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.

Surgical and Anatomic Consideration in Endoscopic Dacryocystorhinostomy of a Patient with Damaged Sinonasal Anatomy Post–Caldwell-Luc Surgery: A Case Report

Background: The Caldwell-Luc (CL) procedure, an outdated operative procedure that is used to treat inflammatory sinus diseases, is rarely performed presently. However, physicians may encounter patients with a history of CL surgery who develop considerable postoperative changes that may lead to diagnostic confusion in imaging evaluation; increase the difficulty of future surgery, such as sinonasal surgery; and increase the incidence of future intraoperative complications. Case summary: A 67-year-old man with a surgical history of chronic sinusitis reported epiphora of the left eye for five years. Balloon dacryocystoplasty was attempted but failed. Endo-DCR (Endoscopic dacryocystorhinostomy) was indicated; however, preoperative CT (computed tomography) imaging and nasal endoscopic examination showed sinonasal anomalies and the loss of internal landmarks for localizing the lacrimal sac. Preoperative CT results indicated previous CL surgery. Endo-DCR was performed with the aid of nasal forceps and a 20-gauge vitreoretinal fiberoptic endoilluminator. A six-month follow-up revealed the complete resolution of symptoms and no signs of recurrence. Conclusions: Epiphora might be a delayed complication of the CL procedure. Before performing endo-DCR, ophthalmologists should be familiar with the sinonasal anatomy and carefully assess preoperative imaging to identify anatomical variations. Nasal forceps and transcanalicular illumination can assist in determining the precise location of the lacrimal sac during endo-DCR.

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.

Endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction: an assessment of post-operative outcomes at a tertiary health care centre

Background: Endoscopic dacryocystorhinostomy (Endo DCR) is a well-established surgical treatment for nasolacrimal duct obstruction (NLDO) cases. Advances in surgical technique and a better understanding of the anatomy have resulted in improvement of the success rate. The objective of this study is to assess the factors responsible for the recurrence of nasolacrimal system obstruction by evaluating the post-operative outcomes of Endo DCR at a tertiary health care centre.Methods: A retrospective study was conducted in the department of ENT, GVP IHC and MT, Visakhapatnam – Andhra Pradesh on 52 patients who underwent Endo DCR procedure from September 2018 to September 2021. The data regarding lacrimal drainage system, operative details, surgical outcomes and complications were analysed.Results: Fifty-two patients (18 male and 34 female) underwent 63 Endo DCR surgeries for NLDO. Success was achieved in 50 cases (79.4%), and failure in 13 (20.6%). Of the 13 failed cases, anatomical obstruction at the fistula site was found in 6 (46.2% of failed cases), whereas functional failure with no evidence of obstruction was found in 7 (53.8%).Conclusions: The success rate appears to be influenced by preoperative parameters like clinical as well as radiological examination of eye and nose; ruling out intraoperative conditions like sinusitis, deviated nasal septum, polyps. These are essential for better coordinating therapeutic expectations and better patient selection. Endo DCR proved to be a safe invasive procedure as it has direct approach to the sac and produced excellent results without any external scar.

Analysis of the etiological factors of relapse after endonasal endoscopic dacryocystorhinostomy

The aim of this work is to study the etiological factors of failures after endonasal endoscopic dacryocystorhinostomy (EEDCR). We retrospectively studied the case reports of 485 patients (521 cases) with a relapse after EEDCR performed for primary dacryocystitis. The obtained data allowed us to reveal that the largest number of cases of relapse after EEDCR was a consequence of partial or complete obliteration of dacryocystorhinostomy (DCR) ostium (278 cases), which amounted to 53.3% of all analyzed cases. In 127 cases, the reason of recurrence after EEDCR was stenosis or obliteration of the common canaliculus ostium (24.4%). In 116 cases (22.3%), relapse after EEDCR was caused by a combination of several etiological factors. Of these, in 86 cases, synechiae and granulation in the area of dacryostomy were revealed. The retrospective analysis carried out within the framework of this work, based on the study of the results of the applied diagnostic methods, including multislice computed tomography with contrast enhancement of lacrimal drainage system, made it possible to determine and systematize the etiological factors of the development of repeated obstruction of the lacrimal drainage system after EEDCR. Key words: relapse, dacryocystitis, DCR, common canaliculus ostium, DCR ostium, synechiae.

Endoscopic Dacryocystorhinostomy in an Elderly Patient With Severe Left Ventricular Dysfunction Under Individualized Monitored Anesthesia Care

Endoscopic dacryocystorhinostomy is generally performed under general anaesthesia. However, elderly patients with multiple comorbidities can impose significant risk during conduction of general anesthesia. We report safe management of an elderly patient with hypothyroidism and severe left ventricular systolic dysfunction having implantable cardioverter defibrillator planned for endoscopic dacryocystorhinostomy using monitored anesthesia care. Emphasis is given to the specific drug choices and technique of oxygen supplementation along with assisted local anesthesia in this scenario.

Evaluation of the Efficacy of Postoperative Triamcinolone in Endoscopic Dacryocystorhinostomy using Lacrimal Symptom Questionnaire

Purpose: To evaluate the effect of postoperative nasal triamcinolone spray use in primary endoscopic dacryocystorhinostomy using The Lacrimal Symptom Questionnaire .Methods: This study included a series of 50 consecutive retrospective cases with primary endoscopic dacryocystorhinostomy and with silicone stent implantation who were followed up for 6 months postoperatively. Patients using nasal triamcinolone spray for 3 months postoperatively were included in the triamcinolone group. Patients not using triamcinolone were included in the control group. Lacrimal stents were removed 3 months postoperatively. The Lacrimal Symptom Questionnaire (Lac-Q) was performed in the preoperative and postoperative 6th month. Anatomical success, functional success, and changes in lacrimal symptom and social impact scores were compared between the two groups 6 months after surgery.Results: Results of 48 endoscopic dacryocystorhinostomies performed on 48 patients (23 triamcinolone group, 25 control group) meeting the inclusion criteria were analyzed. The anatomical success rate (95.7% vs. 84.0%, p = 0.350) and the functional success rate (91.3% vs. 76.0%, p = 0.249) were higher in the triamcinolone group, but this difference was not statistically significant. No complications were observed in the triamcinolone group, whereas complications developed in two patients in the control group (p = 0.490). The mean change in total lac-Q score was 11.0 in the triamcinolone group and 9.0 in the control group (p = 0.011). The mean change in social impact score was 4.0 in the triamcinolone group and 3.0 in the control group (p = 0.005). Mean change in lacrimal symptom score was 6.0 in the triamcinolone group and 6.0 in the control group (p =0.368)Conclusions: Our study indicated that postoperative use of triamcinolone spray increases the success rate of endoscopic dacryocystorhinostomy. also revealed that triamcinolone may also lead to greater improvement in quality of life scores than the control group using a validated questionnaire.