Nasolacrimal Duct Obstruction Group Research Articles

Clinical characteristics of nasolacrimal duct obstruction after iodine therapy in differentiated thyroid cancer patients.

To analyze the clinical characteristics of differentiated thyroid cancer (DTC) patients with nasolacrimal duct obstruction (NLDO) after Iodine-131 (131I) therapy and provide guidance for clinical decision-making. Thirty-one DTC patients with NLDO were retrospectively enrolled from the Nuclear Medicine Department of Shanxi Bethune Hospital during follow-up of 131I therapy between June 2018 and March 2021. Eight hundred and seventy-one thyroid cancer patients during this period without NLDO after 131I therapy were enrolled as the control group. Clinical characteristics, including sex, age, dose, anti-thyroglobulin antibodies (TGAb), and metastatic lesions, were analyzed by χ2 test and logistic multifactor regression. In the NLDO group and without NLDO group, there were statistically significant differences in gender, age, dose, and whether there was metastasis. Among the NLDO group, the proportion of women, age >55years old, dose >5.55GBq, and the presence of metastasis was higher, and the difference was statistically significant; There was no significant difference in the proportion of TGAb positive and negative patients based on 131I therapy (χ2 = 0.27, P = .782).Multivariate logistic regression analysis showed that sex (2.59), age (1.45), dose (2.36), and metastatic lesions (1.93) were all statistically significant influential factors of NLDO after iodine therapy. Significant differences were found in the incidence of NLDO between the number of treatment courses (χ2 = 23.541, P < .001). Prevalence rate of repeat radioiodine therapy (2 times or 3 times and more) is higher than 1 time. Women patients over 55 who had metastatic lesions, and received a dose >5.55GBq, were more likely to have NLDO. When determining therapeutic doses of 131I, doctors should weigh multiple factors and then give appropriate dosage and suggest that high risk populations be referred for appropriate ophthalmic surgical consultation, for timely diagnosis and therapy.

Long-term Outcome and Predictors of Silicone Tube Intubation for Patients with Nasolacrimal Duct Obstruction

Purpose: To evaluate the long-term outcome and prognostic factors according to the degree of obstruction after silicone tube intubation in patients with nasolacrimal duct obstruction (NLDO).Methods: From March 2016 to July 2020, the medical records of 145 eyes of 107 patients with NLDO who underwent silicone tube intubation and had been followed for more than 6 months were analyzed retrospectively. The preoperative lacrimal irrigation and degree of obstruction were classified into three groups, and the surgery outcome was also evaluated. Successful surgery was defined as a case in which the epiphora improved, the height of the tear meniscus decreased, and there was no reflux in the postoperative lacrimal irrigation. Risk factors for recurrence were analyzed using a Cox proportional hazards model and Kaplan-Meier survival analysis.Results: Surgery was successful in 99 eyes (68.3%), while recurrence occurred in 46 eyes (31.7%) after silicone tube removal. The average follow-up period was 23.09 months. The recurrence rate was 30.4%, 29.3%, and 50.0% for functional, partial, and total NLDO, respectively, and did not differ significantly (&lt;i&gt;p&lt;/i&gt; = 0.300). The risk of recurrence was higher at older age (adjusted hazard ratio [aHR] = 1.079, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and with a history of facial palsy (aHR = 4.031, &lt;i&gt;p&lt;/i&gt; = 0.019), and was lower in the functional NLDO group than in the total NLDO group (aHR = 0.368, &lt;i&gt;p&lt;/i&gt; = 0.040). In the Kaplan–Meier survival analysis, the total NLDO group differed significantly from the functional NLDO group (log-rank, &lt;i&gt;p&lt;/i&gt; = 0.011).Conclusions: Age, a history of facial palsy, and the degree of preoperative obstruction were associated with the prediction of recurrence after silicone tube intubation in patients with NLDO.

Tear protein analysis in patients with primary acquired nasolacrimal duct obstruction treated with lacrimal passage intubation.

The pathophysiology of nasolacrimal duct obstruction (NLDO) may involve quantitative as well as qualitative changes in tears. We measured tear protein concentrations in patients with primary acquired NLDO and compared them with the tear proteins in healthy individuals and patients with dry eye disease. Case-control study. Twenty-four patients diagnosed with primary acquired NLDO who underwent endoscopic lacrimal passage intubation were included in the study. Tear fluid was collected with Schirmer's test strips three times: before intubation, after intubation while the nasolacrimal tube was in place, and after extubation. At the same time, 24 age-matched normal controls and 24 patients with dry eye were selected from subjects whose tears were collected during the same study period. We measured the following components of tear fluid: total protein, lactoferrin, albumin, and interleukin 6 (IL-6) levels. Total proteins and albumin levels in tears of the NLDO group were significantly lower than those of the control group (P < 0.001 and P = 0.014, respectively, Mann-Whitney U test). Total proteins, albumin, and lactoferrin levels were significantly increased after extubation of nasolacrimal tube (P < 0.001, P = 0.004, and P = 0.029, respectively, Wilcoxon matched-pairs signed-rank test). There were no statistically significant differences in total protein, albumin, lactoferrin and IL-6 levels between patients with NLDO after lacrimal passage extubation and controls. Our study shows distinct differences in protein composition of tear fluid in NLDO eyes and demonstrates that these can be normalized by nasolacrimal tube placement.

Is there an association between congenital nasolacrimal duct obstruction and cesarean delivery?

The aim of this study was to research the relationship between types of birth and congenital nasolacrimal duct obstruction. The study enrolled 665 infantile patients with prediagnosis of congenital nasolacrimal duct obstruction due to associated ophthalmic symptoms. Age, gender, family history, delivery type, and patient medical records were investigated. Patients were grouped and compared according to their birth type and whether it was the first birth. The number of the infants with and without congenital nasolacrimal duct obstruction was 227 (34.1%) and 438 (65.9%), respectively. Comparison of the congenital nasolacrimal duct obstruction and non-congenital nasolacrimal duct obstruction groups according to the first births showed that ratio of cesarean section was significantly higher in the congenital nasolacrimal duct obstruction group than the non- congenital nasolacrimal duct obstruction group (58.7% and 20.7%, respectively). Number with positive family history also was significantly higher in the congenital nasolacrimal duct obstruction group. Cesarean section in first birth and positive family history of congenital nasolacrimal duct obstruction appear to be important risk factors in the etiopathogenesis of congenital nasolacrimal duct obstruction.

Observation on the efficacy of lacrimal duct stents for lacrimal duct obstruction under lacrimal endoscope

Objective To observe the efficacy of lacrimal duct stents under lacrimal endoscope for the treatment of lacrimal duct obstruction with different position. Methods The data of 62 eyes of 56 cases with lacrimal duct obstruction under endoscope were examined and treated. All patients were divided into three groups, presaccal canalicular obstruction group, nasolacrimal duct obstruction group and refractory lacrimal passage obstruction group. All patients were followed up for 6 months after removed the tube stents, the efficacy of different groups were compared and analyzed. Results The recovery rate in presaccal canalicular group was 89.7%, effective rate was 100%. The recovery rate in nasolacrimal duct obstruction group was 82.1%, effective rate was 92.9%. The recovery rate in refractory lacrimal passage obstruction group was 20%, effective rate was 60%. Conclusion Application of the lacrimal endoscope in the treatment of presaccal canalicular obstruction and nasolacrimal duct obstruction had its unique advantage. Key words: Lacrimal ducts obstruction; Lacrimal endoscope; Stents

Endoscopic dacryocystorhinostomy without silicone stent

Conclusion: In nasolacrimal duct (NLD) obstruction patients that undergo endoscopic dacryocystorhinostomy (DCR), creation of a patent rhinostomy with adequate epithelialization can be accomplished without a stent. However, in common canalicular obstruction patients, a silicone stent seems to have a beneficial role and to bear more favorable results. Objectives: The aim of this study was to evaluate the surgical outcome of endoscopic DCR without the use of a silicone stent. Methods: In all, 36 patients (41 eyes) who underwent endoscopic DCR were enrolled in this study. The patients were classified into a DCR with silicone stent group and a DCR without silicone stent group. Then each of the groups was subdivided into common canalicular obstruction group and NLD obstruction group. Surgical outcomes were evaluated by postoperative symptom improvement and patency of the rhinostomy under nasal endoscopic exam. Results: The epiphora was improved in 84.2% of the silicone stent group and 81.8% of the non-silicone stent group. Categorized by the level of obstruction, in common canalicular obstruction, the success rate was 84.5% (11/13) in the silicone stent group and 57.1% (4/7) in the no stent group. In NLD obstruction, the success rate was 83.0% (5/6) in the silicone stent group and 93.3% (14/15) in the no stent group.

Observation on treatment of lacrimal passage obstruction under lacrimal endoscope

To evaluate the therapeutic efficacy of lacrimal endoscope treatment for lacrimal passage obstruction, and to compare the effectiveness of endoscopically controlled laser surgery and micro-drill surgery for lacrimal passage obstruction. It was a prospective random controlled trial. Eighty nine patients (104 eyes) with lacrimal passage obstruction, including presacral canalicular obstruction (PSCO) and nasolacrimal duct obstruction (NLDO), were collected from September 2006 to December 2006 in Department of Ophthalmology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. Patients were examined by endoscopy of the lacrimal drainage system under local anesthesia to detect the obstruction and changes of lacrimal mucous membrane. The obstructions were treated with laser or microdrill. Irrigation was performed to prove the recanalization of the lacrimal passage followed by injected ointment with 0.3% tobramycin and 0.1% dexamethasone into the lacrimal passage. All patients were followed up after the operation for 9-12 months. The difference between the laser and the microdrill treatment was observed. Chi-square test was used to evaluate the curative effect and complications differences between these two groups. The obstruction scene in the lacrimal passage of 89 patients could be observed effectively. All obstructions (104/104 eyes) were eliminated after the operation. Through the follow-up, the cure rate reached 78.85% (82/104 eyes). The cure rate of PSCO group and NLDO group, reached 77.78% (42/54 eyes) and 80.00% (40/50 eyes), respectively (chi2 = 0.077, P = 0.782). The cure rate of laser group and micro-drill group, was 80.43% (37/46 eyes) and 77.59% (45/58 eyes), respectively (chi2 = 0.125, P = 0.724). The cure rate of laser treatment was 89.66% (26/29 eyes) in the PSCO group and 64.71% (11/17 eyes) in the NLDO group (P = 0.040). The cure rate of micro-drill treatment was 64.00% (16/25 eyes) in the PSCO group and 87.88% (29/33 eyes) in the NLDO group (chi2 = 4.664, P = 0.031). Hemorrhage and palpebral edema occurred in 10.87% (5/46 eyes) and 4.35% (2/46 eyes) after laser treatment, respectively. Percentage of hemorrhage and palpebral edema after the micro-drill treatment was 55.17% (32/58 eyes) (compared to the laser group, chi2 = 21.969, P = 0.000) and 6.90% (4/58 eyes) (compared to the laser group, chi2 = 0.017, P = 0.896). Lacrimal passage obstruction can be observed and treated directly through the endoscopy of lacrimal drainage system. Choosing an appropriate surgical procedure according to the locations of the obstruction can be helpful for improving the effectiveness of the operation.

Non-Endoscopic Endonasal Dacryocystorhinostomy―Technique, Indications, and Results

Purpose: To describe the technique of non-endoscopic endonasal dacryocystorhinostomy (NEN-DCR), and its indications and results. Materials and Methods: In a prospective, non-randomized interventional case series, all consecutive cases presenting with epiphora between 2004 and 2006 were enrolled. Adult patients were divided into three subgroups: chronic nasolacrimal duct obstruction (NLDO), NLDO with dacryocystitis (NLDO-DC), and recurrent NLDO with previous failed external DCR (REV-DCR). All procedures were performed by one surgeon (first author). An endonasal DCR was performed through a nasal speculum without the use of an endoscope. Success was measured by both improvement of the epiphora and patency of the lacrimal system during irrigation. Results: Ninety-five patients (24 men, 71 women) underwent 99 NENDCR procedures; 54% of cases had NLDO, 32% had NLDO-DC, and 14% were REV-DCR. Mean duration of surgery was 30 minutes, and the average amount of intraoperative bleeding was 12 ml. After a minimum follow-up of 6 months, success was achieved in 96% of all patients, 94% in the NLDO group, 97% in the NLDO-DC group, and 92% in the REV-DCR group. The failure rate was 4% overall. Two patients failed from the NLDO group, one patient from the NLDO-DC group, and one patient from the REV-DCR group. No significant late complications were detected. Conclusion: The success rate of NEN-DCR compares favorably with external DCR. The technique is also useful in cases of NLDO-DC and DCR-REV.

Diagnosis and treatment of lacrimal passage obstruction by lacrimal endoscope

The diagnosis and treatment of the lacrimal passage obstruction with lacrimal endoscope was investigated and its subsidiary surgical procedures were evaluated. Ninety-three patients (109 eyes) with lacrimal passage obstruction, including presaccal canalicular obstruction (PSCO) and nasolacrimal duct obstruction (NLDO), were examined under a lacrimal endoscope, and the obstructions were treated with laser or micro-drill. All patients were followed up after the operation for 3-6 months. The difference between the laser and the micro-drill treatment was observed. During the period of follow-up, the curative rate was 82.57%. The healing rate in PSCO group and NLDO was 80.36% and 84.91% respectively (P>0.05). After treatment with the laser, the healing rate was 93.33% in the PSCO group and 66.67% in the NLDO group respectively (P<0.05). After treatment with the micro-drill, the healing rate in PSCO and NLDO groups was 65.39% and 94.28% respectively (P<0.01). The lacrimal passage obstruction can be observed and treated directly through the lacrimal endoscope. Choosing different surgical procedures in operation according to the locations of the obstruction is helpful to improve the effectiveness.