Features of the Postoperative Period in Patients with Chronic Dacryocystitis and Type 2 Diabetes Mellitus after Endoscopic Endonasal Dacryocystorhinostomy Depending on the Degree of Compensation of Diabetes Mellitus

The aim. To identify the features of the postoperative period in patients with chronic dacryocystitis and type 2 diabetes mellitus (DM2) after endoscopic endonasal dacryocystorhinostomy (DCR), depending on the degree of compensation of DM. Materials and methods. The study involved 30 DM2 patients with chronic dacryocystitis who underwent endoscopic endonasal DCR according to standard methods. The patients were divided into groups according to the degree of compensation of DM2: 6 patients with compensated, 7 patients with subcompensated and 17 patients with decompensated DM2. The results of the operation were evaluated after 2 months, 6 months and 2 years. In addition to standard methods, ophthalmic examination included nasolacrimal duct probing, lacrimal duct lavage, and endoscopic examination of the nasal cavity. Results and discussion. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months (58.8 ± 11.9 % of patients) on average was 1.4 times, and after 6 months (52.9 ± 12.1 % of patients) and 2 years (41.2 ± 11,9 % of patients) – it was 1.5 times less than that in subcompensated and compensated DM2 (p < 0.05). In patients with decompensated DM2, tearing was observed in 41.2 ± 11.9 % of patients after 2 months, in 47.1 ± 12.1 % of patients after 6 months and in 58.8 ± 11.9 % of patients after 2 years post-op, which was, on average, 2.7 times, 2.1 times and 1.5 times more often than that in subcompensated and compensated DM2, respectively (p < 0.05); there were no significant differences between the values (p > 0.05). Conclusions. Features of the postoperative period in patients with chronic dacryocystitis after endoscopic endonasal DCR depend on the degree of compensation of DM2. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months is on average 1.4 times, and after 6 months and 2 years it is 1.5 times less than that in subcompensated and compensated DM2. Keywords: type 2 diabetes mellitus, degree of compensation of diabetes mellitus, chronic dacryocystitis, efficiency of endoscopic endonasal dacryocystorhinostomy, features of postoperative period.

Dacryolithiasis diagnosis and treatment: a 25-year experience using nasal endoscopy

BackgroundDacryolith-induced epiphora is caused by a chronic obstruction of the nasolacrimal duct whose aetiology is often specified peroperatively. Dacryocystorhinostomy (DCR) has been often regarded as the gold standard to treat dacryolithiasis. Hasner’s valve (HV) incision is a technique to evacuate lithiasis through its physiological track. The purpose of this study was to describe clinical and radiological findings associated with presence of dacryoliths in patients who underwent surgery and to assess the efficacy of these two procedures.MethodsThis study was a comparative interventional multicentric retrospective study including patients referred for an epiphora. The primary endpoint was to determine clinical and endoscopic findings associated with dacryoliths. The secondary endpoints were to evaluate the performance of CT dacryocystography (CT-DG) in the diagnosis of dacryoliths and the success rate of the surgical treatment 6 months postoperatively.Results4677 nasolacrimal ducts (NLDs) (78.0% female, mean age 59.2) were included in the study. 3913 underwent DCR, and 764 underwent HV incision. 291 out of 4677 NLDs (6.2%) were found to have dacryoliths. Presence of mucocele associated to a permeable lacrimal system (OR 8.17 (95% 4.62 to 14.44), p<0.01) was associated with presence of lithiasis peroperatively. Success rates at 6 months were 95.6% for endonasal DCR and 94.6% for incision of HV in dacryolithiasis group (p<0.01). CT-DG had a negative predictive value of 96.3% to detect lithiasis (p<0.01).ConclusionStrong clinical and endoscopic findings may improve the imputability of dacryoliths in epiphora. Evacuation of dacryolithiasis through its physiological track was first described in this study in adults with similar results to DCR in patients presenting with dacryolithiasis.

A Comparative Study of Dacryocystorhinostomy with or without Stent in a Tertiary Teaching Hospital of Telangana

BACKGROUND Epiphora is a common annoying symptom, embarrassing the patient both socially and functionally and may even endanger the eye. Chronic Dacryocystitis is the most common cause of epiphora which arises from nasolacrimal duct occlusion. Dacryocystorhinostomy (DCR) is the procedure of choice in the management of Dacryocystitis. We wanted to study the final outcome following endonasal DCR for chronic dacryocystitis with or without using silicon stent, evaluate the causes of persistence of epiphora in patients with or without the use of lacrimal stents and identify the methods of overcoming them postoperatively. METHODS A case control study to compare the results of Endonasal DCR with and without stent was conducted among 96 patients of both genders aged above 20 years with symptoms and signs suggestive of nasolacrimal duct blockage. All the cases and controls were randomly selected and included as group A and group B. RESULTS 96 patients were included in this study and they were divided into two groups (Group A and Group B) with 48 patients in each group. More than 75 % of the patients were between 31 and 60 years of age with a mean age of 44.36 ± 3.15 years. In Group B, 72.91 % of the cases were between 31 and 60 years of age with a mean age of 45.50 ± 4.10 years. There was no statistically significant difference in both groups. In group A (DCR with stent) success rate or relief of symptoms was 96 % whereas in group B (DCR without stent) success rate or symptomatic relief was 80 %. CONCLUSIONS Endoscopic endonasal DCR with stent is a safe and minimally invasive procedure and is an effective treatment for patients who have failed primary endoscopic DCR without stent and also in cases of mucocele and pyocele of the sac. KEYWORDS Chronic Dacryocystitis, Dacryocysto-Rhinostomy, Nasolacrimal Duct and Endoscopic Dacryocysto-Rhinostomy

Comparison of Endonasal Endoscopic Dacryocystorhinostomy with External Dacryocystorhinostomy

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.

Dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction: a pilot trial to assess impact on coexisting sinus symptoms

Purpose: To report on coexistent sinus symptoms in a population of patients who underwent endonasal dacryocystorhinostomy (DCR) surgery for nasolacrimal duct obstruction (NLDO) in a pilot study designed to test and refine methods and to estimate patient sample size for a larger multicentre randomised trial. Methods: Ninety-four consecutive patients with NLDO who underwent endonasal DCR by three surgeons in both public and private practice over a two-year period were included in this study. Questionnaires were given preceding DCR surgery and at 10 weeks post-surgery. Sinus symptoms including sinusitis, nasal congestion, hyposmia, nasal discharge, and facial pressure were assessed in the questionnaire. All subjects underwent primary endonasal DCR and all patients underwent the same post-operative regimen. Results: Questionnaire responses revealed that 48/94 (51%) patients had one or more sinus symptoms prior to DCR surgery. Ten-week post-DCR follow-up questionnaires were obtained from 77/94 (82%) patients. About 20/31 (65%) patients with one or more sinus symptoms prior to DCR surgery reported resolution of coexisting sinus symptoms by 10 weeks post-DCR surgery. Conclusion: The data from this pilot study suggest that approximately half of patients attending for NLDO have coexisting sinus symptoms. There was some loss to follow-up. This pilot study highlighted the need for a validated patient questionnaire, longer length of follow-up, control groups for surgical intervention, and use of perioperative medications. Any clinical trial designed to assess the impact of endonasal surgery on sinus symptoms would need to enrol several hundred patients in order to reach a statistically valid conclusion.

Functional outcome of endoscopic and external dacrocystorhinostomy in a teaching hospital

<p class="abstract"><strong>Background:</strong> The objective of the study was to compare &amp; analyse the results of two different techniques of dacrocystorhinostomy (endonasal and external) in different etiological groups.</p><p class="abstract"><strong>Methods:</strong> This prospective study was carried out for nasolacrimal duct obstruction from October 2016 to October 2018 who underwent dacrocystorhinostomy by two different methods. The patient was divided into two groups one who underwent endonasal DCR (n=55) and another group who underwent external DCR (n=55). In each group they were subdivided into 3 groups on the basis of aetiology into idiopathic, post traumatic and revision cases. The results were evaluated in follow up period of 6 months. At the end of the study, decoding of the groups was done and the results were analysed statistically, using Chi Square test and student t-test, using SSPS III software. P value of less than 0.05 was considered statistically significant.</p><p class="abstract"><strong>Results:</strong> The success rate in endonasal DCR and external DCR was almost same in all the three groups (p&gt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> This prospective study shows that both the methods have almost same success rate. This study also emphasises proper case selection and interdepartmental cooperation for optimum results.</p>

Merits of Kerrisons punch over powered drill in endonasal DCR

<p class="abstract"><strong>Background:</strong> DCR is an operation used to treat nasolacrimal duct obstruction. Various types of DCR are conventional, endonasal/endoscopic DCR and endolaser DCR. Several modalities like Kerrison punch and powered drill are used in endoscopic DCR to improve success rate, reduce complications and shorten operative time. Aim of the study were, to compare the advantages of non powered Kerrison punch over powered drill regarding time in endoscopic DCR and to compare the advantages of non powered Kerrison punch over powered drill regarding complication rate in endoscopic DCR</p><p class="abstract"><strong>Methods:</strong> The study was carried out at ENT department of Dr. Ulhas Patil Medical College and hospital Jalgaon from March 2017 to July 2018. Total of 61 patients were included in the study (35 Kerrison punch and 33 drill). </p><p class="abstract"><strong>Results:</strong> A total of 68 endoscopic DCRs. Procedure success rate among Kerrison punch group was 88.00% vs 91% in drill group. The complications for both groups were statistically not significant(P=0.91).The mean operating time among Kerrison punch group was significantly lower than in drill group 80 vs. 135 min (P=0.0001).</p><p class="abstract"><strong>Conclusions:</strong> Kerrison punch showed significant reduction in operating time when compared to drill for endoscopic DCR. No statistically significant difference was found between both groups regarding procedures, success rate and complications.</p>