Nasal flap preservation in endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction

AIM:To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy(DCR)and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction(NLDO),and evaluate factors associated with the surgical success rate.METHODS:Medical records of patients who underwent primary DCR surgery between January 2016 and July 2020 at the Otorhinolaryngology Department of Eye and Ear International Hospital,Lebanon were reviewed.RESULTS:The study group consisted of 50 consecutive modified endoscopic DCR and the control group consisted of 138 consecutive conventional endoscopic DCR.The success rates at 1y were 98.0%(49 out of 50)for modified DCR,significantly higher compared to 84.8%(117/138)for the conventional DCR;there was no significant difference in the success rate throughout the years in terms of both surgical techniques.The modified surgery vs traditional[adjusted odds ratio(aOR)=14.96]and having an adjunctive septoplasty surgery vs not(aOR=3.99)were significantly associated with higher odds of success.CONCLUSION:Mucosal flap preservation and apposition shows significant improvement in the surgical success rate.Moreover,there is no statistically significant difference found in terms of complication rate and mean operative time between the conventional and the modified techniques.

A comparison between monocanalicular and pushed monocanalicular silicone intubation in the treatment of congenital nasolacrimal duct obstruction

AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation(PMCI)of the nasolacrimal duct for congenital nasolacrimal duct obstruction(CNLDO).METHODS: In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation(MCI)(n =28 eyes) or PMCI(n =25 eyes). All procedures were performed by 1oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal.RESULTS: The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25 ±10.08mo(range, 13-49mo) for MCI and 26.85±12.25mo(range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes(90.0%) in the MCI group compared with 10 of 20 eyes(50%) in the PMCI group(P =0.01). In the PMCI group, the tube loss(30%)was greater than the MCI group(5%), however the differences between the 2 groups proved to be not significant(P =0.91).CONCLUSION: Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.

Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction

AIM：To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing.METHODS： This retrospective study was performed on338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing.Intubation was performed under light sedation in operating room and the stent was left 3mo in place.Clinical outcome was investigated 3mo after tube removal.RESULTS： Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation（P =0.00）.In addition,Monoka intubation had better outcomes compared to Masterka technique（P =0.046）.No difference was found between genders but the higher the age,the better the outcomes with bicanalicular technique rather than monocanalicular.CONCLUSION： Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages.Also,based upon our clinical outcomes,Masterka intubation is not recommended in cases of failed probing.

Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction：5-year follow-up

AIM：To evaluate the long-term sucess rate of laserassisted dacryocystorhinostomy （L-DCR） in patients with nasolacrimal duct obstruction （NDO）.METHODS：Forty-one eyes of forty patients aged between 21-85y （mean 56.7y） who underwent L-DCR for the treatment of NDO were included in this retrospective,non-randomized study. The follow-up time was 72mo.Functional sucess was defined as the disappearance of epiphora under normal conditions and the presence of a patent ostium on lacrimal irrigation. Anatomical success was defined as a patent lacrimal passage on syringing besides continuing epiphora. Surgical failure was defined as persistent epiphora and closed ostium.RESULTS：Twenty-seven of 40 patients （67.5%） were female and 13 of 40 patients （32.5%） were male. The NDO was right-sided in 17 （42.5%） patients and left-sided in 22（55%） patients whereas 1 （2.5%） patient had undergone bilateral surgery. In 11 （27.5%） patients there were additional nasal abnormalities requiring simultaneous surgical approach. The average time for L-DCR was 26.50±4.9min（16-39min） and the average total amount of laser energy used was 287±27.9 J （239-367 J）. At the 5y follow-up, anatomical sucess rate was 75.0%（30 patients） and functional success rate was 65.0%（26 patients）, whereas surgical failure was seen in 25%（10 patients）. Revision of surgery was performed in 10 cases （25.0%）; failure of revision surgery was seen in 2 cases（5.0%）.CONCLUSION： Transcanalicular L-DCR is a reliable and fast procedure in the treatment of NDO. It can be alternative to external DCR which is accepted as the gold standard currently. The functional and anatomical success rate is higher in the first months and years, but still satisfactory at fifth year.

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.

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.

Computed tomography imaging features for amyloid dacryolith in the nasolacrimal excretory system:A case report

BACKGROUND Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint,and it may derive from amyloidosis in rare cases.There are a few reports about localized amyloidosis,and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare.CASE SUMMARY A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year.Physical examination touched a firm lump in the left lacrimal sac.Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus.Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct.During an endoscopic exploration and excision,a large number of dacryoliths were exposed.Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.CONCLUSION This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction.In clinical practice,we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.

Cosmetic evaluation of surgical scars after external dacryocystorhinostomy

AIM： To evaluate the surgical scars of external dacryocystorhinostomy （DCR） cosmetically. METHODS： Totally 50 consecutive cases of primary acquired nasolacrimal duct obstruction （PANDO） were included in the study. Surgical scars were assessed by the patients and two independent observers at 2, 6 and 12wk postoperatively on the basis of visibility of the scars and still photographs respectively and were graded from 0-3. Kappa test was utilised to check the agreement of scar grading between the two observers. Wilcoxan signed ranks test was used to analyse the improvement of scar grading.RESULTS： Thirty-four （68%） patients graded their incision site as very visible （grade 3） at 2wk. At 6 and 12wk, incision site was observed as grade 3 by 7 （14%） and 1 （2%） patients respectively. Photographic evaluation of patients by 2 observers showed an average score of 2.75, 1.94 and 0.94 at 2, 6 and 12wk respectively. Change in scar grading from grade 3 to grade 0 in consecutive follow-up （2, 6 and 12wk） was found to be highly significant both for the patient as well for the observers （P〈0.0001）.CONCLUSION： The external DCR is a highly effective and safe procedure and in view of low percentage of cases who complained of marked scarring in the present study, thus scarring should not be the main ground for deciding the approach to DCR surgery, even in young cosmetically conscious patients.

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.

Comparison of Hasner valvulotomy outcomes in pediatric and adult patients: does age matter?

Background:Hasner valve incision has been recently introduced as a new treatment for ophthalmic patients with epiphora symptoms. The aim of this study was to examine whether surgical outcomes of Hasner valve incision for inferior nasolacrimal duct obstruction were different between pediatric and adult patients.Methods:A total of 53 eyes of 52 patients who underwent Hasner valve incision in the Beijing Tongren Hospital from October 2016 to November 2019 were retrospectively observed. Patients were divided into two groups, including pediatric group (23 eyes of 22 patients, <18 years old) and adult group (30 eyes of 30 patients, ≥18 years old). Success rate of surgery was determined by both subjective measure (complete resolution of epiphora) and objective measure (lacrimal passage irrigation and tear meniscus height). Fisher exact test was conducted.Results:By conducting Fisher exact test and comparing complete resolution of epiphora ( P = 0.627), lacrimal passage irrigation ( P = 0.663), measurement of Tear Meniscus Height ( P = 0.561), and appearance of complication ( P = 0.339), there was no statistically significant difference of surgical outcomes between pediatric and adult patients ( P > 0.05). Conclusion:Hasner valve incision was effective for both adult and children with inferior nasolacrimal duct obstruction, with no difference in surgical outcomes between the two groups.