The success rates at 1, 3, and 5 years after surgery were 96.2%, 75.5%, and 70.2%, respectively. At the final follow-up (mean 72.7 ± 26.4 months), 32 (61.5%) eyes chose to retain the silicone tube: silicone stent was well maintained without epiphora and complications once inserted in 18 eyes (34.6%), whereas tube replacement was needed in 14 eyes (26.9%) because of nasal crust or whitish plaque formation on the tube surface. In 13 cases (25.0%), silicone stent was removed because of tube-related complications, and the most common complication was canaliculitis (n = 8, 15.4%). Secondary intubation and maintenance of the stent is an effective and simple procedure for functional epiphora. The main obstacle to long-term maintenance is tube-associated canaliculitis.

Acquired Obliteration of the Proximal Lacrimal Drainage System.

We present a series of patients with acquired obliteration of one or more components of the proximal lacrimal drainage system, including puncta and canaliculi. This finding was noted with and without other obstructions or stenoses of the lacrimal drainage system. Review of these patients in search of possible risk factors for this condition and histopathology of two patients are presented. Medical records of patients treated at the Massachusetts Eye and Ear Infirmary between 2010 and 2016 with diagnosis codes of lacrimal punctum stenosis, stenosis of unspecified lacrimal punctum, epiphora due to insufficient drainage, and epiphora not otherwise specified were retrospectively reviewed. Patients were excluded if there was a history of congenital punctal agenesis, trauma, or any other identifiable etiology of lacrimal system obstruction. Twelve patients were identified with obliterated puncta. Most patients were female (n = 11, 91.7%) and Caucasian (n = 9, 75%). The mean age was 61 years (median 62, range 22-90 years). Clinical findings ranged from one involved punctum to all four puncta, and associated ipsilateral canalicular obstruction was noted in 4 patients (33.3%). The inferior puncta were the more frequently affected structures (61.5%) compared to the superior puncta (38.5%). Nine patients (75%) reported use of topical ophthalmic medications prior to onset of symptoms. The most frequent class of medication implicated was topical antibiotics; however, patients often used a combination of medications. In 2 cases, pathological specimens of the canaliculi revealed absence of a canalicular lumen. Although various combinations of lacrimal system stenoses and obstructions have been described, acquired punctal obliteration is an under-recognized entity. These cases differ from typical punctal stenosis in that the puncta are completely obliterated, and no indication of a punctal opening is clinically detectable. In this study, 3 patients had previously documented normal lacrimal irrigation. The ipsilateral canaliculi were also found to be obstructed in a third of patients. Two patients had complete absence of a canalicular lumen on histopathology. The predominance of inferior punctum involvement, patient history of symptom onset after ipsilateral medication use, and known prior patent irrigation in several cases support the hypothesis that these cases represent a severe yet insidious idiosyncratic reaction to topical medication.

Long-term outcomes after endoscopic dacryocystorhinostomy without mucosal flap preservation.

A growing body of evidence demonstrates that endonasal endoscopic dacryocystorhinostomy (eDCR) techniques provide comparable results to conventional external techniques. The purpose of this study was to evaluate long-term outcomes after powered endoscopic DCR without preservation of mucosal flaps for the management of acquired nasolacrimal duct obstruction performed by a single surgical team. A retrospective review was performed of patients with epiphora secondary to acquired nasolacrimal duct obstruction who underwent eDCR without mucosal flap preservation from May 2003 to April 2013 at a tertiary referral medical center. Main outcome measures were subjective improvement in epiphora and assessment of anatomic patency based on lacrimal irrigation and endoscopic evaluation. Eighty patients (69 primary and 11 revision) totaling 103 procedures (87 primary, 16 revision) were available for analysis at a mean follow-up of 28.7 (range 6-114) months. At the most recent follow-up, 92 of 103 (89.3%) procedures had complete resolution of epiphora, and 10 of 103 procedures achieved mild intermittent epiphora. Complete resolution of epiphora was noted in 93.1% (81 of 87) of primary procedures and 68.8% (11 of 16) of revision procedures. Objective anatomic patency was confirmed in 98% (101 of 103). A revision procedure was required in 5.8% (6 of 103). Outcomes of powered eDCR without the preservation of mucosal flaps compare favorably to previously reported results in the literature. These long-term results suggest that mucosal flap preservation is not required to achieve successful outcomes with eDCR. 4 Laryngoscope, 130:12-17, 2020.

Lacrimal passage irrigation in children with Stevens-Johnson syndrome or toxic epidermal necrolysis: a five-year retrospective study

BackgroundTo identity the effect of lacrimal system irrigation in the acute stage in children with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).MethodsA retrospective review of 39 patients with SJS or TEN from 2012 to 2017 was analyzed. Patients were divided into two subgroups according to whether they received irrigation in the acute stage. The irrigation group included 21 inpatients and the control group included 18 inpatients. The χ2 test was used to compare clinical findings and data in both groups.ResultsThe rate of lacrimal system obstructions in the chronic stage of SJS or TEN in the irrigation group was significantly lower than in the control group (p < 0.01). A significant difference was also found between the epiphora rates in patients with SJS or TEN in the chronic stage in the two groups (p = 0.047). One of 15 patients with mild dry eyes or without dry eyes in the irrigation group had epiphora, and it affected five of 12 in the control group. The difference between the two groups was significant (p = 0.03). Epiphora in the two patients in the control group was long-term, owing to the disappearance of puncta marks.ConclusionsLacrimal system irrigation with dexamethasone drops in the acute stage was a simple way to lessen lacrimal system obstructions and epiphora in patients with SJS or TEN. It should be considered a conventional ocular treatment for SJS or TEN.

External dacryocystorhinostomy

Aim: To analyse the epidemiological data, surgical technique, success rate, and complications of patients who underwent external DCR in Hospital Selayang from January 2015 to December 2016.&#x0D; Method: Retrospective case series.&#x0D; Results: A total of 21 eyes of 20 patients who underwent external DCR from January 2015 to December 2016 were identified and reviewed. There were 15 females (75%) and 5 males (25%). Age ranged from 5 to 75 years old, with a median age of 56 years old (IQR 23). Twelve patients presented with epiphora while eight patients presented with symptoms of dacryocystitis. One case was congenital, two were secondary nasolacrimal duct obstruction and the rest were primary nasolacrimal duct obstruction. All patients underwent external DCR under general anaesthesia. Silicone tube were inserted in 21 eyes, of which all were removed 3 months after the surgery except one patient whom had his tube dislodged accidentally. The overall success rate was 90.5% (n = 19), which was defined as no or minimal intermittent epiphora or no reflux on lacrimal irrigation at 12 months postoperative. There was one patient who had a cerebrospinal fluid leak treated successfully with intravenous antibiotics.&#x0D; Conclusion: The surgical success rate for external dacryocystorhinostomy was comparable to that of the global success rate of external DCR. This is attributed to the application of surgical technique such as anterior suspended flap modification and posterior flap excision.

Long-Term Results in Transcanalicular Laser and External Dacryocystorhinostomy.

Objectives:This study was an examination of the long-term results of transcanalicular laser (TCL) and external (EX) dacryocystorhinostomy (DCR).Methods:Patients who had undergone TCL-DCR or EX-DCR between 2009 and 2013 were invited for long-term follow-up in 2019. All of the patients who responded had an ophthalmic examination and were assessed using lacrimal irrigation. An intranasal evaluation was performed when the irrigation test had non-patent results. TCL procedures were performed with a diode laser (980 nm). Ostium cleansing with a suction unit and a nasal endoscope was performed in the first week. In EX-DCR procedures, an anterior flap was created and tented to the orbicularis oculi muscle. A silicon tube was implanted in both methods and removed at 4-6 months.Results:A total of 74 EX-DCR patients were assessed. The lacrimal irrigation test was negative in 5 cases. The functional success rate was 93.2% with a follow-up of 8 years. A total of 63 patients who had undergone TCL-DCR were evaluated and the irrigation test was negative in 9 patients. The functional success rate was 85.7% with a follow-up of 7 years. The difference in the success rate was statistically insignificant with a p value of 0.09.Conclusion:The long-term success rates of both EX-DCR and TCL-DCR were high.

Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction: 5-year follow-up.

To evaluate the long-term sucess rate of laser-assisted dacryocystorhinostomy (L-DCR) in patients with nasolacrimal duct obstruction (NDO). Forty-one eyes of forty patients aged between 21-85y (mean 56.7y) who underwent L-DCR for the treatment of NDO were included in this retrospective, non-randomized study. The follow-up time was 72mo. Functional sucess was defined as the disappearance of epiphora under normal conditions and the presence of a patent ostium on lacrimal irrigation. Anatomical success was defined as a patent lacrimal passage on syringing besides continuing epiphora. Surgical failure was defined as persistent epiphora and closed ostium. Twenty-seven of 40 patients (67.5%) were female and 13 of 40 patients (32.5%) were male. The NDO was right-sided in 17 (42.5%) patients and left-sided in 22 (55%) patients whereas 1 (2.5%) patient had undergone bilateral surgery. In 11 (27.5%) patients there were additional nasal abnormalities requiring simultaneous surgical approach. The average time for L-DCR was 26.50±4.9min (16-39min) and the average total amount of laser energy used was 287±27.9 J (239-367 J). At the 5y follow-up, anatomical sucess rate was 75.0% (30 patients) and functional success rate was 65.0% (26 patients), whereas surgical failure was seen in 25% (10 patients). Revision of surgery was performed in 10 cases (25.0%); failure of revision surgery was seen in 2 cases (5.0%). Transcanalicular L-DCR is a reliable and fast procedure in the treatment of NDO. It can be alternative to external DCR which is accepted as the gold standard currently. The functional and anatomical success rate is higher in the first months and years, but still satisfactory at fifth year.