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.

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.

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.

Long-term outcomes of laser dacryoplasty combined with intubation using a new silicon tube in patients with lacrimal duct obstruction

AIM:To determine the 15-year outcomes of laser dacryoplasty(LDP)in patients with lacrimal duct obstruction;and to evaluate LDP combined with intubation using a new silicone tube to treat complicated cases.METHODS:Patients with lacrimal duct obstruction and treated with LDP between April 2000 and April 2005 were investigated retrospectively.Totally 116 eyes with completed 15-year follow-up records were included in this study.For complicated cases(52 eyes of 52 patients),both LDP and intubation using a self-made silicon tube were performed.For patients with uncomplicated obstruction(64 eyes of 61 patients),only LDP was performed.Outcomes were assessed based on results of lacrimal irrigation and degree of symptoms during follow-up.RESULTS:At the follow-up time of 15y,81 eyes achieved full success(69.8%);21 eyes got improved(18.1%);and 14 eyes were considered failure(12.1%).The success rate was 71.2%(37/52 eyes)for complicated cases;and 68.8%(44/64 eyes)for uncomplicated cases.No statistically significant difference between two groups was observed(P=0.961).No postoperative complication was observed.CONCLUSION:LDP is a well-tolerated,simple,and effective procedure with satisfactory long-term outcomes in selected patients,which make it a good alternative to conventional dacryocystorhinostomy.In addition,intubation with the self-made mono-canalicular silicone tube facilitates the management of complicated cases with few complications.

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。

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,

影响泪囊造口通畅的因素分析

鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎，具有疗效确切、面部无切口、手术操作简便、并发症少等优点受到医患双方的推崇。泪囊造口通畅程度直接影响经鼻内镜鼻腔泪囊造口术的疗效。笔者对167例（172眼）经鼻内镜鼻腔泪囊造口术患者的资料进行回顾，分析影响泪囊造口通畅的因素，报道如下。

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.

鼻内镜下鼻腔泪囊造口术造口的处理

慢性泪囊炎是眼科常见疾病,通常由眼科医师经鼻外径路行泪囊鼻腔吻合术,该术式取得良好的临床效果,治愈率较高(>80%)[1],但鼻外径路泪囊鼻腔吻合术术后留下面部瘢痕,手术操作较复杂。随着鼻内镜技术的发展,近年来国内外学者对鼻内镜下鼻腔泪囊造口术不断改良,其效果与鼻外径路泪囊鼻腔吻合术相当,已经逐步成为治疗慢性泪囊炎主要手术方式之一。我科2008~2013年运用鼻内镜下鼻腔泪囊造口术,

误诊为单纯泪囊炎的Haller气房囊肿1例

1临床资料患者,女,39岁,主诉左眼角反复流脓半年,伴有内眦痛、眼痛及左侧头痛,无视物模糊,无眼球运动障碍。就诊当地医院眼科,考虑为泪囊炎,门诊给予泪道冲洗,冲洗通畅情况欠佳,头孢克肟抗感染治疗好转,停药后再次出现上述症状。遂就诊我院眼科门诊,眼眶CT考虑左侧鼻窦炎,转诊耳鼻咽喉科门诊,给予鼻喷激素、鼻部促排剂、鼻腔冲洗治疗,症状有好转,停药后再次反复。

Effects of medication methods after simple and effective probing of lacrimal passage

AIM:To evaluate the effect of reducing the use of antibiotics in the treatment of infant bacterial dacryocystitis after probing of the lacrimal duct.METHODS:A total of 542 cases of children under one year old and accepting nasolacrimal duct probing treatment were divided into two groups, which were treated with topical and oral antibiotics, respectively.Conjunctival sac secretions were used as a control index of bacterial infection, whereas the disappearance of epiphora symptoms and lacrimal passage patency were used as cure indexes. The χ2test was used to compare enumeration and measurement data, and a statistical significance was set at P 【0.05. The therapeutic effect on the two groups of postoperative patients was investigated.RESULTS:In the two study groups, no significant differences in gender, age and postoperative control of lacrimal sac infection were observed. The cure rates after three probing operations also showed no significant difference.CONCLUSION:After probing of the lacrimal passage,results of this study confirmed that postoperative medication without oral antibiotics but an ophthalmic dosage of antibiotics was a simple and effective treatment method.

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.

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.

Evaluation of the new OxyPlate^(TM) Anaerobic System for the isolation of ocular anaerobic bacteria

AIM: Anaerobic bacteria can cause ocular infections. We tested the OxyPlateTM Anaerobic System (OXY) to isolate pertinent anaerobic bacteria that can cause ocular disease.METHODS: OXY, which does not require direct anaerobic conditions (i.e. bags, jars), was compared to conventional isolation of incubating culture media in anaerobic bags. Standard colonies counts were performed on anaerobic ocular bacterial isolates under aerobic and anaerobic conditions (anaerobic bags) using agar media: 1) OXY (aerobic only), 2) 5% sheep blood (SB), 3) Chocolate, and 4) Schaedler. The bacteria tested were de-identified ocular isolates cultured from endophthalmitis and dacryocystitis that include 10 Propionibacterium acnes and 3 Actinomyces species. The colony counts for each bacteria isolate, on each culturing condition, were ranked from largest to smallest, and non-parametrically compared to determine the best culturing condition.RESULTS: All anaerobic conditions were positive for all of the anaerobic isolates. SB and Schaedler’s agar under aerobic conditions did not support the growth of anaerobic bacteria. Sparse growth was noted on chocolate agar with Propionibacterium acnes . As an anaerobic system, SB in an anaerobic bag isolated higher colony counts than OXY (P=0.0028) and chocolate agar (P=0.0028).CONCLUSION: Although OXY did not test to be more efficient than other anaerobic systems, it appears to be a reasonable alternative for isolating anaerobic bacteria from ocular sites. The use of an agar medium in a specially designed plate, without the requirement of an anaerobic bag, rendered OXY as an advantage over other anaerobic systems.

Comparison of the extrusion rate of Crawford tubes

· AIM: To compare the outcomes of dacryocystorhinostomy(DCR) using traditional Crawford tubes(TCT) and Crawford tubes with suture(CTS) in the lumen.· METHODS: Retrospective case series consisting of patients who underwent DCR between 2008 and 2013.·RESULTS: A total of 61 DCRs were performed on 50 patients. Patients who underwent DCR using CTS had higher rates of prolapse compared to the TCT group(50% vs 9.4%; P =0.003). Stent removal occurred earlier in patients who received CTS(3.3mo vs 5.1mo; P =0.004). Success rates were equivalent between the two groups(75% vs 81.1%; P =0.684).·CONCLUSION: CTS in the lumen increases the risk of prolapse, prompting earlier tube removal in patients following DCR for nasolacrimal duct obstruction(NLDO).Earlier removal of tubes does not appear to significantly decrease success rates.

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.

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.

Schneiderian papilloma occasionally found in the lacrimal sac

Schneiderian papilloma is a kind of benign tumor that generally arises in the nasal and paranasal sinus mucosa. Here we present a case of Schneiderian papilloma found in the lacrimal sac.