scholarly journals Learning Curve in External DCR – A Trainee’s Perspective

2018 ◽  
Vol 9 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Karan Bhatia ◽  
Sabyasachi Sengupta ◽  
Madhu Bhadauria
Keyword(s):  
Learning Curve ◽  
Success Rate ◽  
Uttar Pradesh ◽  
Complication Rates ◽  
Entire Study ◽  
External Dacryocystorhinostomy ◽  
Sac Syringing ◽  
Anatomical Success ◽  
Over Time ◽  
External Dcr

Purpose: The aim of this study is to determine the success rate over time in patients undergoing External Dacryocystorhinostomy (DCR) with acquired naso-lacrimal duct obstruction (NLDO), when done by a trainee ophthalmologist.Methods: The study was Prospective Observational study and was conducted in Tertiary Eye Hospital, Uttar Pradesh, India. One hundred and fourteen consecutive adult patients underwent external DCR for acquired complete NLDO by a trainee with less than 3 years of experience in ophthalmology between November 2011 and March 2013. Postoperative anatomic success rate was determined at 6 months on the basis of the patency of lacrimal sac syringing and patients were asked to subjectively evaluate improvement of their epiphora using a questionnaire.Results: Anatomical success rate across the entire study period was 93.7% and this improved from 87% in the first tertile of 38 patients to 94% in the second tertile and 100% in the final tertile of cases (p<0.05). Overall complication rate was 16.67% and reduced from 29% in the first tertile to 8% in the final tertile (p<0.05). Loss of anterior nasal flap was the commonest complication (10 cases) during the training period.Conclusion: External DCR, as a primary procedure for acquired NLDO, even when operated by trainee ophthalmologists, has a relatively high success rate that improves over time. As the learning curve improves, complication rates reduce significantly. Financial Disclosure: No author has any financial or proprietary interest in the material or method mentioned.

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.

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 Long-Term Outcomes of External Dacryocystorhinostomy in the Age of Transcanalicular Microendoscopic Techniques

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
M. Alnawaiseh ◽  
N. Mihailovic ◽  
A. C. Wieneke ◽  
V. Prokosch ◽  
A. Rosentreter ◽  
...  
Keyword(s):  
Care Center ◽  
Nasolacrimal Duct ◽  
Long Term Results ◽  
Complication Rates ◽  
Lacrimal Duct ◽  
Eye Care ◽  
Duration Of Symptoms ◽  
External Dacryocystorhinostomy ◽  
External Dcr

Purpose.This study aimed to evaluate long-term results of external dacryocystorhinostomy (DCR) at a tertiary eye care center specializing in lacrimal duct surgery in Germany.Methods.The medical records of 1010 patients with acquired nasolacrimal duct obstruction (NLDO), who had undergone lacrimal duct surgery at a tertiary eye care center, were reviewed. Only adult patients who had undergone external DCR were included. The evaluation included the following parameters: age, gender, duration of symptoms, patient satisfaction, previous dacryocystitis, complication rates, and surgical outcome.Results.154 eyes of 146 patients (14.5%) could be included in the study. The average age was64.1±29.7years. 66.4% of patients were females and 33.6% were males. Acute or chronic dacryocystitis was found in 81 patients (55.5%). Overall, 82.8% of patients had full resolution of symptoms. The success rate of external DCR for patients with previous episodes of dacryocystitis was 82.7% compared to 83.4% for patients without dacryocystitis in their medical history.Conclusion.In cases in which transcanalicular microendoscopic techniques are contraindicated (e.g., after dacryocystitis) or in complex cases where microendoscopic procedures have failed (revision surgery), external DCR is still the surgical treatment of choice with very good postoperative success.

scholarly journals The long-term outcome of the modified external dacryocystorhinostomy

2017 ◽  
Vol 10 (2) ◽  
pp. 56-61
Author(s):  
Vyacheslav V Rakhmanov ◽  
Vitaly V Potemkin ◽  
Elena V Meshveliani ◽  
Alyona A Pirgunova ◽  
Aisa S Alchinova ◽  
...  
Keyword(s):  
Success Rate ◽  
Standard Procedure ◽  
Operation Time ◽  
Modified Technique ◽  
Long Term Outcome ◽  
External Dacryocystorhinostomy ◽  
The Mean ◽  
External Dcr

External dacryocystorhinostomy (DCR) is still the gold standard procedure for treating nasolacrimal duct obstruction or chronic dacryocystitis. Purpose: to evaluate the long-term functional outcome of the modified technique of external dacryocystorhinostomy. Materials. 55 patients (61 eyes) with lacrimal drainage system disorders who underwent the modified technique of external DCR between 2013-2015 were involved in the study. In this modified procedure of external DCR, anastomosis was created by suturing only anterior flaps of the lacrimal sac and nasal mucosa and excision of the posterior flaps. The mean age of the patients was 65.8 ± 12.38 years (range, 27-87 years), including 47 females and 8 males. The mean follow-up time was 19.4 ± 6.9 months (range, 4-33 months). The success rate was recorded during the follow-up period. Cosmetic result of surgery was interpreted by the patients. Results. Criteria for surgical success were defined as no or minimal intermittent epiphora, no reflux on lacrimal irrigation postoperatively and a positive functional dye test. The modified external DCR with only anterior flap anastomosis had a success rate of 93.4%. 4 patients (6.6%) had recurrence of epiphora and not patent lacrimal system to irrigation. In our study, the operation time of DCR varies from 25-40 minutes. After surgery 15 of 55 patients (27.3%) described the incision scar as “invisible” and 3 of 55 patients (5.5%) graded it as very visible, hypertrophic scar. Five of 55 patients (9.1%) were not satisfied with the appearance of the incision. Conclusion. The present study concludes that modified external DCR with anterior flaps anastomosis only is a simple, less time consuming surgical technique that is easy to perform and the outcome is comparable to conventional DCR.

scholarly journals Factors Associated and Management of Functional Failure after External Dacryocystorhinostomy at Zonal Tertiary Hospital

2020 ◽  
pp. 44-53
Author(s):  
Daniel Mashamba ◽  
Edwin Musheiguza ◽  
William Makupa
Keyword(s):  
Associated Factors ◽  
Tertiary Hospital ◽  
P Value ◽  
Management Options ◽  
Functional Failure ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
External Dacryocystorhinostomy ◽  
Anatomical Success ◽  
External Dcr

Aims: To determine factors associated and management of functional failure after Dacryocystorhinostomy among patients attending the eye department at KCMC hospital Moshi Kilimanjaro, from January 2007 to July 2018. Study Design: A retrospective cross-section hospital-based study. Place and Duration of Study: Conducted at Eye Department Kilimanjaro Christian Medical Centre Hospital, between August 2018 and August 2019. Methodology: We recruited 184 patients who underwent external DCR surgery from January 2007 to July 2018. The analysis was done using STATA version 14. Chi-square was used to establish the difference in proportions across groups, multivariable logistic regression models were used to determine the associated factors for functional failure. The 95% confidence intervals were constructed; associations were considered to be statistically significant when a P-value was less than 0.05. Results: Out of 184 external DCR done, 37 (20.1%) had functional failure, 174 (94.6%) attained anatomical success while147 (79.9%) attained functional success. Fifty-one (27.4%) of cases had a primary function failure, of this 50% was managed by probing and irrigation. Functional failure was associated with postoperative complications (AOR=10.58 (95% CI: 2.24 - 49.88). Conclusion: Functional failure after external Dacryocystorhinostomy was 20.1%, the anatomical success of external DCR was 94.6% and functional success was 79.9% in our study. The strongest associated factors for functional failure were a post-operative complication and increased age. Therefore, careful post-operative follow-up after DCR procedure should be emphasized to lacrimal surgeons. On the other hand, external DCR remains the surgical management options with good success.

scholarly journals Practical applications and learning curve for EUS-guided hepaticoenterostomy: results of a large single-center US retrospective analysis

2019 ◽  
Vol 07 (04) ◽  
pp. E600-E607 ◽  
Author(s):  
Theodore James ◽  
Todd Baron
Keyword(s):  
Learning Curve ◽  
Success Rate ◽  
Success Rates ◽  
Practical Applications ◽  
Tertiary Referral Center ◽  
Surgically Altered Anatomy ◽  
Procedure Duration ◽  
Procedural Success ◽  
Few Data ◽  
Over Time

Abstract Background and study aims Endoscopic ultrasound-guided hepaticoenterostomy (EUS-HE) is an effective method of endoscopic biliary drainage in cases where endoscopic retrograde cholangiopancreatography has failed or is deemed impossible. Indications for EUS-HE have expanded, resulting in increased interest by endoscopists to learn the procedure; however, few data exist on breadth of application or experience needed to develop proficiency. We describe utilization of EUS-HE for biliary decompression at a large tertiary referral center along with procedural learning curve. Patients and methods Retrospective evaluation of 60 consecutive patients who underwent attempted EUS-HE by one endoscopist from February 2016 through June 2018. Procedures were divided into chronological and summative experience quartiles. We compared procedural success rate, procedural utilization, and procedure duration over time. Results Sixty patients underwent attempted EUS-HE during the study period: 35 with surgically altered anatomy, 23 with malignant biliary obstruction, 35 outpatients, 35 females; median age, 66 years. The procedure was technically successful in 53 patients. Success rates by summative experience quartile were 80 %, 80 %, 93.3 % and 100 % respectively. Beginning at patient number 40, the remaining cases had a success rate of 100 %. Utilization increased from eight cases in the first chronological quartile to 28 in the fourth. There was no significant reduction in procedure duration over time. Conclusion For an experienced endoscopist, EUS-HE could be performed effectively and safely after the experience of 40 cases. Limitations of this study include a single endoscopist and heterogeneous patient population with variable anatomy that may affect procedural success. Future studies should include data from multiple centers and endoscopists.

CROSS SECTIONAL STUDY OF SUCCESS RATE OF EXTERNAL DACRYOCYSTORHINOSTOMY SURGERY WITH AND WITHOUT INTUBATION STENT USAGE IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 11-12
Author(s):  
Kokila G. Kamath ◽  
Vishal S Jadhav
Keyword(s):  
Success Rate ◽  
Tertiary Care ◽  
Operative Management ◽  
Care Hospital ◽  
Success Rates ◽  
Silicone Tube ◽  
Cross Sectional ◽  
Silicone Tube Intubation ◽  
External Dacryocystorhinostomy ◽  
External Dcr

Dacryocystorhinostomy is widely considered as the standard treatment due to chronic nasolacrimal duct obstruction (NLDO). These procedures include standard external Dacryocystorhinostomy (DCR), non-laser endonasal endoscopic DCR (EN-DCR), and endonasal endoscopic laser DCR (LA-DCR)1. However external DCR is considered as the gold standard surgical method in the treatment of NLDO. Our study describes a comparative study of success rates of external DCR surgery, wherein 30 patients each were included for with and without silicone tube intubation usage respectively. The results showed a higher success rate (90%) in outcome of external DCR surgery using silicone tube intubation as compared to that without its usage (80%). Therefore, this study was aimed to shed further light on EXDCR surgery using intubation stents. The study also helps in shedding light on better post-operative management and obtaining higher success rates in case of EX-DCR surgery.

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

2021 ◽  
Vol 2 (3) ◽  
pp. 159-163
Author(s):  
Aalok Kumar ◽  
◽  
Sanjiv Kumar Gupta ◽  
Keyword(s):  
Retinal Detachment ◽  
Success Rate ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Case Series ◽  
Complication Rates ◽  
Scleral Buckle ◽  
Retrospective Case ◽  
Anatomical Success

AIM: To evaluate the outcomes of patients operated for retinal detachment by scleral buckle technique done by trainee doctors pursuing postgraduate course in ophthalmology. METHODS: This study was a non-comparative retrospective case series to evaluate the demography, clinical features and outcomes of patients underwent rhegmatogenous retinal detachment (RRD) repaired by scleral buckle technique from July 2017 to February 2018 at a tertiary care center in India. Records of all these patients were screened. Statistical analyses were performed and using Fisher's exact test, Mann-Whitney test and Nominal Logistic regression. RESULTS: Totally of 41 patients were included out of which, 32 (78.04%) were males and 9 (21.95%) were females. In our study primary anatomical success rate was 95.12%, with significant visual gain. Postoperative complications were raised intraocular pressure (n=2), new breaks (n=2) and re-detachment in 2 patients which was successfully managed by pars plana vitrectomy (PPV) with internal tamponade and laser. CONCLUSION: The study showed that scleral buckle surgeries done by trainee doctors under supervision can achieve a high success rate in patients of RRD both in terms of postoperative anatomical success, visual acuity and complication rates. Thus, scleral buckle surgery can be an acceptable primary procedure for trainee doctors for management of RRD in selected cases despite the various treatment options now available.

scholarly journals Comparison of Endonasal Endoscopic Dacryocystorhinostomy with External Dacryocystorhinostomy

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Muhammad Tariq ◽  
Ahmad Zeeshan Jamil ◽  
Shahid Ali ◽  
Muhammad Khalid ◽  
Ali Akash
Keyword(s):  
Success Rate ◽  
Invasive Approach ◽  
Female Ratio ◽  
Presenting Symptoms ◽  
Minimal Invasive Approach ◽  
Department Of Ophthalmology ◽  
Significant Difference ◽  
Endonasal Dcr ◽  
External Dacryocystorhinostomy ◽  
External Dcr

Purpose:  To compare anatomical and functional success of Endonasal Dacryocystorhinostomy (DCR) with that of External Dacryocystorhinostomy. Study Design:  Quasi-experimental study. Place and Duration of Study:  Department of Ophthalmology and Otolaryngology, District Headquarter Teaching Hospital, Sahiwal, from July 2018 to July 2019. Methods:  Sixty patients with nasolacrimal duct obstruction were selected by convenient sampling technique and were divided into two groups. Group 1 underwent endonasal DCR while group 2 underwent external DCR. Detailed history with regard to symptoms and duration of the obstruction was taken. Detailed ophthalmological and otolaryngological examination was performed. Patients were followed up for three months. Chi-square test was used to compare the success between two groups. Confidence level of 95% was used and p value of less than 0.05 was considered significant. Results:  Male to female ratio was 4:11. The most common presenting symptoms was epiphora that was present in all patients. Regurgitation of lacrimal sac was present in 75%, conjunctivitis was present in 53.33% and dacryocystitis was present in 41.66% patients. Anatomical success rate for endonasal DCR was 25 (83.33%) and for external DCR was 27 (90%). Functional success rate for endonasal DCR was 23 (76.67%) and for external DCR was 22 (73.33%). There was no statistically significant difference in the short term success of surgery between the two groups. Conclusion:  Endonasal DCR offers minimal invasive approach with comparable anatomical and functional results to the external DCR. Key Words:  Conjunctivitis, Dacryocystorhinostomy, Dacryocystitis, Epiphora.

ASSESSMENT OF ANATOMICAL & FUNCTIONAL SUCCESS IN EXTERNAL DACRYOCYSTORHINOSTOMY BY AIR BUBBLE TEST

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Dr. Vikas Tantuway
Keyword(s):  
Case Series ◽  
Invasive Procedure ◽  
Nasolacrimal Duct ◽  
Good Tool ◽  
Predictive Values ◽  
Reliability Indices ◽  
Air Bubble ◽  
Bubble Test ◽  
External Dacryocystorhinostomy ◽  
Anatomical Success

Aim: To assess reliability indices of Air Bubble Test (ABT) for anatomical and functional success in external Dacryocystorhinostomy (DCR). Methods: Prospective case series of nasolacrimal duct obstruction underwent DCR. Functional success defined as Munk score 0 & 1 & anatomical success as free irrigation at followup.ABT performed by putting antibiotic drops into eye& asking patient to exhale while keeping nose & mouth closed. Formation of bubbles at punctum considered as positive test. Specificity, sensitivity, positive & negative predictive values calculated. Results: There were 103 DCR in 97 patients(23 male,74 female)with mean age 45.56 yr. Anatomical and functional success was 99.02% & 98.05%, respectively.ABT showed sensitivity 96.07%, specificity 100% for anatomical success after DCR. Sensitivity and specificity were 97.02% & 100% for functional success. Conclusion: As non-invasive procedure ABT is a good tool to assess success of DCR, though lacrimal syringing remains the gold standard. Keywords: Anatomical, Dacryocystorhinostomy & Air Bubble Test.

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