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.

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.

scholarly journals Change to win - flapless external dacryocystorhinostomy (DCR)

2020 ◽  
Vol 5 (8) ◽  
pp. 224-230
Author(s):  
Dr. Ravi Ranjan ◽  
◽  
Dr. Kumari Rupam ◽  
Dr. Sudhir Kumar ◽  
◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Symptomatic Relief ◽  
Case Series ◽  
Nasolacrimal Duct ◽  
Medial Side ◽  
Case Series Study ◽  
Lacrimal Bone ◽  
External Dacryocystorhinostomy ◽  
One Year ◽  
Series Study

Introduction: Nasolacrimal Duct obstruction (NLDO) is a common ophthalmic problem and theusual Treatment is Dacryocystorhinostomy (DCR), either external or endonasal. This study aims toevaluate the success of external DCR with neither anterior nor posterior flaps with Mitomycin c(MMC) syringing on the 5th post-operative day (early proliferative phase of wound healing). It wasshown in the present study that a comparable good result can be achieved without tedious flapsmaking and anastomosis. Material and Methods: It is a retrospective, non-comparativeobservational Case series study done from March 2011 to August 2019. A total of 2165 patientswere included in this study qualifying inclusion criterion. 8 to 10 mm Arruga’s bone trephine wasused to make osteum in lacrimal bone and passage in the nasal mucosa. The anterior margin of thelateral side of the remaining sac was sutured to the subcutaneous tissue of the medial side adjacentto the nasal osteotomy. Syringing with 1 ml of 0.4 mg/ ml MMC was done in the newly formedpassage on the 5th post-operative day. These patients were followed up for one year. The successcriteria were symptomatic relief from epiphora subjectively. Objectively a patent nasolacrimal ductupon syringing and Nasal endoscopy. Results: 2136 (out of 2165) patients' eyes treated with thisprocedure showed resolution of epiphora with a success rate of 98.66%. Conclusion: The currentstudy suggest that DCR without flap making is an effective and easy procedure in the managementof NLDO obstruction and flap making is a futile step in the procedure as it has no impact on theoutcome.

scholarly journals Air Bubble Technique for Fundus Visualization during Vitrectomy in Aphakia

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Mahmoud Mohamed Farouk ◽  
Takeshi Naito ◽  
Mohammed Elagouz ◽  
Hatem Ammar ◽  
Alahmady Hamad Alsmman ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Final Visit ◽  
Clinical Trial Registry ◽  
Air Bubble ◽  
Management Of Complications ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Anatomical Success

Purpose. To evaluate the efficacy and safety of air bubble technique for vitrectomy in aphakia. Study Design. Prospective interventional uncontrolled case series. Methods. This study included 53 eyes of 53 patients who are phakic and indicated for phacovitrectomy (7 eyes, group 1), aphakic and indicated for vitrectomy (22 eyes, group 2), or underwent unplanned vitrectomy for immediate management of a phacoemulsification surgery complicated by rupture posterior capsule with dropped nucleus, fragments, or IOL (24 eyes, group 3). Cases with complicated vitreoretinal pathology were not included in this study. All vitrectomy surgeries were conducted by the air bubble technique in the anterior chamber. Main outcomes included anatomical success, visual acuity, and intraoperative and postoperative complications. Results. The surgical success was achieved in 50 eyes (94.3%). Conversion to BIOM viewing system was needed in the retinal detachment cases of groups 1 and 2. The mean overall LogMAR visual acuity was significantly improved from 1.29 ± 0.58 preoperatively to 0.56 ± 0.19 at the final visit, 6 months postoperatively (P<0.001). Conclusion. The air bubble technique as visualization method for vitrectomy in aphakia is an effective and cheap technique for immediate management of complications of phacoemulsification surgery. This trial is registered with Pan African Clinical Trial Registry PACTR201709002466296.

Dacryocystorhinostomy: Evolution of endoscopic techniques after 498 cases

2019 ◽  
Vol 30 (5) ◽  
pp. 998-1003 ◽  
Author(s):  
Matteo Trimarchi ◽  
Antonio Giordano Resti ◽  
Alessandro Vinciguerra ◽  
Giulia Danè ◽  
Mario Bussi
Keyword(s):  
Case Series ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Retrospective Case ◽  
Duct Obstruction ◽  
Endoscopic Techniques ◽  
Endoscopic Dacryocystorhinostomy ◽  
Silicone Stent ◽  
Key Aspects ◽  
Anatomical Success

Introduction: Endoscopic dacryocystorhinostomy is a well-known surgical practice used to treat nasolacrimal duct obstruction and widely considered as a valid alternative to external approaches. Purpose: We present a retrospective case series of 498 endoscopic dacryocystorhinostomies on 401 patients, from July 2004 to May 2018, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. Methods: Of the 498 procedures, 426 were unilateral and 72 were bilateral dacryocystorhinostomy. All patients underwent routine preoperative workup including fluorescein test (Jones test 1–2), probing and irrigation of the lacrimal way, nasal endoscopy, and maxilla-facial computed tomography scan. Surgical technique was based on nasal endoscopic dacryocystorhinostomy followed by positioning of a Catalano’s silicone stent, which was left in place for about 3 months. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. Results: Anatomic success was achieved in 91.54% cases in primary dacryocystorhinostomy and in 89.36% after revision, whereas functional success was obtained in 90.4% in primary and 85.1% in secondary dacryocystorhinostomies. After a second revision of endoscopic dacryocystorhinostomy, anatomical success was achieved in 90.1% and functional success in 88.7% of procedures. Conclusion: Our results confirm that endoscopic dacryocystorhinostomy can be considered as a valid surgical approach to primary nasolacrimal duct obstruction and revision cases. The key aspects in achieving functional and anatomical results are meticulous surgical procedure and precise follow-up.

scholarly journals Aesthetic Appearance of External Dacryocystorhinostomy Scar: A Comparison between W and C Shaped Incision

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Zeeshan Kamil ◽  
Qirat Qurban ◽  
Khalid Mahmood
Keyword(s):  
Case Series ◽  
Sampling Technique ◽  
Nasolacrimal Duct ◽  
P Value ◽  
Aesthetic Appearance ◽  
Group A ◽  
External Dacryocystorhinostomy ◽  
The Difference ◽  
Incision Technique ◽  
Group B

Purpose:  To compare the post-operative appearance of external Dacryocystorhinostomy scar resulting from W and C shaped incisions. Study Design:  Interventional case series. Place and Duration of Study:  Khalid eye clinic, Karachi, from July 2018 to June 2019. Methods:  We recruited ninety-six patients of nasolacrimal duct obstruction by convenience sampling technique. Age ranged from 20 to 50 years and both genders were included. Two groups were made. Group A comprised of patients who underwent external Dacryocystorhinostomy (Ex-DCR) surgery through W shaped incision and group B patients underwent Ex-DCR with curvilinear C shaped incision. Main outcome measure was to observe minimal to no visible scarring at wound site after six months of follow up. All patients were explained about the difference in incision technique and consent was obtained from each patient. Results:  Mean age was 34.3 ± 6.897 years. There were thirty-six (37.5%) males and sixty (62.5%) females. Right side was affected in forty-six (47.9%) cases whereas left side was involved in fifty (52.1%) cases. In Group A, 20 (41.6%) out of 48 patients, whereas in Group B, 38 (79.2%) out of 48 patients had no visible scar at all and it was statistically significant with a p-value of < 0.05. Suture abscess developed in four (8.3%) patients in group A, no other serious complications were observed in either group. Conclusion:  Curvilinear C shaped incision in Ex-DCR has better cosmetic outcome. Key Words:  External dacryocystorhinostomy, C shaped incision, W shaped incision.

scholarly journals Nasolacrimal Obstruction Following the Placement of Maxillofacial Hardware

2020 ◽  
Vol 13 (1) ◽  
pp. 32-37
Author(s):  
J. Minjy Kang ◽  
Evan Kalin-Hajdu ◽  
Oluwatobi O. Idowu ◽  
M. Reza Vagefi ◽  
Robert C. Kersten
Keyword(s):  
San Francisco ◽  
Case Series ◽  
Nasolacrimal Duct ◽  
Maxillofacial Reconstruction ◽  
Institutional Review ◽  
Chronic Dacryocystitis ◽  
External Dacryocystorhinostomy ◽  
The University ◽  
External Dcr

Purpose: This article reviews cases of nasolacrimal obstruction (NLO) secondary to maxillofacial hardware placement. Methods: A retrospective review was performed at a single institution from 2012 to 2017 of patients with NLO following maxillofacial reconstruction. The study was approved by the Institutional Review Board of the University of California, San Francisco, adhered to the tenets of the Declaration of Helsinki, and was Health Insurance Portability and Accountability Act compliant. Patients were included if external dacryocystorhinostomy (DCR) confirmed previously placed maxillofacial hardware as the primary contributor to lacrimal outflow obstruction and had at least 3 months of follow-up. Results: Of 420 patients who underwent external DCR, 6 cases of implant-related NLO were identified. The mean age was 47.3 ± 9.6 years and 66.7% of patients were male. All patients presented with epiphora and 50% also had chronic dacryocystitis. Patients had prior maxillofacial hardware placement for paranasal sinus tumors (66.7%) or facial fractures (33.3%). In addition to external DCR, all patients had revision or removal of implants that were impeding lacrimal outflow by 2 mechanisms: (1) an orbital implant impinging the lacrimal sac or nasolacrimal duct (NLD) and/or (2) maxillofacial screws placed into the bony NLD or nasolacrimal fossa. Five of the 6 patients (83.3%) had complete resolution of symptoms and patency of the nasolacrimal system at their last follow-up visit (range 3-30 months). Conclusion: NLO secondary to hardware placement, though infrequent, is underreported. Two mechanisms of hardware-induced NLO were encountered in this case series. Specific attention to nasolacrimal anatomy at the time of maxillofacial reconstruction may help minimize implant-induced NLO.

scholarly journals External Dacryocystorhinostomy and Patient Satisfaction: Perspective of General Ophthalmologist

2021 ◽  
Vol 13 (2) ◽  
pp. 21-29
Author(s):  
Suresh BK Rasaily ◽  
Kaushal Pokharel ◽  
Sulaxmi Katuwal ◽  
Sabita Bishowkarma ◽  
Ben Limbu ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Success Rate ◽  
Case Series ◽  
Subscale Score ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Surgical Success ◽  
Glasgow Benefit Inventory ◽  
External Dacryocystorhinostomy

Introduction: This study aimed to evaluate patient satisfaction over time in patients undergoing external dacryocystorhinostomy for primary nasolacrimal duct obstruction when done by a general ophthalmologist. Materials and methods: This prospective interventional case series was done in a secondary level eye hospital in the Midwestern region of Nepal from 1st January 2018 to 30th December 2018. Fifty-four consecutive adult patients diagnosed with primary nasolacrimal duct obstruction who underwent external dacryocystorhinostomy performed by a general ophthalmologist were included. The surgical success rate was determined at six months on the basis of the resolution of symptoms with patency on syringing. Postoperative patient satisfaction was evaluated 6 months after surgery with a standardized Glasgow Benefit Inventory and post-intervention questionnaire. Results: A total of 54 eyes were operated on within the study period and a larger number of surgeries were done in the age group 26-30 years. Female constituted 79.6 % and male 20.4% with a ratio of 3.9:1. Overall surgical success rate 6 months after surgery was 96.30%. The mean total Glasgow benefit inventory (GBI) score was 48.83 ± 23.87 (95% CI, 42.96- 56.95), mean general subscale score was 52.70± 23.28 (95% CI, 46.49-60.38), social support subscale was 49.69 ± 44.68 (95% CI, 41.15-60.35) and physical health subscale score was 37.07 ± 41.19 (95% CI, 27.48-49.26). Conclusion: The external dacryocystorhinostomy surgeries performed by general ophthalmologists achieved an excellent surgical success rate and good patient satisfaction proven by a validated questionnaire.

scholarly journals Laparoscopic hand-sewn cardioplasty: an alternative procedure for end-stage achalasia

2021 ◽  
Author(s):  
Fátima Senra ◽  
Lalin Navaratne ◽  
Asunción Acosta-Mérida ◽  
Stuart Gould ◽  
Alberto Martínez-Isla
Keyword(s):  
Assessment Tool ◽  
Case Series ◽  
Invasive Procedure ◽  
Lower Oesophageal Sphincter ◽  
Poor Quality ◽  
Motor Disorder ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
End Stage ◽  
Rescue Procedure

Abstract Background Primary achalasia is a rare oesophageal motor disorder characterized by the absence of swallow-induced relaxation of the lower oesophageal sphincter and diminished or absent oesophageal body peristalsis. Around 5% of these patients will develop end-stage achalasia, where oesophagectomy may be advocated. We present the laparoscopic hand-sewn cardioplasty as an alternative ‘oesophagus-preserving’ procedure in patients with end-stage achalasia. Methods We present a retrospective review of four patients who underwent laparoscopic hand-sewn cardioplasty. Data collected included pre-operative demographic information and investigations; and post-operative outcomes. Patients were scored pre- and post-operatively using Reflux Symptom Index, Eating Assessment Tool-10 and Voice Handicap Index-10 questionnaires. Results Four patients underwent laparoscopic hand-sewn cardioplasty during the study period. In one patient, it was performed as a rescue procedure during attempted myotomy following multiple perforations of friable mucosa. In the other three patients, laparoscopic hand-sewn cardioplasty was performed for end-stage achalasia. None of the patients had post-operative complications and all patients were discharged on the second post-operative day. All patients experienced improvement in swallowing symptoms (EAT-10; p = 0.03) but developed post-operative gastroesophageal reflux. Conclusion To our knowledge, this is the first published case series of laparoscopic hand-sewn cardioplasty for end-stage achalasia. It appears to be a safe and effective procedure for the treatment of end-stage achalasia, offering an alternative minimally invasive procedure to oesophagectomy. Laparoscopic hand-sewn cardioplasty can also be used as a ‘rescue’ procedure during myotomy in patients who have poor-quality mucosa which perforates intra-operatively or is at high risk of perforation/leaking post-operatively.

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