Endonasal Endoscopic Dacryocystorhinostomy with the Use of Radiofrequency (RF) Surgical Technique

Endonazal endoscopic dacryocystorhinostomy (DCR) with radiofrequency (RF) surgical technique is a procedure selected for nasolacrimal duct obstruction and chronic dacryostenosis in the setting of patent canaliculi and a functional lacrimal pump. Two major approaches are utilized: external, via a transcutaneous incision and endonasal endoscopically guided. The surgery has the high success rate via both approaches. We review the history, evolution, current techniques, complications and future directions of DCR radiofrequency RF operative technique. The modified endonasal RF-coagulation technique was performed in patients aged 18 - 85 (women-80, men-35) from 2017 to 2023. All patients suffered from chronic dacryocystitis. They had been administered the course of traditional conservative treatment and were provided with the ophthalmologist’s and otorhinolaryngology’s consultations prior to the surgery. In order to verify the diagnosis, the patients were conducted the CT-scan examination of nasal cavity and paranasal sinuses as well as the endoscopy of nasal cavity. Endonasal dacryocystorhinostomy with RF coagulator proved to be effective in 80% of patients;Over 3 - 4 years following the surgery, the recurrence was manifested in 8 patients after 6 months and in 12 patients, after a year. The above mentioned surgical treatment is administered by minimally invasive surgical method. At the same time, the long-term, for about 1 year, implantation of silicone drainage in the nasolacrimal ducts significantly reduces the risk of recurrence. At the present stage, the endoscopic Endo-DCR surgery is being improved, and the diverse treatment methods, including radiofrequency (RF) in endonasal endoscopic microsurgical techniques, are being studied and introduced into practice.

Endoscopic dacryocystorhinostomy in acute dacryocystitis:a multicenter study in China

AIM:To repor t the clinical profile,endoscopic dacryocystorhinostomy(En-DCR)management,and acute dacryocystitis(AD)outcomes in China.METHODS:Clinical data of 554 adult AD patients(554 eyes)who presented in 7 tertiary eye care centers for 10y from Jan 2010 to Mar 2020 were retrospectively analyzed.Clinical profile,En-DCR management,and outcomes of all cases were recorded.The anatomical and functional success were evaluated for 12mo post-operation.RESULTS:The analysis included 149 males and 368 females with a median age of 55.2y(range:18-84y).There were 459 eyes with a history of epiphora or purulent secretion.The time between a symptom of lacrimal duct obstruction and acute onset was 1 to 540(66.1±58.2)mo.Fifty-nine eyes had a history of the previous acute attack.Seventy-four eyes developed a cutaneous fistula,while 11 eyes had post septal cellulitis pre-operation.En-DCR with an anatomical success of 91.7%and functional success of 90.1%.The success rate of the patients with a history of acute episodes and the preoperative fistula was lower than the overall success rates.CONCLUSION:En-DCR can be performed during an acute episode in AD with a success rate of over 90%.

Treatment of acute dacryocystitis by translacrimal canalicular drainage and D-silicone intubation

AIM:To demonstrate the outcomes of translacrimal canalicular drainage using a lacrimal probe and intranasal drainage by D-silicone intubation for acute dacryocystitis(AD).METHODS:This retrospective study included 23 patients with AD and had undergone abscess decompression with the use of lacrimal probe and intranasal drainage by D-silicone intubation between January 2019 and December 2022.Patients received abscess decompression and systemic antibiotic-corticosteroid from the time of diagnosis.D-silicone tube was inserted within 10d after diagnosis and removed 3-6mo after intubation.The procedure and outcomes of this method were evaluated.RESULTS:All patients showed improvement of signs and symptoms of AD within 72h.No intraoperative and postoperative complications were observed.No recurrence of lacrimal sac abscesses occurred after D-silicone tube removed.CONCLUSION:Lacrimal probe and D-silicone intubation appear to be a feasible,minimally invasive,safe,and effective method,which could be a reasonable choice in the treatment of AD.

New mucosal flap modification for endonasal endoscopic dacryocystorhinostomy in Asians

AIM: To describe a simple modification of fashioning the mucosal flap for endonasal endoscopic dacryocystorhinostomy (EES-DCR) in Asians and investigate its efficacy. METHODS: A total of 120 patients with unilateral primary chronic dacryocystitis (PCD) were randomized into two groups: the new shaped nasal mucosal flap group (group A) and the removed nasal mucosal flap group (group B). All patients underwent standard EES-DCR. Patients in group A were performed a new shaped nasal mucosal flap covering the bared bone around the opened sac and those in group B was removed the nasal mucosal flap uncovering the bared bone. Patients were followed up for one year. The occurrence of granulation tissue, the proliferation of scar tissue and success rate of EES-DCR was compared. RESULTS: In the present study, complete postoperative data were acquired from 54 patients in group A and from 57 patients in group B. During process of review, the occurrence of granulation tissue was at the ostium margins account for 15% (8/54) in group A and 39% (22/57) in group B (P<0.05). At the one-year review, scar tissue was present in 5 patients in group A compared with 18 in group B (P<0.05). The success rate of EES-DCR was 98% (53/54) in group A and 84% (48/57) in group B (P<0.05). CONCLUSION: The simple modification of fashioning nasal mucosal flap can effectively cover the bared bone around the opened sac and reduce formation of granulation tissue, lessen the risk of scar tissue formation and closure of ostium, thus improve the success rate of EES-DCR in Asians.

Outcomes of revision external dacryocystorhinostomy and nasal intubation by bicanalicular silicone tubing under endonasal endoscopic guidance

AIM: To evaluate the long-term treatment outcomes in patients who underwent revision of external dacryocysto- rhinostomy (DCR) and nasal intubation by bicanalicular silicone tubing (BSTI) under endonasal endoscopic guidance. · METHODS: Data from 28 patients with recurrent dacryocystitis were retrospectively reviewed. Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance was performed in 28 eyes of 28 patients. The patients were evaluated with respect to the reason of recurrence, time to recurrence, time to revision, duration of follow-up and surgical success. · RESULTS: Endoscopic endonasal examination detected an osteotomy-side obstruction by the excessive granulation tissue in 24 patients (86%), nasal septal deviation in three patients (10%) and nasal polyp in one patient (4%). Recurrence occurred after a mean duration of 5.3±3.7 months following the first operation. The mean time between the first DCR operation and the revision DCR was 11.5 ± 9.3 months. After a mean follow-up of 14.9±7.8 months, the rate of anatomic success alone was 85% (24/28); the rate of subjective success was 78% (22/28). · CONCLUSION: Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance can be recommended in patients with recurrent dacryocystitis as a surgical approach that achieves satisfactory objective and subjective success rates.

External Dacryocystorhinostomy: 4 Years’ Experience from CHU-IOTA in Mali

Aim: To analyze the clinical characteristics and the surgical outcomes of external dacryocystorhinostomy (DCR) in patients with nasolacrimal duct obstruction (NLDO). Methods: We retrospectively reviewed the clinical record of 62 patients who underwent external DCR for NLDO between November 2015 and November 2019 at CHU-IOTA in Mali. The preoperative clinical findings and the postoperative outcomes after a minimum follow up of 3 months were analyzed. Results: epiphora, discharges and canthal swelling were main symptoms of the 62 patients (68% women, 32% men), with the mean age of 47 years (10 - 76). Among them, 36 had chronic dacryocystitis, 12 had a traumatic NLDO and 8 followed a septal deviation. The majority (77%) were operated on under local anesthesia with sedation. Bicanalicular intubation was performed in 29% of patients. After postoperative follow up of at least 3 months, only 8 patients had persistent watering, thus a subjective functional success of 87%. Conclusion: In the nasolacrimal duct obstruction, most often secondary to chronic dacryocystitis, external dacryocystorhinostomy remains a technique of choice with very good success.

Impact of the interval after endoscopic dacryocystorhinostomy on the outcomes of intraocular surgery: a 4-year retrospective study

Background:Patients with dacryocystitis should be treated for their infection by endoscopic dacryocystorhinostomy(EN-DCR)before any intraocular surgery.However,there is no unified standard for the specific time interval between the two surgeries.This study aimed to determine the appropriate interval for intraocular surgery in patients with previous EN-DCR for chronic dacryocystitis.Methods:The medical files of all patients who underwent intraocular surgery after EN-DCR surgery in our hospital from 2016 to 2019 were reviewed.The EN-DCR data of patients undergoing intraocular surgery at different time intervals and the incidence of endophthalmitis after intraocular surgery were compared.Results:A total of 116 patients(92 females and 24 males,mean age 64.06±7.78 years)underwent EN-DCR and intraocular surgery met the inclusion criteria.The interval between EN-DCR and intraocular surgery varied from 5-475 days.The number of patients undergoing cataract surgery after EN-DCR is the largest(75,64.7%).All patients(100%)who had previously undergone EN-DCR did not develop endophthalmitis infection after intraocular surgery at a follow-up of 12 months.Conclusions:For patients with dacryocystitis who have undergone EN-DCR surgery,there is no time limit when choosing the timing of intraocular surgery.For patients requiring intraocular surgery,operation can be arranged as soon as possible to solve their problems as long as the patients had patency on lacrimal passage irrigation and no secretions.

Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation

AIM:To establish the necessity of silicone tube intubation in acute dacryocystitis(AD)patients undergoing endonasal endoscopic dacryocystorhinostomy(En-DCR).METHODS:Patients presenting with unilateral AD were randomly assigned to two treatment groups.En-DCR procedures were performed following lacrimal abscess formation,with the operation being performed with silicone intubation for patients in group B but not group A.Functional success was defined by an absence of additional AD episodes,no epiphora,and ostium patency as established via endoscopic evaluation or fluorescein irrigation.Operative success rates and demographic variables were compared between treatment groups.RESULTS:In total,66 patients were analyzed in the present study(33 per group),with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B,respectively.All patients exhibited complete resolution of acute inflammation.Upon follow-up,granulation tissue was detected around the ostium at higher rates in group B(9/22,40.9%)relative to group A(4/27,14.8%).At the 12-month follow-up time point,patients in group A exhibited higher success rates(25/27,92.6%)relative to patients in group B(20/22,90.9%),but this difference was not significant.Cases of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ostium.CONCLUSION:Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation,cost,and operative duration,these data do not support the routine silicone intubation of AD patients following En-DCR surgery.

Comparison of scanning electron microscopy findings regarding biofilm colonization with microbiological results in nasolacrimal stents for external, endoscopic and transcanalicular dacryocystorhinostomy

AIM:To compare bacterial biofilm colonization in lacrimal stents following external dacryocystorhinostomy(EX-DCR),endoscopic dacryocystorhinostomy(EN-DCR),and transcanalicular dacryocystorhinostomy(TC-DCR)with multidiode laser.METHODS:This prospective study included 30consecutive patients with nasolacrimal duct obstruction who underwent EXT-,EN-,or TC-DCR.Thirty removed lacrimal stent fragments and conjunctival samples were cultured.The lacrimal stent biofilms were examined by scanning electron microscopy(SEM).RESULTS:Eleven(36.7%)of the 30 lacrimal stent cultures were positive for aerobic bacteria(most commonly Staphylococcus epidermidis and Pseudomonas aeruginosa).However anaerobic bacteria and fungi were not identified in the lacrimal stent cultures.Twenty-seven(90%)patients had biofilmpositive lacrimal stents.The conjunctival culture positivity after the DCR,biofilm positivity on stents,the grade of biofilm colonization,and the presence of mucus and coccoid and rod-shaped organisms did not significantly differ between any of the groups(P】0.05).However,a significant difference was found when the SEM results were compared to the results of the lacrimal stent and conjunctival cultures(P【0.001).CONCLUSION:Type of dacryocystorhinostomy(DCR)surgery did not affect the biofilm colonization of the lacrimal stents.SEM also appears to be more precise than microbiological culture for evaluating the presence of biofilms on lacrimal stents.

Primary non hodgkin's lymphoma of lacrimal sac presented as recurrent acute dacryocystitis: A case report

Primary non Hodgkin's lymphoma of the lacrimal sac is uncommon but potentially delay in diagnosis as it may mimic the presentation of primary post saccal nasolacrimal duct obstruction. In this article, we reported a case of primary non Hodgkin's lymphoma of the lacrimal sac presented with recurrent acute dacryocystitis in a young lady. A 28 years old Malay lady had history of persistent epiphora on left eye for 4 years. Prior to presentation to our clinic, it was preceded by progressive recurrent painful medial canthal swelling for 6 months duration. Clinical diagnosis of post saccal naso lacrimal duct obstruction was made and otorhinolaryngology assessment revealed intranasal mass. Endoscopic excision was done showed diffuse large B cell lymphoma on histology. The patient was started on 6 cycles of chemotherapy which subsequently result in no recurrence of the tumour post chemotherapy. Any case of post saccal nasolacrimal duct obstruction should be investigated thoroughly as it may become as a presentation of other sinister pathology.

Spherical Headed Silicone Intubation in the Treatment of 26 Cases (31 eyes) of Chronic Dacryocystitis under Nasal Endoscopy

Purpose:To observe the clinical efficacy of spherical headed silicone implantation in the treatment of chronic dacryocystitis under nasal endoscopy.Methods:Twenty-six patients (31 eyes) with chronic dacryocystitis were subjected to spherical headed silicone implantation under topical anesthesia (lacrimal passage and nasal mucosal surface).Lacrimal passage irrigation was performed daily throughout the first postoperative week,and once each month thereafter.Results:All spherical headed silicone tube placements were successfully performed.The operative time ranged from 6 to 11 minutes.Symptoms of epiphora were immediately ameliorated post-operatively,and irrigation demonstrated patency of the lacrimal system in all patients.All patients were followed from 7 to 24 months,during which symptoms of tearing were improved.The lacrimal ducts of 27 eyes (87.7%) were normal.The lacrimal ducts of 4 others.(12.3%).were still blocked.Lacrimal passage irrigation was open and secretion disappeared in 28 eyes(90.3%).Tearing was observed in 3 eyes (9.68%).Conclusion:Spherical headed silicone tube implantation under nasal endoscopy is successful in relieving symptoms of tearing.

Computed tomography for guidance in the diagnosis and surgical correction of recurrent pediatric acute dacryocystitis

Importance:This is the first retrospective study of the effect of computed tomography(CT)in diagnosis and surgical correction of recurrent pediatric acute dacryocystitis(PAD).Objective:To explore the pathogenesis of recurrent PAD and the impact of CT in guidance of surgical planning.Methods:Medical histories,clinical manifestations,and CT results of 10 patients with recurrent PAD were reviewed.Etiologies and treatment effectiveness were recorded for all patients.results:CT revealed that three patients had congenital dacryocystocele with lacrimal sac cyst,enlargement of the nasolacrimal canal,and intranasal cyst of affected sides.After regression of local inflammation,marsupialization was performed.CT showed that four patients had PAD secondary to congenital nasolacrimal canal dysplasia;these patients exhibited normal upper portions of the nasolacrimal canals,but had stenotic or atretic middle and terminal segments.After improvement of local inflammation,endonasal dacryocystorhinostomy was performed.Three patients had PAD secondary to congenital lacrimal sac diverticulum;after contrast injection,CT showed that the cysts at the lacrimal sac area were filled with contrast,and were connected to the normal lacrimal sac.After the topical infection was controlled,transcutaneous dacryocystorhinostomy was performed in combination with excision of the lacrimal sac diverticulum.No recurrence of PAD was detected at 6-month follow-up.Interpretation:Causes of PAD include congenital dacryocystocele,congenital lacrimal sac diverticulum,or congenital nasolacrimal canal dysplasia.Marsupialization with endoscope,endonasal dacryocystorhinostomy,and transcutaneous dacryocystorhinostomy constitute distinct surgeries for PAD treatment.CT provides an important diagnostic function and facilitates selection of specific surgical approaches for recurrent PAD.

两种术式治疗慢性泪囊炎的疗效对比

泪囊鼻腔吻合术是治疗慢性泪囊炎较为经典、有效的手段,但也存在一些缺点,鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎是近20年逐步发展的新技术,具有微创、并发症少等优点,是替代传统的泪囊鼻腔吻合术的理想手段[1~4]。我院自2011年开展鼻内镜下鼻腔泪囊造口术,现将两种术式的术后疗效、并发症等做对比分析,报道如下。1.1一般资料。将48例（52眼）鼻泪管阻塞、慢性泪囊炎患者分成两组,

慢性泪囊炎合并睑板腺功能障碍综合治疗后疗效评价

目的:探讨慢性泪囊炎合并睑板腺功能障碍患者通过泪道激光成型并置管术及术后联合睑板腺治疗的疗效。方法:收集我院2021-03/2022-12慢性泪囊炎合并睑板腺功能障碍的患者128例,均行泪道激光成型联合置管术;术后随机分为2组,A组64例(无睑板腺治疗)、B组64例(睑板腺治疗),术后3 mo取出泪道置管后评价两组泪道冲洗通畅率;并对比两组眼表疾病指数(OSDI)评分、非侵袭性泪膜破裂时间、泪河高度、眼红分析、睑板腺分析、泪液脂质层厚度、泪液蕨类试验、结膜印记细胞检查的变化情况。结果:A组与B组泪道冲洗通畅率分别为78.1%、81.2%,两者比较无差异(P>0.05);与A组比较,术后3 mo B组患者非侵袭性泪膜破裂时间延长,OSDI评分、眼红分析、泪液蕨类试验及结膜印记细胞学分级降低(均P<0.05),而泪河高度、泪液脂质层厚度、睑板腺缺失评分两者无明显差异(均P>0.05)。结论:慢性泪囊炎合并睑板腺功能障碍患者综合治疗后其舒适度、泪膜稳定性、局部炎症反应有所好转,这类患者手术治疗的同时应同步重视眼表微环境异常的改善,以期达到满意的疗效。

布地奈德联合鼻内镜手术治疗慢性泪囊炎

目的探讨布地奈德鼻喷雾剂联合鼻内镜手术治疗慢性泪囊炎的效果。方法将慢性泪囊炎患者80例(80眼)纳入前瞻性单盲研究,随机分为布地奈德组(40例)和对照组(40例)。所有患者均接受鼻内镜下鼻腔泪囊吻合术。布地奈德组应用布地奈德鼻喷雾剂喷鼻3个月,对照组应用生理性海水喷鼻3个月。比较2组手术疗效、Lund-Kenndey评分和并发症发生情况。结果随访6个月时,布地奈德组疗效优于对照组(P<0.05)。术后3个月时,2组Lund-Kenndey评分低于术前,布地奈德组Lund-Kenndey评分低于对照组(P<0.05)。布地奈德组并发症发生率低于对照组(5%vs.20%,P<0.05)。结论鼻内镜下鼻腔泪囊吻合术后应用布地奈德鼻喷剂治疗慢性泪囊炎安全有效,手术成功率更高、术后出现吻合口粘连、肉芽肿的概率更小,且不增加术后感染的风险。

泪囊鼻腔造孔术联合板蓝根液棉片在慢性泪囊炎中的应用效果

目的观察泪囊鼻腔造孔术联合板蓝根液棉片在慢性泪囊炎中的应用效果。方法选取2020年2月至2022年2月丰城市中医院收治的90例慢性泪囊炎患者作为研究对象,以随机数字表法分为研究组与对照组,每组各45例。对照组患者接受泪囊鼻腔造孔术治疗,研究组患者接受泪囊鼻腔造孔术联合板蓝根液棉片治疗,对所有患者术后随访1年。比较两组治疗后3个月临床疗效、术后并发症及随访期间复发率,并比较两组治疗前、治疗后1年生活质量变化情况[健康调查简表(SF-36)进行评估]。结果研究组治疗3个月的总有效率高于对照组,差异有统计学意义(P<0.05);两组并发症总发生率比较,差异无统计学意义(P>0.05);研究组随访1年期间复发率低于对照组,差异有统计学意义(P<0.05);两组治疗后1年SF-36评分均高于同组治疗前,差异有统计学意义(P<0.05);研究组治疗后1年SF-36各项评分高于对照组,差异有统计学意义(P<0.05)。结论应用泪囊鼻腔造孔术联合板蓝根液棉片治疗慢性泪囊炎具有确切疗效,能够显著降低术后复发率,具有良好安全性。

单眼慢性泪囊炎患者鼻中隔偏曲的情况观察

目的基于泪道电子计算机断层扫描(CT)造影观察单眼慢性泪囊炎患者鼻中隔偏曲情况。方法纳入2019年7月—2021年2月于成都中医药大学附属医院眼科就诊的单眼慢性泪囊炎患者181例。所有患者入院后均进行泪道CT造影检查,观察鼻中隔偏曲情况,并测量泪囊顶部与底部到鼻中隔的垂直距离。结果(1)鼻中隔偏曲情况:有140例(77.35%)患者存在鼻中隔偏曲,其中鼻中隔偏向患侧的有113例(80.71%),鼻中隔偏向健侧的有27例(19.29%)。(2)泪囊顶部与底部到鼻中隔的垂直距离分析:患侧泪囊顶部到鼻中隔的平均垂直距离低于健侧泪囊顶部到鼻中隔的平均垂直距离,差异有统计学意义(t=-9.293,P=0.000);患侧泪囊底部到鼻中隔的平均垂直距离低于健侧泪囊底部到鼻中隔的平均垂直距离,差异有统计学意义(t=-9.238,P=0.000)。结论本研究发现单眼慢性泪囊炎多见于中老年女性患者,多伴有鼻中隔偏曲,且患侧泪囊到鼻中隔的垂直距离小于健侧泪囊到鼻中隔的距离。

改良鼻内镜下鼻腔泪囊造孔置管术治疗慢性泪囊炎的疗效观察

慢性泪囊炎为临床常见疾病。我院自2012年1月～2013年3月采用改良鼻内镜下鼻腔泪囊造孔置管术治疗慢性泪囊炎42例（42眼），取得了良好的疗效，报道如下。

鼻内镜下低温等离子泪囊鼻腔吻合术

慢性泪囊炎的传统手术方法是Toti在1904年首次采用的鼻外径路行泪囊鼻腔吻合术,该术式为临床广泛应用,并有较好的临床疗效,但其手术操作较复杂,且术后遗留面部瘢痕[1]。自2000年5月～2006年12月我们在鼻内镜下使用低温等离子技术行泪囊鼻腔吻合术治疗慢性泪囊炎25例（32侧），取得了良好的效果，报道如下。

新型鼻腔泪囊吻合术联合丙酸氟替卡松治疗慢性泪囊炎

目的:探讨新型鼻腔泪囊吻合术联合丙酸氟替卡松治疗慢性泪囊炎患者的疗效。方法:前瞻性研究。选择2021-01/2022-12我院收治的慢性泪囊炎患者100例100眼,依据患者入院顺序编号分为对照组50眼(行新型鼻腔泪囊吻合术治疗)和观察组50眼(行新型鼻腔泪囊吻合术联合丙酸氟替卡松治疗)。比较两组患者手术前后最佳矫正视力(BCVA)、生活质量评分以及复发情况。结果:所有患者均完成术后6 mo随访,观察组患者术后总有效率优于对照组(98%vs 84%,P=0.001),手术前后BCVA比较无差异(P>0.05)。术前两组患者生活质量评分比较无差异(P>0.05),术后6 mo,对照组患者的躯体功能、心理功能、社会功能和物质生活状态评分均比观察组低(均P<0.001)。术后6 mo,对照组复发9眼(18%),观察组复发1眼(2%),两组比较有差异(χ^(2)=-2.739,P=0.001)。结论:新型鼻腔泪囊吻合术联合丙酸氟替卡松治疗慢性泪囊炎患者效果佳,可以提高患者的生活质量,降低复发率。