Surgical Outcomes Of Endoscopic Dacryocystorhinostomy Research Articles

Surgical outcomes of endoscopic dacryocystorhinostomy for eyes with nasolacrimal duct obstruction via tear meniscus height evaluation.

To evaluate the association of tear meniscus height (TMH) with clinical outcomes of patients who underwent endonasal dacryocystorhinostomy. We recruited 304 patients from two institutes. The TMH was measured using anterior segment optical coherence tomography before surgery. All patients underwent endoscopic DCR with lacrimal intubation stent insertion. The lacrimal stent was removed 2months after surgery. The TMH was measured at 2months and 12months after surgery. Improvements in epiphora were assessed using a visual analogue scale (range, 0-2). Recurrence was determined based on lacrimal irrigation and endoscopic evaluation results. All patients experienced improvements in subjective symptoms 2months after surgery. The mean TMH also decreased significantly compared with that before surgery. During the follow-up period, four patients experienced recurrence. The mean TMH 12months after surgery was significantly lower than that before surgery. The rate of change in the TMH was significantly associated with the use of a dacryoendoscope during sheath-guided lacrimal stent intubation at all time points. Of the 251 patients who were followed up at 12months after surgery, three reported recurrences, and 17 reported mild improvement of epiphora. The rate of change in the TMH was significantly associated with epiphora improvement. Height was also associated with epiphora improvement. Endoscopic DCR is an acceptable surgical procedure for managing nasolacrimal duct obstruction. Sheath-guided lacrimal stent intubation using a dacryoendoscope resulted in a greater reduction in postoperative TMH compared to the blind insertion technique, which may lead to favorable clinical outcomes.

Effects of Topical Anti-Glaucoma Medications on Outcomes of Endoscopic Dacryocystorhinostomy: Comparison with Age- and Sex-Matched Controls.

This study analyzed the effects of topical anti-glaucoma medications on the surgical outcomes of endoscopic dacryocystorhinostomy (EDCR) in nasolacrimal duct obstruction (NLDO). This retrospective study included patients who underwent EDCR for NLDO between September 2012 and April 2021. Thirty patients with topical anti-glaucoma medications and 90 age- and sex-matched controls were included. The success rate of EDCR was higher in the control group than in the anti-glaucoma group (97.8% vs. 86.7%, p = 0.034). Univariate and multivariate logistic regression analyses identified prostaglandin analogs as the most influential risk factor for EDCR success among anti-glaucoma medication ingredients (p = 0.005). The success rate of the group containing all four anti-glaucoma medication ingredients was statistically significant (p = 0.010). The success rate was significantly different in the group of patients who used anti-glaucoma medication for >24 months (p = 0.019). When multiplying the number of drug ingredients by the duration in months, the group > 69 showed a significantly decreased success rate (p = 0.022). Multivariate logistic regression analysis identified the number of anti-glaucoma medications as the most significant risk factor for EDCR success (odds ratio, 0.437; 95% confidence interval, 0.247 to 0.772; p = 0.004). The authors suggest that the anti-glaucoma medications might cause NLDO and increase the failure rate after EDCR. Therefore, when performing EDCR in patients using topical anti-glaucoma medications, surgeons should consider the possibility of increased recurrence after EDCR in clinical outcomes.

Comparison of the surgical outcomes of endoscopic dacryocystorhinostomy in chronic dacryocystitis with or without previous bicanalicular silicone tube intubation

AimsTo compare the outcomes of endoscopic dacryocystorhinostomy (En-DCR) in chronic dacryocystitis (CD) with or without previous bicanalicular silicone tube intubation (BSTI), and investigate whether previous BSTI influenced postoperative outcomes. MethodsWe conducted a retrospective review of medical records of CD patients (group A) who had previously undergone BSTI for nasolacrimal duct stenosis and an age- and sex-matched control group of CD patients (group B) without previous intubation receiving En-DCR from November 2017 to January 2022. Sixty-one patients (61 eyes) were included in group A and age- and sex-matched 122 patients (122 eyes) in group B. Dacryocystic parameters were measured by computed tomography-dacryocystography and surgical findings were recorded during surgeries. The surgical success rates of the two groups were compared at 12 months post-operation. ResultsThe mean horizontal, sagittal, and vertical lengths were 6.06 ± 1.24, 6.03 ± 1.44, and 8.05 ± 2.00 mm, respectively, in group A and 6.33 ± 1.25, 6.26 ± 1.19, and 10.40 ± 2.45 mm, respectively, in group B. There were no differences in the horizontal or sagittal parameters between the two groups. The vertical parameter in group A was significantly lower than that in group B. Scar formation in the sac was observed in 54 patients in group A but was absent in group B. At 12 months postoperatively, the anatomical and functional success rates were 88.52 % and 85.25 %, respectively, in group A and 92.62 % and 89.34 %, respectively, in group B, with no difference between the two groups. ConclusionPrevious BSTI reduced dacryocyst vertical parameter and caused dacryocyst scar formation but did not affect postoperative En-DCR efficacy.

Surgical Outcome of Endoscopic Dacryocystorhinostomy with and Without Prolene Stent in Chronic Dacryocystitis: A Randomized Controlled Trial.

Popularity of Endoscopic dacryocystorhinostomy is rising over a conventional external dacryocystorhinostomy. One of the most frequent reasons for procedure failure is the closing of neo-ostium. To compare the surgical results of endoscopic Dacryocystitis operations with and without Prolene stents in terms of procedure success rates and postoperative complications. A randomized controlled trial of 2years was carried out including 100 patients of chronic dacryocystitis. The cases were randomly split into two groups with 50 cases each in Endoscopic DCR with stent and without stent groups. The results, both the subjective and objective were noted. At the end of 3months, the overall success rate was 88% and 90% in group with and without stent respectively with no significant statistical difference. 12% subjects had wound infection, 8% had granulations around the rhinostoma, 6% had synechiae, 10% had discomfort from the tube in stent group. In Group B (without stent), 16% had wound infection, 4% had granulations around the rhinostoma. As Endoscopic DCR without stent has equally good results and less complications as compared to with stent, we recommend endoscopic DCR without stent. Use of Stent should be reserved for special conditions like revision cases, common canalicular block, fibrosed lacrimal sac.

Endoscopic dacryocystorhinostomy with short-term, pushed-type bicanalicular intubation vs. pulled-type monocanalicular intubation for primary acquired nasolacrimal duct obstruction.

Dacryocystorhinostomy (DCR) has been a primary treatment for adults with nasolacrimal duct obstruction, while the optimal approach and technique remain controversial. With the advancement of endoscopic DCR and the silicone stents, an update of the surgical outcomes and preferable approaches is required. This study aims at comparing the surgical outcomes of endoscopic DCR using pushed bicanalicular intubation (BCI) to pulled monocanalicular intubation (MCI) in adults with primary acquired nasolacrimal duct obstruction (PANDO). Forty five eyes of 45 patients were enrolled, including 22 eyes of 22 patients treated with endoscopic DCR with pulled MCI and 23 eyes of 23 patients with pushed BCI from January 2014 to June 2021. The success rates at stent removal, 1 month and 3 months after removal were 95, 91, and 82%, respectively, in the MCI group, and 100, 87, and 87% in the BCI group. The BCI group had better success rates but failed to reach a significant difference (p = 0.49, p = 0.67, p = 0.24, respectively). After analyzing with binary logistic regression, the implant material was demonstrated as the predictive of surgical success (p = 0.045). There was no significant difference in success rates between patients with dacryocystitis and those without dacryocystitis. We conclude that endoscopic DCR with pushed BCI is easily manipulated and has a promising surgical outcome over pulled MCI. Stent indwelling duration as well as history of dacryocystitis have less influence on the success rates.

Study the demographic, clinical and surgical outcomes of endoscopic dacryocystorhinostomy

This study was done with an aim to study the demographic, clinical and surgical outcomes of Endoscopic Dacryocystorhinostomy. The records of patients who underwent Endoscopic DCR in the last five years were retrieved from the archival records of Department of Otorhinolaryngology and Head-Neck Surgery, K.G.M.U and were reviewed for demographic data, laterality, pre-operative complaints, co-morbidities, clinical and surgical profiles, adjunctive procedures, complications, and success rates at the last follow up. Result: The distribution of cases according to operation type is shown in table-7. Among the cases, Endoscopic DCR Left operation was performed in 94 (41.6%) cases while Endoscopic DCR Right operation was performed in 131 (58.0%) cases. There was one case operated with Endoscopic Bilateral DCR. On comparing pre to post op tearing status, it was found that at pre op the mean tearing score was 5.80±2.02 which was reduced to 1.17±1.35 at post op. So a mean reduction of 4.63±0.12 was observed which was significant statistically (p<0.001). Conclusion: Endoscopic DCR can be adopted the first-line surgical procedure for the treatment of acquired Nasolacrimal duct obstruction. Endoscopic DCR avoids external scar, endoscopic visualization and assessment can be done immediately with correction of pathology including endonasal pathologies (DNS, turbinate hypertrophy etc.).

Diagnostic Algorithm for Proper Selection of Patients Undergoing Endoscopic Dacryocysto rhino stomy

Abstract Background: Increased lacrimation or tearing is considered a symptom of a large number of pathologies and differential diagnoses. It may be due to increased lacrimal outflow as a result of infection, allergy, and trauma, or may be due to defective drainage function of the lacrimal system resulting in epiphora (1). Defective drainage function may be due to obstruction or stenosis at any level of the drainage system, or may be due to week apposition of the lacrimal puncti on the eye globe like patients with ectropion due to scarring or muscle weakness in which the lid gets outwards eversion, a condition that is called ectropion. This condition can be caused by various etiologies, the most important of which are tractional by scarring or paretic by facial paralysis or senile atrophy (2). So proper identification of the nature of tearing (lacrimation or epiphora) and the level of obstructed drainage is of para-mount importance to target our management or surgical approach and to obtain higher success rates, less failures and minimal recurrences (3). Depending upon the level of the obstruction, specific surgical procedures were used. These may include any of the following procedures, punctual dila-tation, punctoplasty, Canalicular reconstruction, Canaliculo-dacryocystorhinostomy, Close dacryointubation, dacryo-cystorhinostomy (External and Endoscopic), Conjunctivo dacryocystorhinostomy and Dacryocystectomy etc (4). Endo-scopic dacryocystorhinostomy is considered an effective and safe approach addressing obstructive etiology of epiphora other than punctual pathologies (5). So proper preoperative diagnostic work at various levels (history, examination and investigations) is essential for successful management. Aim of Study: 1- The first aim of our study is to construct a diagnostic algorithm and management plan for patients with obstructive lacrimal pathology and epiphora. 2- To evaluate this Algorithm as regards the surgical outcome of endoscopic dacryocystorhinostomy. Patients and Methods: A prospective, study conducted from September 2015 to December 2020 on 20 patients suffering increased lacrimation. Patients have been subjected to special stepwise diagnostic algorithm and classified into three main groups A, B and C according to the pathology and treatment plan. Group A of 11 patients suffering retro-punctual obstruction managed by endoscopic dacryocystorhinostomy while 5 patients in group B suffering punctual etiology (ob-struction and diversion or malposition) and 4 patients in group C suffering increased lacrimation rather than obstruction have been fulfilled the exclusion criteria and referred for proper ophthalmological management. Results: In group A, 11 patients undergone the diagnostic algorithm and fulfilled the inclusion criteria of retro-punctual obstruction of the lacrimal drainage system. Patients in group A have been managed by endoscopic dacryocystorhinostomy except one infant patient. They were doing well throughout the follow up period (4-6 months). In the 10 operated patients and before silicon tube removal, 7 patients reported complete improvement of epiphora, 2 patients reported decreased epiphora and 1 patient has no change of epiphora. After stent removal all operated patients of group A (10) reported complete improvement of epiphora with no recurrence after 6 months. 5 Patients in group B suffering punctual etiology (obstruction and diversion) and 4 patients suffering increased lacrimation rather than obstruction have been referred for ophthalmologist and managed accordingly. They were doing well except two patients in group B suffering punctual stenosis and obstruction who needed repeated dilatations and one patient reported to be indicated for punctoplasty. Conclusion: Application and following the diagnostic Algorithm steps and adhering to it have markedly improved patient selection and the final outcome of endoscopic dacry-ocystorhinostomy and effectively referred non obstructive or punctual patients for proper ophthalmologic management to avoid non indicated endoscopic dacryocystorhinostomy and treatment failure.

English

English

Surgical outcomes of endoscopic dacryocystorhinostomy: analysis of age effect

There is limited evidence in literature determining age effect on outcomes of endoscopic dacryocystorhinostomy (EDCR) in adult patients with primary acquired nasolacrimal duct obstruction (NLDO). We aimed to analyze the outcomes of EDCR according to age in primary acquired NLDO. A retrospective study was performed on consecutive adult patients and patients were divided into two age groups; group 1 (aged to 61 years) and group 2 (aged 62 to 89 years) based on the average value. The minimum required follow-up period was 6 months. A total of 441 EDCRs performed in 342 patients were enrolled. The anatomical success rate was not significantly different between the two groups (91.8% and 88.2%, P = 0.209). However, the functional success rate was significantly lower in the group 2 (85.1% and 76.9%; P = 0.036). Functional failure was associated with old age and a history of diabetes mellitus (P = 0.024 and P = 0.008). In subgroup analysis of patients with anatomical success but functionally failed EDCR, group 2 had significantly more comorbid conditions such as eyelid laxity (P = 0.026). In conclusion, the comorbid conditions which increase with age may affect functional outcome, especially eyelid laxity, careful preoperative examination of the eyelid and conjunctiva should be emphasized to lacrimal surgeons before performing EDCR.

A Systematic Review of Benefit of Silicone Intubation in Endoscopic Dacryocystorhinostomy.

ObjectivesInsertion of a silicone stent during endoscopic dacryocystorhinostomy (DCR) is the most common procedure to prevent rhinostomy closure. It has been claimed that silicone intubation improves the surgical outcomes of endoscopic DCR. However, many reports have documented an equally high success rate for surgery without silicone intubation. Accordingly, we conducted a systematic review and meta-analysis to clarify the outcomes of endoscopic DCR with and without silicone intubation and determine whether silicone intubation is actually beneficial for patients.MethodsPubMed, Embase, and Cochrane Library databases were searched to identify relevant controlled trials evaluating endoscopic DCR with and without silicone intubation. The search was restricted to English articles published between January 2007 and December 2016. Relevant articles were reviewed to obtain information pertaining to interventions and outcomes. We also performed a meta-analysis of the relevant literature.ResultsIn total, 1,216 patients included in 12 randomized controlled trials were pooled. A total of 1,239 endoscopic DCR procedures were performed, and silicone stents were used in 533 procedures. The overall success rate for endoscopic DCR was 91.9% (1,139/1,239), while the success rates with and without silicone intubation were 92.9% (495/533) and 91.2% (644/706), respectively. There was no statistically significant heterogeneity among the included studies. A meta-analysis using a fixed-effects models showed no significant difference in the success rate between endoscopic DCR with silicone intubation and that without silicone intubation (OR, 1.38; 95% CI, 0.89 to 2.12; P=0.148; z=1.45). Furthermore, there were no significant differences with regard to surgical complications such as synechia, granulation, and postoperative bleeding.ConclusionThe findings of our meta-analysis suggest that the success rate and postoperative complication rate for endoscopic DCR is not influenced by the use of silicone intubation during the procedure.

Surgical outcomes of endoscopic dacryocystorhinostomy: analysis of 1083 consecutive cases

ObjectiveWe report on the surgical outcome of endoscopic dacryocystorhinostomy (DCR) and analyze factors that influence surgical failure. DesignRetrospective observational cases series. ParticipantsA total of 1083 cases who underwent endoscopic DCR with bicanalicular lacrimal stent insertion, performed by 1 surgeon between January 2007 and February 2013. MethodsA retrospective chart review of 1083 cases who underwent endoscopic DCR with bicanalicular lacrimal stent insertion was performed, focusing on factors that were expected to affect the surgical outcomes. Surgical outcomes were recorded as the resolution of symptoms and endoscopic evidence of ostium patency postoperatively. ResultsThe overall success rate of DCR was 92.7% (1004 cases). Of 79 cases with unsuccessful outcomes, the visualization of anatomical obstruction with endoscopy was possible in 68 cases (86%), whereas no anatomic evidence of obstruction was found in 11 cases (14%). In total, 64 cases underwent additional lacrimal intervention, and 12 cases underwent revision surgery twice after the initial DCR operation. Radioactive iodine ablation was associated with surgery failure by logistic regression analysis. However, other factors, such as sex, age, the presence of earlier accidental tube removal, indications for surgery, and Guardix injection, did not show statistically significant differences. ConclusionsEndoscopic DCR is a surgical technique that has a predictable, favourable success rate. It could be considered appropriate for the initial treatment of nasolacrimal duct obstruction.

Endoscopic dacryocystorhinostomy with canalicular marsupialization in common canalicular obstruction

ObjectiveTo evaluate the surgical outcomes of endoscopic dacryocystorhinostomy with canalicular marsupialization (EDCR CM) in common canalicular obstruction. DesignRetrospective review of medical records. ParticipantsThirty-six patients (38 eyes) who had undergone EDCR CM for chronic epiphora caused by common canalicular obstruction. MethodsSurgical outcomes were evaluated postoperatively by improvement of subjective symptoms and patency of the neo-ostium of DCR on nasal endoscopy. ResultsSubjective symptoms improved in 81.6% (31/38) after primary EDCR CM and 94.7% (36/38) after revision surgery. In cases of silicone stent intubation, the surgical results were relatively superior compared with patients without silicon stent insertion (83.3% and 75.0%, respectively; p = 0.624). On postoperative nasal examination after primary surgery, the patency of dacryocystorhinostomy site was lower in patients with silicone stent insertion than those without (86.70% and 100%, respectively; p = 0.560), and the patency rate of the canalicular neo-ostium was higher in patients with silicone stent insertion than those without (90.0% and 75.0%, respectively; p = 0.279). There were no serious intraoperative complications except mild punctual erosion (4 patients, 10.5%). ConclusionEDCR CM showed favourable surgical outcomes and few surgical complications. This surgical treatment could be the first-line treatment for patients with distal common canalicular obstruction.

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.

Surgical Results of Endoscopic Dacryocystorhinostomy and Lacrimal Trephination in Distal or Common Canalicular Obstruction

ObjectivesTo evaluate the surgical outcomes of endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stenting in patients with distal or common canalicular obstructions.MethodsThe medical records of 29 patients (31 eyes) from January 2001 to December 2009 who underwent endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone tube insertion for the treatment of distal or common canalicular obstructions were retrospectively reviewed. The level of obstruction was confirmed by intraoperative probing. The outcome of the surgery was categorized as a complete success, partial success, or failure according to the functional and anatomic patency.ResultsThe average age of the patients was 52 years. The duration of silicone intubation ranged from 4 to 11 months with an average of 5.7±1.6 months. The follow-up period after stent removal ranged from 4 to 15 months with an average of 8.2±3.3 months. Complete success was achieved in 25 out of 31 eyes (80.6%), partial success in 4 out of 31 eyes (12.9%), and failure in 2 out of 31 eyes (6.5%).ConclusionEndoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stent intubation may be safe and considered as an initial treatment of patients with distal or common canalicular obstructions.

The Surgical Outcome of Endoscopic Dacryocystorhinostomy According to the Obstruction Levels of Lacrimal Drainage System

ObjectivesMany factors influence the outcome of endoscopic dacryocystorhinostomy (DCR). One of the most important prognostic factors is the level of obstruction in the lacrimal drainage system. The main objective of this report is to evaluate both the frequency of obstruction by anatomical region of the lacrimal drainage system on dacryocystography (DCG) and the surgical outcome of endoscopic DCR according to the obstruction level.MethodsA retrospective series of 48 patients (60 eyes) who had undergone endoscopic DCR from January 2005 to November 2007 were enrolled. Preoperative evaluation consisted of a standard examination which included lacrimal irrigation, probing, DCG and osteomeatal unit (OMU) computed tomography. Patients were classified into four groups according to the obstruction level on DCG. Surgical outcome was evaluated postoperatively by subjective improvement of epiphora and patent rhinostomy opening on nasal endoscopic exam.ResultsOf 60 eyes, the levels of obstruction were the common canaliculus in 14 eyes (23.3%), the lacrimal sac in 13 eyes (21.7%), the duct-sac junction in 13 eyes (21.7%) and the nasolacrimal duct (NLD) in 20 eyes (33.3%). The ductsac junction obstruction was treated most successfully (100%), followed by NLD obstruction (90%), common canaliculus obstruction (78.6%) and saccal obstruction (69.2%).ConclusionIn patients with lacrimal drainage system obstruction, preoperative evaluation of obstruction level using DCG may be helpful for predicting the surgical outcome of endoscopic DCR. The saccal obstruction may have a worse prognosis than the other obstruction levels.