Endoscopic endonasal dacryocystorhinostomy vs nasolacrimal duct intubation in pediatric nasolacrimal duct obstruction - a comparative study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Rana Atia ◽  
Magda Samy ◽  
Sheriff Elwan ◽  
Thanaa Helmy ◽  
Ashraf Shaat ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Success Rate ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Endoscopic Endonasal ◽  
Duct Obstruction ◽  
Tube Removal ◽  
Group A ◽  
The Difference ◽  
Group B

Abstract Study design; Pilot randomized controlled study. Objective To compare success rates of endoscopic endonasal dacryocystorhinostomy and nasolacrimal duct intubation in congenital nasolacrimal duct obstruction (NLDO) in a trial to define the superiority of either technique. Patients & Methods Sixty-six eyes of 61 patients were diagnosed as having epiphora and mucopurulent discharge due to congenital NLDO. The patients were randomly divided into two groups; Group A; 33 eyes of 28 patients (treated by probing and silicone intubation only (NLDI)) and Group B; 33 eyes of 33 patients (treated by endoscopic endonasal dacryocystorhinostomy and silicone tube intubation (EDCR). All tubes were removed 6 months after the operation. Results The success rate, defined as complete resolution of clinical symptoms and signs after 6 months of follow up, was 72.7 % in Group A and 81.8% in Group B. Although the success rate was higher in Group B, yet the difference was shown to be statistically nonsignificant. Preoperative symptoms were assessed postoperatively after tube removal. Complete cure had a higher rate of occurrence in Group B than in Group A (27eyes (81.8%) versus 25 eyes of 22 patients (75.8%) respectively). Postoperative positive fluorescein dye disappearance test (FDDT) after tube removal was more in Group B than in Group A (27 eyes (81.8) versus 24 eyes of 21 patients (72.7 %) respectively). In Group A, silicone tubes had to be repositioned due to prolapse in 3 eyes of 3 patients (9.1%) and had to be removed early in 3 eyes of 3 patients (9.1%) due to failure of repositioning. In Group B, silicone tubes did not require early tube extraction before the date of removal in any of the patients. Intraoperative, there was only one case (3.0%) of fat prolapse during EDCR in Group B with no subsequent postoperative complications. Hemostasis did not represent a problem in any of the patients. Postoperative complications occurred more in Group B than Group A (21 eyes (63.6%) versus 13 eyes of 13 patients (39.4 %) respectively). Late complications occurred more in Group B than Group A (18 eyes (54.5%) versus 12 eyes of 12 patients (36.4%) respectively) in the form of persistent epiphora and tube prolapse. Conclusion The success rate of pediatric EDCR was higher than that of pediatric NLDI. The difference was statistically non-significant. Complications were comparable between the two groups. The study, being pilot in its comparative aspect between endoscopy and intubation, opens the horizon for further study on a larger group that probably will expand this difference.

scholarly journals Success Rate of Probing for Congenital Nasolacrimal Duct Obstruction in Children

Folia Medica ◽  
2019 ◽  
Vol 61 (1) ◽  
pp. 97-103 ◽  
Author(s):  
Krasina P. Valcheva ◽  
Snezhana V. Murgova ◽  
Emilia K. Krivoshiiska
Keyword(s):  
Success Rate ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Cure Rate ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
History Of ◽  
Group A ◽  
Group B

Abstract Aim: To determine the success rate of initial and repeated probing for congenital nasolacrimal duct obstruction (CNLDO) in children between 2-41 months. Patients and methods: One hundred and twelve children aged 1.8 to 13 years responded to the control examination. They were diagnosed with CNLDO in the past and now included in a retrospective study. The mean follow-up period was 5.2 years (from 0.6 to 11.6 years). Patients were divided into two groups according to their age at the time of surgery: group A (2-12 months) and group B (13-41 months). Probing and irrigation of NLD was performed in the Eye Clinic in Pleven under general anesthesia in all subjects. A controlled examination was done to evaluate the effect of probing on the basis of a history of watery eyes, regurgitation test, and dye disappearance test (DTT). Results: Of the 131 eyes in 112 children, 110 eyes (84%) had one probing and 21 eyes (16%) had repeat probing. Success rate of the initial probing was 90% (99 of 110) for all patients’ eyes: 89% (70 of 79) in group A and 94% (29 of 31) in group B. The cure rate of the repeat probing was 76% (16 of 21) for all patients: 88% (7 of 8) in group A and 69% (9 of 13) in group B. The overall success rate of probing was 88% (115 of 131). Conclusion: Nasolacrimal duct probing followed by irrigation is a commonly performed, highly successful treatment for congenital nasolacrimal duct obstruction in children. The success rate for initial and repeated nasolacrimal duct probing is not affected by age.

scholarly journals Comparison of early versus standard timing for silicone stent removal following External Dacrocystorhinostomy under local anaesthesia

2019 ◽  
Vol 11 (1) ◽  
pp. 24-28
Author(s):  
Ben Limbu ◽  
Hannah S Lyons ◽  
Mohan Krishna Shrestha ◽  
Geoffrey C Tabin ◽  
Rohit Saiju
Keyword(s):  
Success Rate ◽  
Financial Burden ◽  
Controlled Trial ◽  
Nasolacrimal Duct ◽  
Complication Rates ◽  
Tube Removal ◽  
Significant Difference ◽  
Silicone Stent ◽  
Group A ◽  
Group B

Introduction: The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients. Methods: A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups. Results: At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications. Conclusion: Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.

scholarly journals Outcomes of external dacryocystorhinostomy and endoscopic endonasal dacryocystorhinostomy in the management of nasolacrimal duct obstruction

2015 ◽  
Vol 7 (1) ◽  
pp. 39-46 ◽  
Author(s):  
S Duwal ◽  
R Saiju
Keyword(s):  
Success Rate ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Endoscopic Endonasal ◽  
Duct Obstruction ◽  
Dence Interval ◽  
External Dacryocystorhinostomy ◽  
Group 2 ◽  
External Dcr ◽  
Group 1

Introduction: Dacryocystorhinostomy (DCR) is the treatment of choice for nasolacrimal duct obstruction. Although external DCR is regarded as the gold standard, endoscopic DCR is evolving as an equally-effective alternative. Objectives To compare the success rate of treating nasolacrimal duct obstruction by endoscopic endonasal method compared to the conventional DCR surgery.Materials and methods This prospective, comparative, non-randomised study was conducted in 2009 - 2010. Thirty consecutive patients undergoing endoscopic endonasal DCR (Group 1) and 30 consecutive patients undergoing external DCR (Group 2) between July 2009 and September 2010 at the oculoplasty unit of the Tilganga institute of ophthalmology were included in this study. A patent lacrimal passage on syringing and symptomatic improvement at six months after surgery was de¿ned as a successful outcome. The intraoperative and postoperative complications were also compared. Results Our study included 31 eyes of 30 patients in Group 1 and 34 eyes of 30 patients in Group 2. The success rate for endoscopic endonasal dacryocystorhinostomy was 90.3 % (95 % con¿dence interval 80 - 100) and external dacryocystorhinostomy was 94.1 % (95 % con¿dence interval 80 - 100). The difference of surgical success among the two methods was not statistically significant (p = 0.7). The rate of intra-operative and post-operative complications was similar in the two methods (p = 0.5). Conclusion: The short term outcomes and complication rates of endoscopic endonasal dacryocystorhinostomy and external dacryocystorhinostomy were similar.

scholarly journals Comparison of the efficacies of 1.0mm and 1.5mm silicone tubes for the treatment of nasolacrimal duct obstruction

2021 ◽  
Author(s):  
Jutaro Nakamura ◽  
Tomoyuki Kamao ◽  
Arisa Mitani ◽  
Nobuhisa Mizuki ◽  
Atsushi Shiraishi
Keyword(s):  
Recurrence Rate ◽  
Patency Rate ◽  
Large Diameter ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Silicone Tube ◽  
Duct Obstruction ◽  
Tube Removal ◽  
The Difference ◽  
One Year

Abstract Purpose: We compared the difference in postoperative patency rates due to the differences in the diameter of silicone tubes used for bicanalicular intubation for the treatment of nasolacrimal duct obstruction (NLDO). Methods: Patients diagnosed with NLDO at Ehime University Hospital between August 2013 and November 2020 who underwent endoscopic-assisted nasolacrimal duct intubation (ENDI) were included in the study. The patients involved were 130 cases and 157 sides (age 72.6 ± 11.3 years) who were eligible for follow-up for more than six months after the removal of the lacrimal silicone tube. The postoperative recurrence rate was compared retrospectively based on the difference in tube caliber. The patients were divided into two groups: those intubated with a 1.5-mm large diameter tube (Group LD) and those with a 1.0-mm normal diameter tube (Group ND). The survival rates of the two groups at one year after tube removal were compared by Kaplan-Meier's curve and Restricted mean survival time (RMST) method with τ = 365 days. Results: There were no significant differences in age, gender, or observation period after tube removal between the two groups. Meanwhile, the preoperative occlusion period was significantly longer in the ND group. The recurrence rate after tube removal was significantly lower in the LD group (12 / 85 sides, 14.1%) compared to the ND group (27 / 72 sides, 37.5%) (p = 0.001). The patency rate at one year after removal of the lacrimal tube was 0.857 (0.754-0.919) in the LD group and 0.739 (0.617-0.828) in the ND group. In comparing patency rates by the RMST method at τ = 365 days, the RMST difference, RMST ratio, and RMTL ratio were significantly higher in the LD group at p = 0.045, 0.052, and 0.046, respectively. Conclusion: Regarding the bicanalicular silicone tube intubation, the patency rate at one year after removal was significantly higher in the thicker tubes with a diameter of 1.5 mm compared with that of a diameter of 1.0 mm for the treatment of NLDO.

scholarly journals A Comparative Study of Endoscopic Endonasal Dacryocystorhinostomy with and without Intraoperative Mitomycin-C Application

2013 ◽  
Vol 6 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Raman Wadhera ◽  
Sat Paul Gulati ◽  
Ashok Kumar Khurana ◽  
Harikesh Sharma ◽  
Vijay Kalra ◽  
...  
Keyword(s):  
Comparative Study ◽  
Success Rate ◽  
Mitomycin C ◽  
Nasolacrimal Duct ◽  
Complete Relief ◽  
Tertiary Referral Hospital ◽  
Endoscopic Endonasal ◽  
Group A ◽  
Endonasal Dcr ◽  
Group B

ABSTRACT Aim To evaluate the role of intraoperative mitomycin-C application in primary endoscopic endonasal dacryocystorhinostomy (DCR) and compare the results with conventional endoscopic endonasal DCR. Study design Prospective comparative interventional study. Setting Tertiary referral hospital. Materials and methods Fifty patients in the age group of 16 to 50 years presenting with symptoms and signs suggestive of nasolacrimal duct blockage refractory to conventional medical treatment were included in the study. They were assigned randomly into two groups of 25 patients each. Group A patients underwent endoscopic endonasal DCR followed by application of mitomycin-C. Group B patients underwent endoscopic endonasal DCR without application of mitomycin-C. The two groups were compared with regard to success rate and complications. The main outcome measures for success were the resolution of epiphora and patency with lacrimal irrigation. Results After 1 year, 24 patients (96%) in each group had complete relief from their symptoms while one patient (4%) had no relief. Syringing was patent in 24 patients (96%) in each group and blocked in one patient (4%) after 1 year of surgery. Conclusion The present study did not show any additional benefit of using mitomycin-C at the stoma site after primary endoscopic endonasal DCR in terms of success rate. How to cite this article Wadhera R, Gulati SP, Khurana AK, Sharma H, Kalra V, Ghai A. A Comparative Study of Endoscopic Endonasal Dacryocystorhinostomy with and without Intraoperative Mitomycin-C Application. Clin Rhinol An Int J 2013;6(1):5-9.

scholarly journals Use of Oil as a Lubricant makes Lacrimal Sac Massage Efficient in Congenital NasoLacrimal Duct Obstruction (CNLDO)

2014 ◽  
Vol 1 (1) ◽  
pp. 13
Author(s):  
Prachi Pawar ◽  
Aruna Patil ◽  
Mihir Patel ◽  
Saurabh Shah
Keyword(s):  
Specific Treatment ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Cure Rate ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Significant Difference ◽  
Group A ◽  
Group B

<strong>Introduction:</strong> Congenital NasoLacrimal Duct Obstruction (CNLDO) is a frequent entity in the paediatric age. CNLDO has a 20% to 30% incidence rate out of which only 1% to 6% become symptomatic.<sup>1</sup> The 4% of premature infants are affected with CNLDO.<sup>2</sup> The management of failed Crigler's Sac massage is probing, secondary probing, external DCR and with or without intubation is well known to all. To avoid the sequelae of CNLDO, cure of CNLDO is mandatory. Hence the aim of the study is primary cure for CNLDO by using specific treatment of Crigler's Sac massage with Oil is emphasised. <strong>Method:</strong> This study was about 140 eyes and in each group, 70 eyes were enrolled with lost to follow up considerations. Patients had been selected and randomised alternatively when visited ophthalmology OPD. The CNLDO patients were selected from the age group ranged 1 to 9 months. Follow up of all patients was taken every month up to 15 months of age. Each and every patient from both the groups had to complete the formality of clinical consultation, doctors counselling to parents specially mothers explaining the procedure of sac massage and taking a live demonstration by mother/ parent hence confirming the proper technique to be followed at home. <strong>Results:</strong> In group A, Standard Crigler's Method was used only on 54 eyes out of enrolment of 70 eyes. In group B, Standard Method with add on therapy of oil massage had been given to 66 eyes out of 70. In group B, cure rate was found in 60(91%) which was significantly differing from the cure rate of group A 30(56%) by Standard Crigler's Method at P&lt;0.001. Complications were found in 20 eyes in group A and in group B only one patient showed complication unrelated to the treatment of CNLDO used by the patients in this group. No significant difference was seen in the sex distribution in relation to CNLDO at P&gt;0.05. <strong>Conclusion:</strong> The primary need of Crigler's Sac Massage using Oil has given the importance towards good compliance and success of curing CNLDO.

scholarly journals Use of Triamcinolone Acetonide in External Dacryocystorhinostomy

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Qirat Qurban ◽  
Zeeshan Kamil ◽  
Khalid Mahmood
Keyword(s):  
Success Rate ◽  
Triamcinolone Acetonide ◽  
Nasolacrimal Duct ◽  
Quasi Experimental ◽  
Group A ◽  
Silicone Intubation ◽  
External Dacryocystorhinostomy ◽  
The Difference ◽  
Group B ◽  
External Wound

Purpose:  To study the effect of Triamcinolone Acetonide injection into the ostium through the external wound after one week of external Dacryocystorhinostomy. Study Design:  Quasi experimental study. Place and Duration of Study:  Khalid Eye Clinic, Karachi, from July 2018 to June 2019. Methods:  This study included forty patients with age ranging between 18 to 36 years. All patients had obstruction of the nasolacrimal duct. Patients were categorized into two groups. Both groups underwent external dacryocystorhinostomy with silicone intubation, with the difference being that patients in group A were injected with 20 units of Triamcinolone acetonide 40 mg/ml into the ostium through wound using 27 gauge needle, one week after the surgery. Group B did not receive any injection. Both groups were followed for a period of four months, at which time the silicone tube was removed and patency of lacrimal system was ascertained via syringing with balanced salt solution through the lacrimal puncta. Main outcome measure was the success rate of procedure. Results:  The mean age of the patients was 27.1 ± 5.48 years. Success rate was 100% among the patients of group A and 85% in the patients of group B at the end of the four months followup period. However, the results were statistically insignificant (p = 0.115). Conclusion:  Although statistically insignificant but clinically Triamcinolone Acetonide proved helpful in reducing fibrosis and ostium granuloma formation in patients with Ex-DCR. Thus preventing failure of external Dacryocystorhinostomy. Key Words:  Triamcinolone acetonide, external dacryocystorhinostomy, DCR.

scholarly journals Non endoscopic endonasal dacryocystorhinostomy versus external dacryocystorhinostomy

1970 ◽  
Vol 6 (4) ◽  
pp. 437-442 ◽  
Author(s):  
BR Sharma
Keyword(s):  
Direct Method ◽  
Case Series ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Successful Outcome ◽  
Success Rates ◽  
Endoscopic Endonasal ◽  
Duct Obstruction ◽  
Surgical Success ◽  
External Dacryocystorhinostomy

Aims and Objectives: To compare the success rates of non endoscopic endonasal dacryocystorhinostomy and conventional external dacryocystorhinostomy for the surgical management of primary acquired nasolacrimal duct obstruction. Materials and methods: A retrospective, nonrandomized, comparative interventional case series of 302 patients who underwent either endonasal or external dacryocystorhinostomy over a period of 2 years. All surgeries were performed by a single surgeon and patients with primary nasolacrimal duct obstruction with a minimum of 6 months post operative follow up were included in the study. While external dacryocystorhinostomy was performed using traditional technique, endonasal dacryocystorhinostomy was performed using direct method of nonendoscopic visualization. Results: Of the 302 cases included in the study 165 patients had endonasal dacryocystorhinostomy whereas 137 underwent external dacryocystorhinostomy. Success was defined by resolution of symptoms of tearing, a negative fluorescein dye disappearance test and patency of the canalicular system on lacrimal irrigation. In the external dacryocystorhinostomy group 124 (90.5%) patients had surgical success whereas 146 (88.5%) of the endonasal dacryocystorhinostomy patients had successful outcome. The overall success rate was 89.4%, and the difference of surgical success between the two groups was not statistically significant ( P=0.57). Conclusion: Non endoscopic endonasal dacryocystorhinostomy gives surgical results comparable to those of external dacryocystorhinostomy and is a viable alternative where dacryocystorhinostomy is indicated for primary acquired nasolacrimal duct obstruction. Key words: Endonasal Dacryocystorhinostomy (ENDCR), External Dacryocystorhinostomy (EXDCR), Primary acquired nasolacrimal duct obstruction (PANLDO)   doi: 10.3126/kumj.v6i4.1731  Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 437-442     

scholarly journals External dacryocystorhinostomy

2019 ◽  
Vol 16 (3) ◽  
pp. 179-185
Author(s):  
Li Ying Long ◽  
Safinaz Mohd Khialdin ◽  
Nazila Binti Ahmad Azli
Keyword(s):  
Surgical Technique ◽  
Success Rate ◽  
Case Series ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Retrospective Case ◽  
Duct Obstruction ◽  
Posterior Flap ◽  
External Dacryocystorhinostomy ◽  
External Dcr

Aim: To analyse the epidemiological data, surgical technique, success rate, and complications of patients who underwent external DCR in Hospital Selayang from January 2015 to December 2016. Method: Retrospective case series. Results: A total of 21 eyes of 20 patients who underwent external DCR from January 2015 to December 2016 were identified and reviewed. There were 15 females (75%) and 5 males (25%). Age ranged from 5 to 75 years old, with a median age of 56 years old (IQR 23). Twelve patients presented with epiphora while eight patients presented with symptoms of dacryocystitis. One case was congenital, two were secondary nasolacrimal duct obstruction and the rest were primary nasolacrimal duct obstruction. All patients underwent external DCR under general anaesthesia. Silicone tube were inserted in 21 eyes, of which all were removed 3 months after the surgery except one patient whom had his tube dislodged accidentally. The overall success rate was 90.5% (n = 19), which was defined as no or minimal intermittent epiphora or no reflux on lacrimal irrigation at 12 months postoperative. There was one patient who had a cerebrospinal fluid leak treated successfully with intravenous antibiotics. Conclusion: The surgical success rate for external dacryocystorhinostomy was comparable to that of the global success rate of external DCR. This is attributed to the application of surgical technique such as anterior suspended flap modification and posterior flap excision.

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