scholarly journals Objective and subjective outcomes following external dacryocystorhinostomy and inferior tear duct stenting in patients with acquired lacrimal drainage system obstruction

2021 ◽  
Author(s):  
Julia Prinz ◽  
Niklas Plange ◽  
David Kuerten ◽  
Hannah Schellhase ◽  
Antonis Koutsonas ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Drainage System ◽  
Objective Evaluation ◽  
Symptom Improvement ◽  
Success Rates ◽  
Subjective Success ◽  
Clinical Scoring ◽  
External Dacryocystorhinostomy ◽  
Subjective Outcomes ◽  
Time Point

Abstract Background: We compared objective and subjective outcomes of dacryocystorhinostomy (DCR) vs. inferior tear duct stenting (stenting) in acquired infrasaccal stenosis.Methods: In this retrospective study 114 eyes of 100 patients who underwent 50 DCRs and 64 stentings between August 2009 and September 2018 were evaluated. Subjective success was quantified by interviewing the patients (complete, some or no improvement) at 10 days, 3 months and 17.2±17.2 months postoperatively. Success was objectified by postoperative clinical examinations at 10 days, 3 months and 9.3±7.8 months postoperatively and clinical scoring. Complete improvement was defined as complete success. Complete and some improvement was considered qualified success. Intra- and postoperative complications were evaluated.Results: At the last time point, DCR (78.0%) had significantly higher complete subjective success rates than stenting (59.4%, p=0.044). Qualified subjective success rates were comparable (DCR 88.0% vs. stenting 76.6%, p=0.147). DCR (76.0%) had significantly higher complete objective success rates than stenting (51.6%, p=0.006) and similar qualified objective success rates (88.0% vs. 75.0%, p=0.097).There were no significant differences between subjective and objective success rates at any time point (p=0.125-1.0). At the last time point, patients with the stent left in place for at least 4 months had significantly higher objective qualified success rates (92.7%) than those who had the stent removed (43.5%, p<0.001; mean removal interval 2.9±1.0 months). The stent-in-place group had comparable complete (obj. p=0.067, subj. p=0.344) and qualified (obj. p=0.506, subj. p=0.556) success rates to DCR at the last time point, while the stent-removal group performed worse (complete: obj. p=0.007, subj. p=0.031; qualified: obj. p=0.002; subj. p<0.001). No major intra- or postoperative complications occurred.Conclusion: DCR lead to high subjective and objective success rates. Stenting can be a minimally invasive alternative to DCR, particularly when the stent remains in place. Subjective and objective evaluation of symptom improvement showed high agreement.

scholarly journals Comparison of Modifications in Flap Anastomosis Patterns and Skin Incision Types for External Dacryocystorhinostomy: Anterior-Only Flap Anastomosis with W Skin Incision versus Anterior and Posterior Flap Anastomosis with Linear Skin Incision

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Burcu Dirim ◽  
Selam Yekta Sendul ◽  
Mehmet Demir ◽  
Erdem Ergen ◽  
Zeynep Acar ◽  
...  
Keyword(s):  
Drainage System ◽  
Skin Incision ◽  
Success Rates ◽  
Posterior Flap ◽  
Assessment Scores ◽  
Scar Assessment ◽  
Significant Difference ◽  
Group A ◽  
External Dacryocystorhinostomy ◽  
Group B

Purpose. To compare the outcomes of external dacryocystorhinostomy (E-DCR) by using two different flap anastomosis patterns and skin incision types.Methods. This study included 79 patients (88 eyes) with lacrimal drainage system disorders who underwent E-DCR surgery. Fifty eyes of 44 patients (group A) underwent E-DCR by suturing anterior and posterior flaps (H-flap) of the lacrimal sac with curvilinear skin incision whereas in 38 eyes of 35 patients (group B) DCR was performed by suturing only anterior flaps (U-flap) with W skin incision.Results. The success rate was evaluated according to lacrimal patency and scar assessment scores. Patency was achieved in 78 patients (88.6%). In terms of groups, patency was 44 eyes (88.0%) in group A and 34 eyes (89.5%) in group B. There was no statistically significant difference in the success rates of lacrimal patency between the two groups. Further, there was no statistically significant difference concerning cutaneous scar scores.Conclusion. Our study suggests that anastomoses of only anterior flaps or both anterior and posterior flaps have similar success rates; suturing only anterior flaps is easier to perform and shortens the operative time. In addition, W skin incision is a reasonable alternative to curvilinear incision for reducing scar formation.

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     

Opening a dacryocystorhinostomy into the opposite nasal cavity in a case of hemiarhinia

2022 ◽  
Vol 15 (1) ◽  
pp. e245424
Author(s):  
Rachna Meel ◽  
Asha Samdani ◽  
Sahil Agrawal ◽  
Deepsekhar Das
Keyword(s):  
Congenital Anomaly ◽  
Nasal Cavity ◽  
Surgical Approach ◽  
Drainage System ◽  
Corneal Opacity ◽  
Maxillary Hypoplasia ◽  
Rare Congenital Anomaly ◽  
Lacrimal Drainage System ◽  
External Dacryocystorhinostomy ◽  
Lacrimal Drainage

Heminasal agenesis is an exceedingly rare congenital anomaly which is frequently associated with disorders of eye, lacrimal drainage system and face. At times, a proboscis may also be noted with this condition. Herein, we present a case of a 13-year-old boy who presented to us with heminasal agenesis with concomitant microphthalmos, leucomatous corneal opacity, blepharoptosis, dacryocystocoele and maxillary hypoplasia. The child underwent a modified transeptal external dacryocystorhinostomy with placement of a lacrimal stent. There was significant improvement of epiphora and discharged following surgery. Heminasal aplasia with dacryocystocoele is surgical challenge; however, a well thought out surgical approach can yield satisfactory outcomes.

scholarly journals External Dacryocystorhinostomy with Intubation in Shrunken Fibrotic Sac in Chronic Dacryocystitis

2020 ◽  
Vol 36 (2) ◽  
Author(s):  
Erum Shahid ◽  
Asad Raza Jafri ◽  
Uzma Fasih ◽  
Arshad Shaikh
Keyword(s):  
Postoperative Complications ◽  
Nasal Bone ◽  
P Value ◽  
Intraoperative Bleeding ◽  
Document Frequency ◽  
Chronic Dacryocystitis ◽  
Quasi Experimental ◽  
Secondary Objective ◽  
External Dacryocystorhinostomy ◽  
Cross Tabulation

Purpose:  To assess anatomical success rate of external dacryocystorhinostomy (DCR) with intubation in long standing chronic dacryocystitis with shrunken fibrotic sac. Secondary objective was to document frequency of intraoperative and postoperative complications of external DCR in such cases. Study Design:  Quasi experimental study. Place and Duration of Study: Ophthalmology department, Abbasi Shaheed Hospital, Karachi from January 2015 to December 2017. Material and Methods:  Patients with chronic dacryocystitis for 2 years or more, 18 to 60 years old, repeated acute attacks twice or more in past 1 year and fibrotic sacs were included. Canaliculitis, canalicular blocks, punctal agenesis and enlarged sacs were excluded. Surgeries were carried out under general anaesthesia. Fibrotic lacrimal sac was identified and excised, ostium was created in nasal bone and bi canalicular intubation was done. Surgery was labeled successful if patency of the pathway was achieved by syringing at 6 month postoperatively. Results:  There were 82 patients, with 59 (72%) females. Mean ages were 32 ± 10.3 years. Left eye was seen in 44 (53.7%) patients. Surgery was successful in 61 (74.3%) patients. Intraoperative bleeding occurred 8 (9.8%) and lacrimal crest was difficult to locate in 6 (7.3%) cases. Postoperatively wound infection and ecchymosis was seen in 8 (9.8%) patients, cheese wiring in 5 (6.1%) and fistula was seen in 2 (2.4%) patients. Cross tabulation was done between gender and successful dacryocystorhinostomy which was statistically not significant (p value 0.71). Conclusion:  Dacryocystorhinostomy with intubation has good surgical outcome in long standing chronic dacryocystitis with fibrosed sacs. It has few Intraoperative and postoperative complications but they are manageable.

scholarly journals A retrospective study analysis of success rate following endonasal dacryocystorhinostomy with stents

2019 ◽  
Vol 5 (3) ◽  
pp. 568
Author(s):  
Ritesh Mahajan ◽  
T. M. Nagaraj
Keyword(s):  
Success Rate ◽  
Revision Surgery ◽  
Objective Evaluation ◽  
Subjective Assessment ◽  
Nasolacrimal Duct ◽  
Success Rates ◽  
Endoscopic Endonasal ◽  
Persistent Symptoms ◽  
Primary Surgery ◽  
Single Centre Study

<p class="abstract"><strong>Background:</strong> Endoscopic endonasal dacryocystorhinostomy (EN DCR) has now become a procedure of choice for nasolacrimal duct obstruction or in chronic dacryocystitis. Lots of debate is still going on regarding stent placement following surgery. The purpose of this study is to analyse the subjective and objective success following EN DCR with stents.</p><p class="abstract"><strong>Methods:</strong> In this single centre study, 30 patients underwent EN DCR surgery from May 2011 to March 2013, out of those 20 eligible patients with 26 nasolacrimal duct obstructions underwent EN DCR with stents, and they were included in the study. Success rates were determined with subjective assessment of the patient symptoms and objective evaluation by lacrimal syringing.  </p><p class="abstract"><strong>Results:</strong> 80.7% patients underwent primary surgery and 19.2% patient’s revision surgery, overall success rates was 88.4% out of which 95.2% success rate for primary surgery and 60% success rates of revision surgery. 11.5% of patients complained of persistent symptoms and success rate of ENDCR with stents was observed in 95.2% of patients after primary surgery and in 60% of patient’s after revision surgery. Stent removal was done on 4-6 weeks (mean duration- 5 weeks) and patients follow up time was 6 months.</p><p class="abstract"><strong>Conclusions:</strong> Whether to stent or to not still remain a topic of debate in EN DCR surgery, however ENDCR with stents represents the procedure of choice for treating nasolacrimal duct obstructions.</p>

scholarly journals A Novel Clinical Scoring Model for Interventional Therapy in Chronic Total Occlusion of the Coronary Artery

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Bin Xiao ◽  
Lang Hong ◽  
Xinyong Cai ◽  
Hongmin Zhu ◽  
Bin Li ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Rapid Development ◽  
Area Under The Curve ◽  
Interventional Therapy ◽  
Success Rates ◽  
Clinical Value ◽  
Total Occlusion ◽  
Scoring Model ◽  
Clinical Scoring

Objective. With the rapid development of technology and experience, the current percutaneous coronary intervention of chronic total occlusion (CTO-PCI) preoperative scoring model needs to be updated. This study aimed to evaluate the clinical value of the operator-CTO score in predicting the outcome of interventional therapy for chronic total occlusion of the coronary artery. Methods. The data of 144 lesions in 130 patients with CTO were analyzed prospectively. The CTO procedures were performed by 10 operators with different skills and experiences. Before the procedures, J-CTO, progress, ORA, recharge, and operator-CTO scores were determined. Then, the clinical, imaging, and procedural data of patients in different operator-CTO score groups and between different operators were compared. The final focus was on comparing the predictive ability of each score on the outcome of CTO-PCI. Results. The overall technical and procedural success rates were 90.9% and 88.9%, respectively. A decreasing trend in the technical success of CTO-PCI was observed according to the operator-CTO score hierarchy of “easy (≤2 points), moderate (3 points), difficult (4 points), and extremely difficult (≥5 points)” (99.0%, 87.5%, 53.8%, and 25.0%, respectively). All five scoring models were well calibrated, and the area under the curve (AUC) for the operator-CTO score was 0.901 (95% CI: 0.821–0.982, P < 0.01 ), larger than the AUC for the remaining four scoring models, showing excellent ability to predict technical outcomes. Conclusion. The operator-CTO score is a new clinical scoring tool that can predict the outcome of CTO-PCI and can be used to grade the difficulty of the procedure, with the potential to work well with a broad group of operators.

Vitrectomy in Uveitis

2021 ◽  
pp. 21-26
Keyword(s):  
Postoperative Complications ◽  
Success Rates ◽  
Visual Prognosis ◽  
Visual Results

Nowadays, with the development of modern vitreoretinal microsurgery techniques, indications of vitrectomy in uveitis have expanded significantly and visual results have improved. In selected cases, surgeries performed by suppressing inflammation in the required indications affect the visual prognosis positively. However, it should be kept in mind that anatomical and functional success rates are lower in eyes with uveitis compared to other eyes, and the risk of developing postoperative complications is higher. The purpose of this review is to discuss the role of vitrectomy in the treatment of uveitis.

Caudal Septal Division and Interposition Batten Graft: A Novel Technique to Correct Caudal Septal Deviation in Septoplasty

2019 ◽  
Vol 128 (12) ◽  
pp. 1158-1164 ◽  
Author(s):  
Shin Ae Kim ◽  
Yong Ju Jang
Keyword(s):  
Postoperative Complications ◽  
Nasal Obstruction ◽  
Surgical Outcomes ◽  
Septal Cartilage ◽  
Septal Deviation ◽  
Surgical Approaches ◽  
Symptom Improvement ◽  
Level Of Evidence ◽  
Novel Technique ◽  
Evaluation Scores

Background: Correction of caudal septal deviation is a challenging task that may require multiple surgical approaches. Objective: To introduce a novel technique – caudal septal division and interposition batten graft – and evaluate its surgical outcomes in patients undergoing correction of caudal septal deviation. Method: The surgical procedure includes a division of the deviated caudal L-strut preserved after resection of the deviated quadrangular septal cartilage at the central portion. A batten graft made of septal cartilage or bone is interposed between the cut ends of the caudal L-strut, the upper part of which mobilized toward the more concave side of the nasal cavity, and then sutured. The medical records of 29 patients with caudal septal deviation who underwent septoplasty using caudal L-strut division and interposition batten graft technique between January 2016 and March 2018 were retrospectively reviewed. Patient satisfaction and symptom improvement were evaluated by using the Nasal Obstruction Symptoms Evaluation scores. Endoscopic assessment of deviation correction was performed and postoperative complications were analyzed. Results: Of the 29 patients, 19 (65.5%) answered the telephonic interview. Mean Nasal Obstruction Symptoms Evaluation scores were 62.1 preoperatively and 9.2 postoperatively, exhibiting significant improvement ( P < .001). Satisfaction was rated as much improved in 9 (32.0%) patients, improved in 16 (57.0%), unchanged in 2 (7%), and worse in 1 (4%). Records of endoscopic examinations showed that 26 (82.9%) patients had a straight septum, 4 (11.4%) had improved but persisting caudal deviation, and 2 (5.7%) had no available data. Four patients had postoperative complications: 2 had septal abscesses, 1 had wound dehiscence, and 1 had synechia. All of these complications were managed without persistent problems. Conclusions: Caudal septal division and interposition batten graft can serve as an alternative surgical approach with acceptable surgical outcomes for managing severely deviated caudal septum. Level of evidence: 4

scholarly journals Results of Endoscopic Dacryocystorhinostomy under Local Anesthesia with Minimal Sedation

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Woong Chul Choi ◽  
Ji-Sun Paik ◽  
Sang Hee Doh
Keyword(s):  
Postoperative Pain ◽  
Local Anesthesia ◽  
Patient Questionnaire ◽  
Success Rates ◽  
Nerve Blocks ◽  
Wound Site ◽  
Surgical Success ◽  
Endoscopic Dacryocystorhinostomy ◽  
Pain Scores ◽  
Subjective Success

Purpose. We evaluated the tolerability and efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in patients treated in the leaning position and under local anesthesia with minimal sedation (LAS). Study Design. Questionnaire to determine subjective success of Endo-DCR. Methods. From May 2013 to August 2014, a total of 95 eyes with epiphora presented to the Myoung Eye Plastic Surgery Clinic in Seoul, Korea, and were treated with Endo-DCR under LAS. Three nerve blocks were administered to achieve local anesthesia. Postoperatively, the wound site was packed with Nasopore to control bleeding and promote wound healing. Outcome measures included a patient questionnaire completed on postoperative day 7 to evaluate intraoperative and postoperative pain based on the VAS (0 to 10). Results. Mean intraoperative and postoperative pain scores were 1.03 and 1.64, respectively, for 95 eyes. Of the 95 eyes treated, the patients in 82 eyes (86.31%) reported that they would prefer LAS over GA for a repeat Endo-DCR. The subjective and objective surgical success rates were 90.14% and 95.77%, respectively. Conclusions. Endo-DCR carried out under LAS with the patient in the leaning position is more useful, efficient, and feasible than Endo-DCR performed under GA with the patient in the supine position.

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