Endoscopic Dacryocystorhinostomy With Ologen Implant

Objective: To compare the effectiveness of endoscopic dacryocystorhinostomy with ologen implant versus endoscopic dacryocystorhinostomy with silicon tube implantation.Background: Chronic dacryocystitis is an inflammatory disorder of the lacrimal sac that is mostly accompanied by partial or total nasolacrimal duct obstruction. Watering and discharge are the most common symptoms, however some cases can escalate to serious ocular and extraocular complications. It can result in severe ocular morbidity and loss of productivity at work, as it can temporarily obscure vision, prevent a person from concentrating on their task, and be socially uncomfortable. The goal of this research is to find a way to reduce recurrence after DCR surgery.Methods: We conducted a prospective controlled study to evaluate effectiveness of endoscopic dacryocystorhinostomy with ologen implant versus endoscopic dacryocystorhinostomy with silicon tube implantation. A total of 40 patients underwent primary endoscopic DCR surgery in Menoufia University Hospital from march 2020 till march 2021. A total of 20 cases did endoscopic DCR using ologen implant (group A) and the other 20 cases did endoscopic DCR using silicon tube (group B). Results: The success rate, which was evaluated by MUNK score and syringing test, was compared between both groups also rate of complications like epistaxis, implant complications and post surgery synechiae was compared. Success rates was 75% in ologen group and 85%in the other group. Epistaxis, infection and post sugery synechiae were statistically in significant between the two groups but implant complications was more in ologen group than the other group.Conclusion: Endoscopic DCR with ologen implantation is not superior to endoscopic DCR with silicon stenting due to the challenging ologen implantation procedure and the high cost relative to silicon stenting.

A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy: Scopy-Guided Approach

PurposeTo compare and assess classic endoscopic dacryocystorhinostomy (cEDCR) and scopy-guided endoscopic dacryocystorhinostomy (sEDCR) which is a new approach we developed in cases of primary nasolacrimal duct obstruction (PNLDO).MethodsFifty eyes (7 in both eyes) of 43 patients who applied with epiphora and underwent endoscopic DCR and silicone tube implantation between 2015 and 2019 were prospectively studied. cEDCR was performed on 26 of 50 eyes, and sEDCR was performed on 24 of 50 eyes. In sEDCR application, 5 cc non-ionizing opaque material was injected after punctum dilatation, lateral oblique radiographs were taken from the obstructed side with C-arm scope, and the size and location of the lacrimal sac were made visible. Thence, the most appropriate part of the passage was visualized, and surgical intervention was made through this point. Patients were followed in day 1, week 1, 3rd and 6rd mounth. Functional success was assessed according to Munk scoring, and anatomic success was assessed with nasolacrimal lavage. Two groups were compared according to surgical success, time, and complications.ResultsMean age of the cases were 47.85 (±11.8) in the cEDCR group and 54.29 (±16.23) in the sEDCR group. Female and male gender distribution was 21 (80.8%) - 5 (19.2%) for cEDCR and 15 (62.5%) - 8 (37.5%) for sEDCR, respectively. Functional success was spotted as 92.3% in the cEDCR group and 95.8% in the sEDCR group (p:1.0); anatomical success was spotted as 88.5% in the cEDCR group, and 95.8% in the sEDCR group (p:0,611). There was no significant difference between two groups. Mean surgery time was 43 minutes in the cEDCR group and 48 minutes in the EDCR group. Complications were minor and rare (p >0.05). ConclusionAs we are aware of that, our study is the first in literature in which scopy is used in endoscopic DCR. In our study, the sEDCR approach is assessed as a useful modification which improves success and facilitates surgery.

The importance of clinical presentation on long-term outcomes of external dacryocystorhinostomies: Our experience on 245 cases

Purpose External dacryocystorhinostomy (EXT-DCR) is a surgical approach commonly used to treat post-canalicular acquired lacrimal obstruction whose success rate has been described, equally with endoscopic DCR, to be superior to other available treatments. Methods At San Raffaele Hospital, Milan (Italy), from January 2008 to December 2020, 245 EXT-DCRs were performed. All patients underwent routine pre-operative work-up including Jones tests and probing and irrigation of the lacrimal pathway; when necessary, a multidisciplinary approach with nasal endoscopy was performed. The surgical approach was followed by positioning of a bicanalicular stent which was left in place for 6 months. Success was defined as resolution of clinical signs/symptoms and free lacrimal flow on functional test. Results Of the cases enrolled, 26.9% were treated for recurrent epiphora (group 1), and 73.1% for epiphora associated with chronic dacryocystitis (group 2). After a median follow-up of 71 months, group 1 had success at T0 (1 month) and T1 (long-term) of 81.8% and 60.6%, respectively, compared to 93.8% and 77.7% in group 2. Statistical analysis showed a significant association with surgery both at T0 ( p = 0.018) and T1 ( p = 0.012) with group 2 showing better outcomes. Additionally, the cosmetic outcome of the external scar was defined as invisible in 91.8% of cases and slightly visible in 8.2%. Conclusions External dacryocystorhinostomy provides long-term reliable results particularly in case of chronic dacryocystitis. Moreover, the optimal esthetic outcome of the external scar should be no longer considered the only guiding principle of treatment modality, particularly in the elderly.

Possibility of Pseudo-Obstruction in Lacrimal Canalicular Obstruction Diagnosed with Dacryocystography

<b><i>Introduction:</i></b> Endoscopic dacryocystorhinostomy (DCR) is the treatment of choice for patients with lacrimal drainage system obstruction. Dacryocystography (DCG) is one of the most common preoperative studies and considered as a useful test demonstrating the anatomy of lacrimal drainage systems. <b><i>Objective:</i></b> This study was designed to evaluate the diagnostic efficacy of DCG for canalicular obstruction and to compare surgical outcomes between true-obstruction versus pseudo-obstruction diagnosed with DCG. <b><i>Methods:</i></b> A retrospective study was performed on 45 consecutive patients with lacrimal canalicular obstruction who had underwent endoscopic DCR with silicone tube insertion from January 2009 to December 2014 at a single tertiary hospital. A review of medical records included demographic data, preoperative symptoms and signs, results of intraoperative canalicular probing, and surgical outcomes including the postoperative symptom improvement and endoscopic finding. <b><i>Results:</i></b> Of 45 patients, 34 patients (75.6%) had true-canalicular obstructions and 11 patients (24.4%) had pseudo-canalicular obstructions. The success rate of endoscopic DCR was 50% (17 of 34) in cases with true-canalicular obstruction while 90.9% (10 of 11) in pseudo-canalicular obstruction (<i>p</i> value &#x3c;0.05). No intraoperative or postoperative complications including sinusitis or synechia were found. <b><i>Conclusions:</i></b> About a quarter of lacrimal canalicular obstruction cases diagnosed with DCG seem to be pseudo-obstruction. The success rate of endoscopic DCR in pseudo-canalicular obstruction is similar to that of saccal and nasolacrimal ductal obstruction.

Post-operative outcomes of endoscopic dacrocystorhinostomy without intubation at holy family hospital, Pakistan.

Objective: This study aims to present the outcomes of the patients who underwent endoscopic dacryocystorhinostomy (DCR) without intubation at a tertiary care hospital. Study Design: Observational Study. Setting: Holy Family Hospital, Rawalpindi, Pakistan. Period: October 2018 to November 2019. Material & Methods: Endoscopic dacryocystorhinostomy operation was performed in a total of 52 patients presenting with chronic epiphora. Silastic tubes were not used to maintain the patency. Patients were prescribed antibiotic eye drops, oral painkillers, decongestant eye drops, and regular nasal douches. Results: Fifty patients (96.2%) presented with successful post-operative outcomes on the 12th week for follow-up. Post-operative canal patency was evaluated by endoscopic examination and syringing. Patients were also evaluated for the presence of epiphora. Conclusion: Our results of 52 patients who underwent endoscopic DCR without stenting are as promising as those with stenting. Hence, the procedure without intubation is recommended.

Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.

Agger nasi mucocele cause nasolacrimal duct obstruction and chronic dacryocystitis: clinical profile, management and outcome

Epiphora is the first symptom of acquired nasolacrimal duct obstruction (NLDO), which may be due to various causes, including paranasal sinuses and tumours of the nasal cavity. A 28-year-old male patient presented chronic dacryocystitis with left-sided epiphora. Endoscopically, a bulging of the lateral nasal wall at the left-sided agger nasi area was noted. Imaging studies (CT and MRI) revealed a left-sided giant agger nasi mucocele. An endonasal endoscopic dacryocystorhinostomy (DCR) as well as opening of the agger nasi cell with mucocele removal and anterior ethmoidectomy was performed. Based on the literature, intranasal causes have very often occurred in patients with chronic dacryocystitis, but not reported as the cause of inflammation in the mucocele of agger nasi. Identification and recognition of this endonasal rare cause of NLDO-like agger nasi mucocele entity may facilitate timely intervention and can be treated successfully with a simultaneous endoscopic DCR procedure.

A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy Scopy-Guided Approach

PurposeTo compare and assess classic endoscopic dacryocystorhinostomy (cEDCR) and scopy-guided endoscopic dacryocystorhinostomy (sEDCR) which is a new approach we developed in cases of primary nasolacrimal duct obstruction (PNLDO).MethodsFifty eyes (7 in both eyes) of 43 patients who applied with epiphora and underwent endoscopic DCR and silicone tube implantation between 2015 and 2019 were prospectively studied. cEDCR was performed on 26 of 50 eyes, and sEDCR was performed on 24 of 50 eyes. In sEDCR application, 5 cc non-ionizing opaque material was injected after punctum dilatation, lateral oblique radiographs were taken from the obstructed side with C-arm scope, and the size and location of the lacrimal sac were made visible. Thence, the most appropriate part of the passage was visualized, and surgical intervention was made through this point. Patients were followed in day 1, week 1, 3rd and 6rd mounth. Functional success was assessed according to Munk scoring, and anatomic success was assessed with nasolacrimal lavage. Two groups were compared according to surgical success, time, and complications.ResultsMean age of the cases were 47.85 (±11.8) in the cEDCR group and 54.29 (±16.23) in the sEDCR group. Female and male gender distribution was 21 (80.8%) - 5 (19.2%) for cEDCR and 15 (62.5%) - 8 (37.5%) for sEDCR, respectively. Functional success was spotted as 92.3% in the cEDCR group and 95.8% in the sEDCR group (p:1.0); anatomical success was spotted as 88.5% in the cEDCR group, and 95.8% in the sEDCR group (p:0,611). There was no significant difference between two groups. Mean surgery time was 43 minutes in the cEDCR group and 48 minutes in the EDCR group. Complications were minor and rare (p >0.05). ConclusionAs we are aware of that, our study is the first in literature in which scopy is used in endoscopic DCR. In our study, the sEDCR approach is assessed as a useful modification which improves success and facilitates surgery.

A comparative study of the results of endoscopic dacryocystorhinostomy with and without stent placement

<p class="abstract"><strong>Background:</strong> Aim and objectives were to evaluate and compare the outcomes of endoscopic dacryocystorhinostomy (DCR) with and without silicone stenting. Surgical success was assessed both subjectively and objectively. </p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted. Total 30 patients with acquired NLD obstruction were enrolled in the study. The patients who underwent the surgery were randomly assigned into two groups: group I: with silicone stent placement, group II: without stent placement. The patients were evaluated in terms of symptoms relief (subjective assessment) and patency of neo-ostium (objective assessment). </p><p class="abstract"><strong>Results:</strong> In our study, success rate for patients with placement of stent was 91.66% and without stenting was 77.77%. Statistical data proved that, there was no significant difference between two groups. Endoscopic DCR with stenting had good long term outcome. It maintains patency and prevents re-closer of neo-ostium. With stenting cases cause of failure was synechiae formation and in without stenting cases causes was infection, granulation formation and stoma closer. So both cases had their own merits and demerits.</p><p class="abstract"><strong>Conclusions:</strong> The endoscopic DCR is minimally invasive and simple procedure. Patient’s discomfort, synechiae, granulations are drawbacks of stenting but stents had given good long term outcome in maintaining patency of neo-ostium. Still data proved, there was no significant difference in both groups. This was due to our small sample size. Regular follow up is necessary for better post-operative outcome and prevention of further complications. So ultimately it is surgeon choice and level of expertise decides use of stent in DCR. </p>

Results of endoscopic endonasal dacryocystorhinostomy: a prospective cohort study

Objective: To evaluate the success rate of endoscopic endonasal Dacryocystorhinostomy Methods: This prospective cohort study was conducted at Ophthalmology and Otorhinolaryngology Department of Shifa Foundation Community Health Centre, Islamabad, Pakistan, from Oct 2017 to Sep 2019. The patients with chronic dacryocystitis who underwent endoscopic endonasal Dacryocystorhinostomy (DCR) were enrolled. Data for demographic information and clinical features (mucocele, deviated nasal septum, epiphora, purulent discharge and regurgitation test, history of acute dacryocystitis and probing and syringing etc.) was noted. Endoscopic DCR with or without lacrimal intubation was performed under general anesthesia. Patients were reviewed at post-operative week1, 1 month, 6 months and 12 months with documentation of epiphora, purulent discharge, need for syringing, nasal adhesions etc. Telephonic interviews were done in cases of missing data. Statistical analysis was done with SPSS 20.0. Results: The study enrolled 47 patients, majority of them were females (87.2%). The mean age of patients was 40.70 ± SD 10.84 yrs, Range 25-66 yrs.. Minimum postoperative follow up period was 12 months; mean duration (14.53 ± 3.0 months). Lacrimal intubation was performed in 31 (66%) patients. Nasal endoscopy was performed and lacrimal tubes were removed after 6 months post operatively. Surgical success was achieved in 46 (97.9%) patients: 37 (78.7 %) patients were completely symptom free, 9 (19.1%) were partially symptomatic and were managed conservatively. Treatment failure requiring repeat surgical procedure was observed in only one patient (2.1%). Continuous...