Nasal Endoscopic Dacryocystorhinostomy Research Articles

Endoscopic Dacryocystorhinostomy Following Nasolacrimal Drainage System Trauma and Medial Orbital Wall Reconstruction.

Case series. To describe the assessment and surgical approach to dacryocystorhinostomy (DCR) for patients with nasolacrimal duct obstruction (NLDO) in the presence of orbital wall hardware. The pre-operative assessment, management and outcomes of two patients with secondary acquired NLDO following medial orbital wall fracture repair treated by nasal endoscopic DCR. Anatomical and functional success was achieved in both cases at 6weeks post operatively without disruption of the orbital plate. There was persistent success at 1 and 3years' post-operatively. Endoscopic DCR is a good option for the treatment of NLDO in patients with previous medial orbital wall fracture repair where the location of the plate may complicate the external approach.

Efficacy and Safety of Adjunctive Triamcinolone in Nasal Endoscopic Dacryocystorhinostomy

Objective: To assess safety and long-term efficacy of use of triamcinolone acetonide (TA) soaked absorbable gel foam dressing in Endoscopic Dacryocystorhinostomy in our population. Study Design: Quasi experimental study Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jan 2016 to Jan 2019. Methodology: Endoscopic Dacryocystorhinostomy was performed on 103 eyes of 98 patients for unilateral or bilateral primary acquired nasolacrimal duct obstruction or previously failed Endoscopic Dacryocystorhinostomy without triamcinolone acetonide. Endoscopic Dacryocystorhinostomy was done using a standardized technique employing a 30° nasal endoscope (Karl Storz, Germany). In addition, a gel foam (15x10x5mm) soaked with 1ml of 40mg triamcinolone acetonide was threaded along the silicone tube metallic guide and advanced to ostium at the end of procedure. Anatomical success (patent lacrimal passage on irrigation), functional success (resolution of epiphora) and complications at 6 and 12 months of follow up, were the outcome measures documented and analyzed. Results: Out of 103 cases, there were 41(39.8%) male and 62(60.2%) female patients. Mean age was 47.10±12.80 years (age range 18–72 years). Anatomical success rate of 90(87.4%) and 89(56.4%) was observed at 6 and 12 months, whereas functional success rate of 88(85.4%) was observed at both 6 and 12 months follow up respectively. No major complications were observed in our study. Conclusion: Endoscopic Dacryocystorhinostomy with triamcinolone acetonide is a safe and effective procedure for epiphora secondary to previous failed Endoscopic Dacryocystorhinostomy or primary acquired nasolacrimal duct obstruction.

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

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

Influence of Indwelling Lacrimal Drainage Tube on the Curative Effect of Endonasal Endoscopic Dacryocystorhinostomy

Endonasal endoscopic dacryocystorhinostomy (EES-DCR) has gradually become the main surgical method for treating chronic dacryocystitis. Whether the placement of the lacrimal drainage tube during the operation can improve the operation’s success rate is an issue. This study observes the effect of an indwelling lacrimal drainage tube on the curative effect of EES-DCR in patients with chronic dacryocystitis. The cure rate of the Lacrimal duct drainage tube non-indwelling group A was 93.8% (46/49). The 3 cases failed because of the nasal cavity’s inflammation, which resulted in the adhesion of the anastomotic stoma and the middle turbinate. The cure rate of the Lacrimal drainage tube indwelling group B was 85.7% (42/49). The 7 cases failed because of the excessive proliferation of the tissue around the anastomosis, the hyperplasia of granulation tissue, the shedding of the lacrimal duct drainage tube, the crack of the lacrimal duct, and the premature removal of the lacrimal duct drainage tube caused the contraction of the mucosa around the anastomosis, resulting in the anastomosis obstruction. There was no obvious difference between the two groups (P> 0.05). At 6 months, 46 cases of the EES-DCR group A had gradually epithelialized anastomoses without granulation tissue growth with the follow up time extension. In the EES-DCR group B, 42 cases of anastomoses were gradually epithelialized without granulation tissue growth. Nasal endoscopic dacryocystorhinostomy combined with an indwelling lacrimal duct drainage tube can be used to treat chronic dacryocystitis, but an indwelling lacrimal duct drainage tube has no significant effect on the efficacy of chronic dacryocystitis.

The observation of curative effect in different types of chronic dacryocystitis under nasal endoscopic dacryocystorhinostomy

The observation of curative effect in different types of chronic dacryocystitis under nasal endoscopic dacryocystorhinostomy

Dacryocystorhinostomy: Evolution of endoscopic techniques after 498 cases.

Endoscopic dacryocystorhinostomy is a well-known surgical practice used to treat nasolacrimal duct obstruction and widely considered as a valid alternative to external approaches. We present a retrospective case series of 498 endoscopic dacryocystorhinostomies on 401 patients, from July 2004 to May 2018, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. Of the 498 procedures, 426 were unilateral and 72 were bilateral dacryocystorhinostomy. All patients underwent routine preoperative workup including fluorescein test (Jones test 1-2), probing and irrigation of the lacrimal way, nasal endoscopy, and maxilla-facial computed tomography scan. Surgical technique was based on nasal endoscopic dacryocystorhinostomy followed by positioning of a Catalano's silicone stent, which was left in place for about 3 months. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. Anatomic success was achieved in 91.54% cases in primary dacryocystorhinostomy and in 89.36% after revision, whereas functional success was obtained in 90.4% in primary and 85.1% in secondary dacryocystorhinostomies. After a second revision of endoscopic dacryocystorhinostomy, anatomical success was achieved in 90.1% and functional success in 88.7% of procedures. Our results confirm that endoscopic dacryocystorhinostomy can be considered as a valid surgical approach to primary nasolacrimal duct obstruction and revision cases. The key aspects in achieving functional and anatomical results are meticulous surgical procedure and precise follow-up.

Efficacy of nasal endoscopic dacryocystorhinostomy for chronic dacryocystitis: A systematic review protocol of randomized controlled trial.

Background:This study aims to assess the efficacy and safety of nasal endoscopic dacryocystorhinostomy (NED) for patients with chronic dacryocystitis (CD).Methods:The following 7 electronic databases will be searched from inception to the present: Cochrane Library, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. In addition, the clinical trials registry and reference lists of included studies will also be searched. We will only include randomized controlled trials of NED for CD in this systematic review. Two review authors independently carry out the study selection, data extraction, and methodological quality assessment. Whenever it is possible, we will pool the data and conduct meta-analysis by using RevMan 5.3 software.Results:This study will evaluate the efficacy and safety of NED for patients with CD. The primary outcome includes success rate of ostial patency. The secondary outcomes consist of duration of surgery, quality of life, postoperative complications, and surgeon's comfort.Conclusion:The findings of this study may summarize the latest evidence of NED for patients with CD.PROSPERO registration number:PROSPERO CRD42019123664.

Efficacy of application of Norton in dacrystorhinostomy for the treatment of chronic dacryocystitis

Objective To investigate the efficacy of application of Norton in nasal endoscopic dacryocystorhinostomy. Methods The data of 100 eyes of 100 cases of chronic dacryocystitis who received dacryocystorhinostomy from Dec.2012 to Dec.2017 were analyzed retrospectively. All cases were divided into 2 groups randomly. The treatment group, 50 cases, were treated with Norton cotton slice in nasal cavity before operation, and the control group, 50 cases, were treated with adrenaline cotton slice before operation. The nasal mucosa was contracted by placing cotton slices twice, once per 5 minutes.in the nasal cavity 10 minutes before operation. All cases underwent endoscopic dacryocystorhinostomy. Results There were 49 cases cured, 1 case improved and no case of ineffective in the treatment group, and in the control group 45 cases cured, 3 cases improved and 2 cases ineffective. The difference of total effective rate was not statistically significant between the two groups (P=0.179). The treatment group had clear visual field, wide visual field and sustained operation.The blood pressure was stable, heart rate fluctuated slightly, less intraoperative hemorrhage. No bleeding occurred after operation.The operation time was shorter, and no obvious complication occurred during and after operation. Conclusion Application of Norton in dacryocystorhinostomy under nasal endoscope has advantages of quick onset, long curative effect and less adverse reactions. Key words: Norton; Dacryocystitis, chronic; Dacryocystorhinostomy, nasal endoscopic

A comparative study of external dacryocystorhinostomy with nasal endoscopic dacryocystorhinostomy

A comparative study of external dacryocystorhinostomy with nasal endoscopic dacryocystorhinostomy

Comparision of the effects between Merogel and expansion sponge in nasal endoscopic dacryocystor hinostomy

Objective To compare the effects between Merogel and expansion sponge in nasal endoscopic dacryocystorhinostomy. Methods Ninty-two cases (104 eyes) of dacryocystitis in the Harbin 242 Hospital from May 2014 to May 2015 were collected and randomly divided into 3 groups.Merogel group contained 31 cases (37 eyes), expansion sponge group contained 34 cases (39 eyes), and the blank control group contained 27 cases (28 eyes). The epiphora, lacrimal situation and regional pain symptoms were observed after the surgery. And then the curative effects, including the cure rate and effective rate, were compared. Results The curative rates of Merogel group and expansion sponge group were 86.5% and 61.5%, respectively, and the difference was statistically significant (P 0.05). The differences in the effective rates between blank control group and Merogel group or expansion sponge group were statistically significant (P 0.05). However, between Merogel group and blank control group, the difference was statistically significant (P<0.05). The curative rate of Merogel group was higher than that of blank control group. Conclusion The anastomotic epithelialization of lacrimal nasal mucosa can be siginificantly improved by using Merogel stoma plasters which can inhibite scar proliferation and granulation tissue formation and increase curative rate of dacryocystorhinostomy with no after-surgery discomfort.It is an effective, safe and efficient biomaterials. Key words: Merogel; Expansion sponge; Dacryocystorhinostomy, nasal endoscopic

Clinical reasearch of re-operation for postoperative recurrence of chronic dacryocystitis

Objective To compare the effect of improved exterior route dacryocystorhinostomy and nasal endoscopic dacryocystorhinostomy for postoperatively recurrent chronic dacryocystitis. Methods Eighteen eyes of 18 cases with postoperative recurrence of chronic dacryocystitis were randomly divided into two groups. 8 eyes of group A was treated with improved dacryocystorhinostomy, and 10 eyes of group B was treated with improved nasal endoscopic dacryocystorhinostomy. All patients were followed up for 6 months. Results In group A, 6 eyes were cured, 1 eyes was improved and 1 eye was noneffective; the total therapeutic effective rate was 87.5%. In group B, 9 eyes were cured, 1 eyes was improved and none was noneffective; the total treatment effective rate was 100%. The difference between two groups was statistically significant(χ2=7.8030, P=0.0019). Conclusion Nasal endoscopic dacryocystorhinostomy is suitable for postoperative recurrence chronic dacryocystitis. Interdisciplinary cooperation between ophthalmologist and rhinologist is required. Key words: Dacryocystorhinostomy, nasal endoscopic; Dacryocystitis, chronic, recurrent; Cooperation, interdisciplinary, ophthalmology, rhinology

The clinical analysis of 62 cases of dacryocystorhinostomy under nasal endoscope

Objective To investigate the methods and clinical effect of nasal endoscopic dacryocystorhinostomy.Methods 64 eyes of 62 cases of nasal endoscopic dacryocystorhinostomy were analyzed and summarized.Followed up for 6 months after surgery.Results 56 eyes were cured (87.5％) and eight eyes were improved (12.5％).The rate of success was 100％.Conclusion The effect of endoscopic dacryocystorhinostomy is ideal,with small trauma,high cure rate and without affecting the appearance. Key words: Nasal endoscope; Dacryocystorhinostomy; Dacryocystitis

Applying mitomycin C during nasal endoscopic dacryocystorhinostomy for chronic dacryocystitis

Objective To observe clinical effects of applying MMC during nasal endoscopic dacryocystorhinostomy for chronic dacryocystitis.Methods 158 eyes of 150 cases of chronic dacryocystitis were enrolled in the study and were randomly divided into two groups:treatment group (75 cases,80 eyes) and control group (75 cases,78 eyes).The treatment group underwent nasal endoscopic dacrystorhinostomy combined with MMC placed on the bone window for 10 minutes.The control group only accepted nasal endoscopic dacryocystorhinostomy.The follow up was 3 ～ 12 months.Results At 3 month postoperatively,the cure rate and effective rate of the treatment group was 95.00％ and 98.75％ respectively,and the cure rate and effective rate of the control group was 75.64％ and 93.59％ respectively.The effective rate of the treatment group was higher than that of the control group significantly (x2 =11.90,P ＜ 0.05).Conclusion Nasal endoscopic dacryocystorhinostomy combined with application of MMC is a new surgical method which can prevent postoperative cicatricial adhesion and elevate the surgical effective rate. Key words: Endoscope, nasal; Mitomycin C (MMC); Dacryocystorhinostomy

Nasal endoscopic dacryocystorhinostomy with lacrimal stent implantation

Objective To explore the outcome of nasal endoscopic dacryocystorhinostomy (NESDCR) with lacrimal stent for refractory dacryocystitis.Methods 68 eyes of 51 cases of refractory dacryocystitis were treated by NES-DCR with lacrimal stent implantation.The stent was removed at 3 months after surgery.Follow up were 6 ～ 12 months.Results Of 68 eyes,59 eyes were cured and the conditions were improved in 4 eyes.The effective rate was 92.65％.Epiphora was still existed in 5 cases,accounting for 7.35％.Conclusion NES-DCR with lacrimal stent implantation has good surgical outcomes and high effective rate for refractory dacryocystitis. Key words: Dacryocystitis, refractory; Dacryocystorhinostomy, endoscopic, nasal; Stent, lacrimal; Rate, success

Pathologic change after intranasal endoscopic dacryocystorhinostomy with hyaluronate stuffing on rabbits

Objective To investigate the pathological changes in the post-operative lacrimal sac mucosa by intranasal endoscopic dacryocystorhinostomy with hyaluronate (HYAFF,MeroGel) stuffing.Methods 24 rabbits received nasal endoscopic dacryocystorhinostomy were randomly divided into 3 groups.The hyaluronate,gelatin sponge and Vaseline gauze were used respectively for stuffing anastomosis.And two rabbits were normal control.The clinical signs and lacrimal sac mucosa pathological changes were observed in each group by double-blind.Results 3-5 days after operation,clinical reaction and pathological inflammatory reaction were mild in hyaluronate group; In this group,we observed that the hyaluronate dissolved and the anastomotic was covered by epithelia 7 days after operation.The dissolved hyaluronate was absorbed partly 10 days after operation.Conclusion The hyaluronate can reduce the lacrimal sac mucosal inflammation after nasal endoscopic dacryocystorhinostomy,promote incision healing,and dissolve itself gradually. Key words: Nasal endoscopy; Dacryocystorhinostomy; Hyaluronate; Rabbit

Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis

ABSTRACT Objective To compare the results of conventional nasal endoscopic dacryocystorhinostomy (DCR) and inferior nasal endoscopic DCR in Study cases of idiopathic chronic dacryocystitis. Materials and methods Forty patients diagnosed with idiopathic chronic dacryocystitis were divided into two groups alternately. After relevant investigations, they were subjected for endoscopic DCR by two techniques. Twenty patients underwent conventional endoscopic DCR and 20 underwent inferior endoscopic DCR under transoral pterygopalatine block and topical lignocaine (4%) with adrenaline 1:2,000. After 3 months of follow-up in the outpatient department, nasal endoscopy along with fluorescein dye disappearance test (FDDT) at 10 minutes was done. Results Ninety-five percent (19/20) of patients undergoing conventional endoscopic DCR and 90% (18/20) of patients undergoing inferior endoscopic DCR were found to have patent anatomical fistula. On FDDT, nasal endoscopy after 10 minutes revealed 84% (16/19) in group I and 94.4% (17/18) in group II with fluorescein in nasal cavity. Conclusion Present study concludes the importance of bony, tendinous, and muscular support of lacrimal sac in physiological lacrimal pump functioning and advantage of relatively new technique of inferior endoscopic DCR. Inferior endoscopic DCR is associated with less operative time as well as less local complications. How to cite this article Thakur K, Kashyap A, Negi S, Chauhan PL. Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis. Clin Rhinol An Int J 2017;10(2):86-90.

鼻内視鏡下涙嚢鼻腔吻合術症例の検討―手術手技の工夫と成功率の比較―

Nasolacrimal duct obstruction is normally treated with extranasal dacryocystorhinostomy, but nasal endoscopic dacryocystorhinostomy has recently become more common due to the development of nasal endoscopy. The subjects of the study were 23 patients who underwent nasal endoscopic dacryocystorhinostomy between December 2001 and July 2005 at Kohka Public Hospital, and who were followed for 6 months or longer. The presence or absence of lacrimal canaliculus obstruction was examined in a lacrimal probe test before surgery, and lacrimal contrast XP and CT were performed. During surgery, a Nunchakutype silicon tube was indwelled usually. The silicon tube was removed 3 months after surgery, and the success of the surgery was evaluated based on the improvement of subjective symptoms. The success rate was 88%, but obstruction recurred in 3 patients. Nasal endoscopic dacryocystorhinostomy was repeated in all recurrent cases, and obstruction recurred again in 1 patient. Pus was retained in the lacrimal sac in the recurrent cases, suggesting the involvement of infection.