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.

Evaluation of the Role of Silicone Intubation in Non-complicated External Dacryocystorhinostomy

Aim: Evaluation of the role of silicone intubation in non-complicated External dacryocystorhinostomy (Ext-DCR). Background: Silicone intubation is described as a step of Ext-DCR. It was proposed that it may prevent obstruction involving the osteotomy or the common canaliculus. However, its necessity in non-complicated Ext-DCR is controversial. Objective: To study the effect of intubation and its duration on the results of non-complicated Ext-DCR. Methods: A prospective randomized interventional study that included 75 Ext-DCRs. Patients with a high risk of failure were not included. Patients were randomly distributed between 3 equal groups with either traditional 3 months intubation (group A), short-term intubation for 2-3 weeks (group B), or non-intubation (group C). Results: The success rate was 92%, 96%, and 92% in groups A, B, and C, respectively, with no significant differences (P = 0.853). Temporary foreign body sensation was reported in 16% in group A and 12% in group B. No significant complications were recorded in any of the 3 groups. Conclusion: Intubation (either short-term or 3 months) did not affect the results of Ext-DCR, which gives more evidence that it is not necessary in non-complicated cases.

Outcome of External Dacryocysto-Rhinostomy (DCR) Operation Without Silicone Tube Intubation

Background: Dacryocysto-rhinostomy (DCR) is a bypass surgery in which an anastomosis is made between the medial wall of the lacrimal sac & the lateral wall of the nasal mucosa by cutting the intervening bone at the level of middle meatus to restore the flow of tears when the obstruction is beyond the common canaliculus. The aim of this study was to evaluate the surgical intervention of conventional external DCR without silicon tube intubation.Methods: This study was conducted at Jahurul Islam Medical College Hospital, Kishoregonj, from July 2016 to January 2018. Fifty cases with chronic dacryocystitis were selected for the study. The operation was done under local anaesthesia. The patients were followed up for 3 months.Result: The mean age of the patient at the time of surgery was 40.9±13.1 years ranged from 16 to 65 years. Male to female ratio was 1:2.1. There were three patients with reactionary haemorrhage, one wound infection, two with wound gap, one epicanthal fold and one granuloma formation. There were no failed DCR in this series.Conclusion: Conventional DCR is the most common oculoplastic surgery performed for managing epiphora due to nasolacrimal duct obstruction.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 121-123

Retained Herrick Plug

A 79-year-old female with a history of keratoconjunctivitis sicca presented with several years of epiphora of both eyes. Thirteen years earlier, intracanalicular Herrick lacrimal plugs (Lacrimedics, Eastsound, WA, USA) had been placed in both eyes to treat her dry eye syndrome. After 13 years the patient felt the epiphora was intolerable and underwent endoscopic dacryocystorhinostomy (DCR) of the left, then the right side. Intraoperatively, during the right endoscopic DCR, a Herrick lacrimal plug was found in the common canaliculus into the lacrimal sac. Postoperatively, the patient did well with improved epiphora. The Herrick plug is designed to be intracanalicular, and this case illustrates that the plug can migrate and be retained for many years. Collared punctal plugs have a lower risk of this type of complication.

An Easy Method for Intraoperative Confirmation of Lacrimal Sac Patency in Endoscopic Dacryocystorhinostomy

Purpose Few studies have focused on the intranasal localization of the lacrimal sac during endoscopic dacryocystorhinostomy: landmarks in order to find the medial wall of the lacrimal sac have been described, but there is a lack of description of methods for the verification of the complete marsupialization of the lacrimal sac during surgery. In this report, we propose an easy and effective method for certain intraoperative identification of lacrimal sac. Methods A method in order to verify the effective marsupialization of the lacrimal sac is applied and described: to ensure that the opening of the sac in the nasal cavity is complete, the surgeon should identify the Rosenmuller valve, which is the end of the common canaliculus in the lacrimal sac. Continuous irrigation with saline solution through the inferior canaliculus can be useful to obtain a clean surgical area and to permit easy intraoperative identification of the valve. Results Between 2007 and 2015, 193 endoscopic dacryocystorhinostomies were performed in our institutions. Postoperative surgical success at last follow-up (minimum 12 months) was 93.8% (181 out of 193 of cases). No major complications were observed. Conclusions Correct and complete exposure of the lacrimal sac during surgery is crucial for a good outcome: when the opening of the common canaliculus is identified, the surgeon is assured that the sac has been correctly and completely marsupialized inside the nasal cavity.

In Vivo and Cadaver Studies of the Canalicular/Lacrimal Sac Mucosal Folds

Purpose.The study aimed to investigate canalicular/lacrimal sac mucosal folds (CLS-MFs) in vivo and in cadavers in order to explore their functional roles in the lacrimal drainage system.Method.The observations of CLS-MFs in vivo were performed on 16 patients with chronic dacryocystitis after undergoing an endonasal endoscopic dacryocystorhinostomy (EE-DCR). The lacrimal sacs and common canaliculi of 19 adult cadavers were dissected. The opening/closing of an orifice and mucosal fold was recorded. All of the specimens were subjected to a histological examination.Results.The upper and lower lacrimal canaliculi in all of the samples united to form a common canaliculus that opened to the lacrimal sac. CLS-MFs were observed in 10 of the 16 patients (62.5%) and 9 of the 19 cadavers (47.4%). The orifices or mucosal folds could be opened or closed when related muscles contracted or relaxed. Histological sections showed a mucosal fold at one side of an orifice.Conclusion.Common canaliculus is the most common type that the canaliculus opens to lacrimal sac. CLS-MFs exist in a certain ratio that can be opened/closed with the movement of the orifices. They may be involved in the drainage of tears or the pathogenesis of acute dacryocystitis or lacrimal sac mucocele.