Endoscopic surgery for inverted papilloma with carcinoma change of lacrimal drainage apparatus and nasal cavity

Dear Sir,Iam Dr.Yin-Hung Chang from the Department of Otolaryngology,Taipei Tzu Chi Hospital,the Buddhist Tzu Chi Medical Foundation.I would like to present a case of inverted papilloma with carcinoma change of lacrimal drainage apparatus and nasal cavity that had been successfully treated by endoscopic surgery.Lacrimal drainage apparatus tumors are rare but important

Acupuncture Treatment for 34 Cases of Epiphora with Dysfunction of Lacrimal Duct

We have treated 34 cases of epiphora due to dysfunction of the lacrimal duct with a warm needle puncturing at the Jingming (UB 1) point. The effect was significantly better than that of the control group treated with lacrimal duct irrigation and norflaxacin eye drops (a total effective rate of 91.07% vs. 54.29%).

TREATMENT OF EPIPHORA DUE TO INSUFFICIENCY OF LACRIMAL PASSAGE BY ACUPUNCTURE AT JINGMING

Since 1995,the authors have employed acupuncture at Jingming(UB 1)with the warmingneedles to treat epiphora due to insufficiency of lacrimal passages.Of the 68 treated eyesin 42 patients,28 eyes were cured,35 improved,and 5 ineffective with a total effective rateof 92.65%;and 12 eyes were cured and 34 improved by only one course of treatment.

Corneal perforation and rare primary adenocarcinoma of the lacrimal gland: A case report

Rationale:Primary adenocarcinoma of the lacrimal gland is rare,and its presentation as corneal perforation is even rarer.Corneal perforation is an ocular emergency that warrants urgent ophthalmic surgery,yet complete staging of lacrimal gland tumor pre-operatively is essential for optimal oncological management.Patient's concerns:A 57-year-old man presented with left eye pain was found to have left eye proptosis and fleshy tissue mass around the eyeball.Uveal tissue was prolapsing over the perforated keratitis cornea,and the eye was full of discharge.Diagnosis:Bedside ultrasound B-scan confirmed vitreous haze,and emergency contrast computed tomography(CT)revealed soft tissue density mass(>40 mm)molding around the left globe and optic nerve without any rim enhancing abscess.Left exogenous endophthalmitis from exposure keratopathy secondary to proptosis caused by the bulky lacrimal tumor located in the confined orbital cone was diagnosed.Interventions:Emergency enucleation surgery of the left eyeball was done for this painful blind eye to control the infection from spreading.Orbital walls were biopsied intra-operatively,and tumor staging was completed by positron emission tomography-CT scan and magnetic resonance imaging.Without evidence of metastasis,left orbital exenteration was followed by adjuvant orbital chemoradiotherapy for the sake of close proximity of resection margin.Outcomes:Left exenterated orbit was fully epithelialized at around 2 months,and there was no recurrence of the disease up to present at the 1 year follow-up.Lessons:Thorough workup on the staging of the disease to minimize the number of operations for oncological patients is always a top priority,yet it may not always be possible as in our case presenting with corneal perforation.

Lacrimal sac lymphoma: a case series and literature review

AIM: To study the clinical and pathological characteristics of the lacrimal sac lymphoma, which is rare but it is the major type of non-epithelial malignant tumor in the lacrimal sac region. METHODS: Sixty-four cases of malignant lacrimal sac tumors in our hospital from 1986 to 2020 were retrospectively reviewed. Eight cases of lacrimal sac lymphoma were carefully reviewed. RESULTS: There were five mucosal-associated lymphoid tissue(MALT) lymphomas, one diffused large B-cell lymphoma, one NK/T cell lymphoma, and one mantle cell lymphoma. All eight patients represented symptoms of epiphora with swelling in the lacrimal sac for a certain period of time and showed no signs of systemic involvement at the first time of clinical visits. They had received either chemotherapy or radiotherapy after surgery. Long-term follow-up(from 11 to 220 mo) showed that, except one patient with MALT lymphoma died for unknown reasons at 104 mo after surgery, the other 7 patients were all alive with no signs of local recurrence, neither in other organs. CONCLUSION: Non-epithelial malignant tumors of the lacrimal sac are rare and lymphoma is the major subtype.

Efficiency and therapeutic effect of modified pigtail probe in anastomosing lacerated lacrimal canaliculus

Objective： To investigate the necessity of modification to the traditional pigtail probe and evaluate its efficiency and therapeutic effect in searching the nasal cut ends and anastomosing the lacerated lacrimal canaliculus. Methods： Eighty-seven patients （including 87 eyes） suffering from canalicular laceration were randomized into two groups： 41 patients treated with traditional pigtail probes （Group A） and 46 with modified pigtail probes （Group B）. During the reconstruction of the lacerated canaliculi, the traditional pigtail probe and the modified pigtail probe were used respectively to seek for the nasal cut ends of lacerated lacrimal canaliculi. Peripherally inserted central catheter （PICCTM） silicone tube with diameter of 0.95 mm was intubated as a stent for 4-6 months. The surgical outcomes were retrospectively analyzed after stent removal. Results： In Group B, the primary success rate of searching the nasal cut ends of lacerated lacrimal canaliculi was 93.48% （43/46） and the final success rate was 97.83% （45/46）. No false passage formed in Group B. Statistical sig- nificance was found between Group A and Group B as the primary success rates of searching the nasal cut ends （ x^2 = 10.522, P〈0.01） and the false passage forming rates were concerned （ x^2=4.704, P〈0.05）, whereas no significance was found between the two groups as the final success rates were concerned （ x^2=0.007, P〉0.05）. The mean time of searching the nasal cut ends of lacerated lacrimal canaliculi in Group B was （5.02±2.73） minutes and the mean time of operation was （33.90±4.84） minutes, and both were significantly shorter than those of Group A （t1=9.779, t2=10.700, P〈0.01）. The cure rate of Group B was 95.65%, though higher than that of Group A, no statistical significance was found （Z=-1.007, P〉0.05）. Totally, 2 patients （2.30%） were found to be absent of common canaliculus and underwent bicanalicular nasal intubation in the two groups. Conclusions： Pigtail probes are efficient and convenient apparatus for searching the nasal cut ends of the lacerated lacrimal canaliculi in the reconstruction of canalicular laceration. Necessary or proper modifications to the pigtail probes can minimize the risk of iatrogenic damages or complications and enhance the efficiency and therapeutic effect of canalicular repair.

Therapeutic effects of two anastomoses of lacrimal passage on canalicular laceration

Objective： To evaluate the therapeutic effects of two anastomoses （canaliculus-to-lacrimal sac anastomosis and end-to-end anastomosis） on nasolacrimal laceration for over 7 mm from the broken end to the dacryon. Methods： A total of 71 patients （44 males and 27 females, aged 16-55 years, mean=34.32 years） with fresh canalicular laceration were treated in our hospital from March 2003 to April 2008. Under a microscope, 37 patients were treated with lacrimal sac anastomosis （the treatment group） and 34 with end-to-end anastomosis （the control group）, detaining silicone tubes till 3 months later. Results： The cure rate of the treatment group （89.19%） was significantly higher than that of the control group （55.56%）. Class I cure rates were 70.27% in the treatment group and 47.06 % in the control group, and the difference between the two groups was significant （P〈0.05）. Postoperative inflammatory reactions had significant influences on the two kinds of anastomosing methods, but no significant difference was found between the two groups （P〉0.05）. Conclusions： When the distance from the broken end to the dacryon is over 7 mm, especially when it is necessary to find the paranasal broken end of the lacrimal canaliculus with dacryocystotomy, canaliculus-to-lacrimal sac anastomosis is a better treatment method than end-to-end anastomosis for laceration of lacrimal canaliculus.

Diagnosis and therapy of lacrimal system diseases by micro lacrimal endoscope

The lacrimal endoscope is applied to the diagnosis and therapy of the disorders of the lacrimal system in combination with laser or micro drills under orthophoria.The changes of mucous membranes,the characteristics of pathological changes and the predilection sites of lacrimal system diseases were initially approached.One hundred and forty six pairs of eyes of 128 patients with lacrimal system disease were observed by the lacrimal endoscope in the Ophthalmology Department of Tongji Hospital from June 2006 to March 2007.The dynamic changes in mucous membranes,lesion sites,secreted substances and formation of membrane could be observed under orthophoria.Combined with laser or micro drill,the endoscope was applied to the therapy of lacrimal system disorders and the difference before and after the treatment was observed.Results are as follows:(1)The examination and therapy using the lacrimal endoscope were completed under topical anesthesia in 122 patients,and 6 patients of neonatorum dacryocystitis were examined and treated under general anaesthesia.All patients reported painless.(2)Sharp images of the lacrimal system were obtained by the endoscope.Normal lacrimal mucosal membrane was smooth and light pink,expanded and unobstructed during irrigation.In chronic dacryocystitis patients,the inhomo-geneous colour of mucosal membranes was red and white,with different degrees offibrotic membranes at the superior,middle and inferior parts of the nasolacrimal canals and secreted substances at sac could be observed.The lacrimal ducts could not be expanded and obstructed during irrigation.The patients with lacrimal system obstruction had different extents of membrane formation,and stenosis or complete obstruction of the lacrimal duct could be observed,and the corresponding mucosal membrane was not smooth which could not be expanded and obstructed during irrigation.(3)After the treatment by the endoscope combined with laser or micro drill,the major proliferation of the membrane disappeared and the lacrimal duct was unobstructed during irrigation.The cure rate and effective rate were 80.1%and 93.1%,respectively.The lacrimal endoscope is a new method in the diagnosis of lacrimal system diseases.Through a combination with laser or micro drill to carry out the therapy under orthophoria,it will bring a great change to the diagnosis and therapy of lacrimal system diseases.

Clinical effects of three types of silicone intubations in repairing lacerations of canaliculus

Objective： To evaluate the clinical effects of onepassage, double-passage and circular canalicular intubations in repairing lacerations of canaliculus. Methods： Atotal of 109 eyes in 109 cases ofcanalicular laceration were repaired with three types of silicone intubations, among which 23 with one-passage canalicular intubation, 51 with double-passage canalicular intubation, and 35 with circular canalicular intubation. The average follow-up period was 12-15 months. Results： The wound/junction of the lacrimal canaliculi was ruptured in 5 cases （9.80%） of the double-passage group, 3 cases （8.57%） of the circular group, and 8 cases （34.78%） of the one-passage group. The rupture incidence of the one-passage group was significantly higher than that of the other two groups （ χ^2=9.416, P〈0.01）. During the inmbation, canaliculitis was observed in 12 cases （23.53%） of the double-passage group, while only 3 cases （8.57%） in the circular group and 8 cases （34.78%） in the one-passage group. The circular group had significantly lower incidence of canaliculitis than the other two groups （ χ^2=6.095, P〈0.05）. After extubation 6 months after laceration repair, the lacrimal passage remained patent with canalicular irrigation in 46 cases （90.20%） in the double-passage group, 30 cases （85.71%） in the circular group and 15 cases （65.22%） in the one-passage group. Six months after surgery, the canalicular patency in the one-passage group was significantly lower than that of the other two groups （ χ^2=7.390, P〈0.05）. Conclusions： Circular canalicular intubation is more stable and has less surgical complications than the doublepassage and one-passage canalicular intubations. It is also more effective clinically 12-15 months after laceration surgery.