Comparison of the efficacies of 1.0mm and 1.5mm silicone tubes for the treatment of nasolacrimal duct obstruction

This study was designed to compare the postoperative outcomes of bicanalicular intubation using different diameters of silicone tubes to treat post-saccal nasolacrimal duct obstruction. A total of 130 patients diagnosed with post-saccal obstruction who underwent endoscopic-assisted silicone tube intubation were included in the study. The patients were divided into two groups; those intubated with a 1.5-mm large diameter tube (Group LD) and those with a 1.0-mm normal diameter tube (Group ND). The patency rates of the two groups at one year after tube removal were compared using the Kaplan–Meier's curve and Restricted mean survival time (RMST) method with τ = 365 days. Results showed that the recurrence rate after tube removal was significantly lower in the LD group compared to the ND group (p = 0.001). The patency rates at one year after removal in the LD and ND group were 0.857 (0.754-0.919) and 0.739 (0.617-0.828), respectively. When comparing the patency rates by the RMST method at τ = 365 days, the RMST difference, RMST ratio, and RMTL ratio were higher in the LD group at p = 0.045, 0.052, and 0.046, respectively.

Comparison of the efficacies of 1.0mm and 1.5mm silicone tubes for the treatment of nasolacrimal duct obstruction

This study was designed to compare the postoperative outcomes of bicanalicular intubation using different diameters of silicone tubes to treat post-saccal nasolacrimal duct obstruction. A total of 130 patients diagnosed with post-saccal obstruction who underwent endoscopic-assisted silicone tube intubation were included in the study. The patients were divided into two groups; those intubated with a 1.5-mm large diameter tube (Group LD) and those with a 1.0-mm normal diameter tube (Group ND). The patency rates of the two groups at one year after tube removal were compared using the Kaplan–Meier's curve and Restricted mean survival time (RMST) method with τ = 365 days. Results showed that the recurrence rate after tube removal was significantly lower in the LD group compared to the ND group (p = 0.001). The patency rates at one year after removal in the LD and ND group were 0.857 (0.754-0.919) and 0.739 (0.617-0.828), respectively. When comparing the patency rates by the RMST method at τ = 365 days, the RMST difference, RMST ratio, and RMTL ratio were higher in the LD group at p = 0.045, 0.052, and 0.046, respectively.

Acquired nasolacrimal duct obstruction: clinical and histological findings of 275 cases

Background Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. However, cases exist where the primary nasolacrimal system obstruction is caused by malignancies. Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and compare their clinical manifestations. Methods This retrospective clinical study included 275 patients with acquired nasolacrimal duct obstruction who underwent external dacryocystorhinostomy and lacrimal sac biopsy. Cases were classified into tumor or nonspecific pathology groups and subdivided according to the level of inflammation. Histological and clinical data were analyzed. Results Three tumors (1.1%) (an adenoid cystic carcinoma, an eccrine spiradenoma and small B cell lymphoma) were diagnosed. Chronic nongranulomatous inflammation was the most common histological finding, corresponding to 194 cases (70.5%). The other 81 (29.5%) were subacute, acute forms of nongranulomatous inflammation, tumors and fibrosis cases. Epiphora with continuous purulent discharge was the most common clinical sign reported by 144 (52.4%) patients, and two (0.7%) patients had a palpable mass near the medial canthal tendon, which was identified as an eccrine spiradenoma and small B cell lymphoma. There was no significant difference in the clinical symptoms, duration or case history between the nonspecific pathology and tumor groups (p = 0.292). Conclusions Chronic nongranulomatous inflammation of the lacrimal sac was the most common finding among acquired nasolacrimal duct obstruction cases. There were no associations between the histological findings and clinical presentation. The authors recommend a lacrimal sac biopsy only in cases when a tumor is clinically suspected.

ENDOSCOPIC ENDONASAL DACRYOCYSTORHINOSTOMY: EXPERIENCE OF HUNDRED CASES

Objective: To determine the success rate of Endonasal Endoscopic Dacryocystorhinostomy (Endo-DCR) in cases of chronic dacryocystitis secondary to primary acquired nasolacrimal duct obstruction (NLDO). Study Design: Quasi-experimental study. Place and Duration of Study: Department of Oculoplastic Surgery, Armed Forces Institute of Ophthalmology Rawalpindi, from Sep 2018 to Nov 2019. Methodology: Endo-DCR under General Anaesthesia was performed on 100 patients of primary acquired nasolacrimal duct obstruction causing chronic dacryocystitis. Post-operatively these patients were checked on first post-op day, then on one week and finally four months after surgery. We removed silicone tubes of all the patients four months after surgery. To ensure patency of lacrimal passage, we did syringing and irrigation of lacrimal system of all cases, at conclusion of the study. We chose absence of epiphora and patent lacrimal system on syringing as indicators of successful procedure. Results: Hundred patients (males 37; females 63) were recruited for this study. Mean age of our sample population was 51.1 ± 29 years. Right nasolacrimal duct obstruction cases were 56 whereas left nasolacrimal duct obstruction cases were 44. Subjective improvement i.e., absence of epiphora was found in 90% patients. We got successful irrigation of lacrimal passages (objective improvement) in 94% of patients. Conclusion: Endo-DCR yields comparable results to external Dacryocystorhinostomy (Ex DCR). It offers additional benefits of esthetically better outcome, lesser complication rate and short surgery and patient recovery time.

Secondary acquired nasolacrimal duct obstruction due to the toxic effect of antineoplastic agents

In recent years, the use of chemotherapeutic agents in the treatment of cancer became more common. At the same time, the number of complications associated with this is also increasing. Among the rare complications of therapy with some antitumor drugs is the formation of secondary acquired nasolacrimal duct obstruction. The aim was to analyze and systematize information about secondary acquired nasolacrimal duct obstruction due to the toxic effect of antitumor drugs. Materials and methods. The authors analyzed the literature available in the MEDLINE and RSCI search engines in February 2021. The analysis included 55 publications. Results. In the literature, there are indications that such antitumor drugs as 5-fluorouracil and similar drugs, mitomycin C, as well as therapy with radioactive iodine, are characterized by the possibility of developing complications in the form of secondary acquired nasolacrimal duct obstruction. Preliminary screening of the drainage function of the tear ducts, as well as prescribing of local anti-inflammatory and antibacterial treatment in the form of instillations in the conjunctival sac can help to reduce the risk of complications. This explains the need to recommend patients to consult an ophthalmologist if there are relevant complaints before or during treatment. In the absence of timely treatment, obstruction of the tear ducts often becomes an indication for reconstructive interventions. Conclusion. Secondary acquired nasolacrimal duct obstruction is one of the rare, but systematically occurring complications of antitumor therapy. To date, the pathogenesis of these complications is not fully understood, and some of the data is contradictory. In the future, the accumulation of knowledge concerning the pathogenesis of this complication will contribute to the development of personalized methods of prevention.

Comparison of the efficacies of 1.0mm and 1.5mm silicone tubes for the treatment of nasolacrimal duct obstruction

This study was designed to compare the postoperative outcomes of bicanalicular intubation using different diameters of silicone tubes to treat post-saccal nasolacrimal duct obstruction. A total of 130 patients diagnosed with post-saccal obstruction who underwent endoscopic-assisted silicone tube intubation were included in the study. The patients were divided into two groups; those intubated with a 1.5-mm large diameter tube (Group LD) and those with a 1.0-mm normal diameter tube (Group ND). The patency rates of the two groups at one year after tube removal were compared using the Kaplan–Meier's curve and Restricted mean survival time (RMST) method with τ = 365 days. Results showed that the recurrence rate after tube removal was significantly lower in the LD group compared to the ND group (p = 0.001). The patency rates at one year after removal in the LD and ND group were 0.857 (0.754-0.919) and 0.739 (0.617-0.828), respectively. When comparing the patency rates by the RMST method at τ = 365 days, the RMST difference, RMST ratio, and RMTL ratio were significantly higher in the LD group at p = 0.045, 0.052, and 0.046, respectively.

Rhinological Status of Patients with Nasolacrimal Duct Obstruction

Introduction Studying the state of the nasal cavity and its sinuses and the morphometric parameters of the inferior nasal conchae, as well as a comparative analysis of obtained values in patients with primary (PANDO) and secondary acquired nasolacrimal duct obstruction (SALDO), is relevant. Objective To study the rhinological status of patients with PANDO) and SALDO). Methods The present study was based on the results of computed tomography (CT) dacryocystography in patients with PANDO (n = 45) and SALDO due to exposure to radioactive iodine (n = 14). The control group included CT images of paranasal sinuses in patients with no pathology (n = 49). Rhinological status according to the Newman and Lund-Mackay scales and volume of the inferior nasal conchae were assessed. Statistical processing included nonparametric statistics methods; χ2 Pearson test; and the Spearman rank correlation method. Results The difference in values of the Newman and Lund-Mackay scales for the tested groups was significant. A significant difference in scores by the Newman scale was revealed when comparing the results of patients with SALDO and PANDO. Comparing the scores by the Lund-Mackay scale, a significant difference was found between the results of patients with SALDO and PANDO and between the results of patients with PANDO and the control group. Conclusion It was demonstrated that the rhinological status of patients with PANDO was worse than that of patients with SALDO and of subjects in the control group. No connection was found between the volume of the inferior nasal conchae and the development of lacrimal duct obstruction.

Comparison of the efficacies of 1.0mm and 1.5mm silicone tubes for the treatment of nasolacrimal duct obstruction

Purpose: We compared the difference in postoperative patency rates due to the differences in the diameter of silicone tubes used for bicanalicular intubation for the treatment of nasolacrimal duct obstruction (NLDO). Methods: Patients diagnosed with NLDO at Ehime University Hospital between August 2013 and November 2020 who underwent endoscopic-assisted nasolacrimal duct intubation (ENDI) were included in the study. The patients involved were 130 cases and 157 sides (age 72.6 ± 11.3 years) who were eligible for follow-up for more than six months after the removal of the lacrimal silicone tube. The postoperative recurrence rate was compared retrospectively based on the difference in tube caliber. The patients were divided into two groups: those intubated with a 1.5-mm large diameter tube (Group LD) and those with a 1.0-mm normal diameter tube (Group ND). The survival rates of the two groups at one year after tube removal were compared by Kaplan-Meier's curve and Restricted mean survival time (RMST) method with τ = 365 days. Results: There were no significant differences in age, gender, or observation period after tube removal between the two groups. Meanwhile, the preoperative occlusion period was significantly longer in the ND group. The recurrence rate after tube removal was significantly lower in the LD group (12 / 85 sides, 14.1%) compared to the ND group (27 / 72 sides, 37.5%) (p = 0.001). The patency rate at one year after removal of the lacrimal tube was 0.857 (0.754-0.919) in the LD group and 0.739 (0.617-0.828) in the ND group. In comparing patency rates by the RMST method at τ = 365 days, the RMST difference, RMST ratio, and RMTL ratio were significantly higher in the LD group at p = 0.045, 0.052, and 0.046, respectively. Conclusion: Regarding the bicanalicular silicone tube intubation, the patency rate at one year after removal was significantly higher in the thicker tubes with a diameter of 1.5 mm compared with that of a diameter of 1.0 mm for the treatment of NLDO.

Prevalence of Congenital Nasolacrimal Duct Obstruction and its related risk factors among newborns

Introduction: Lacrimal drainage system disorders are among the most common ocular disorders faced by physicians. The prevalence of congenital nasolacrimal duct obstruction (CNLDO) is different in various studies, and the role of such factors as maternal and neonatal demographic characteristics have not been completely investigated in CNLDO. The present study aimed to assess the prevalence of CNLDO and its related factors in newborns in Sabzevar. Methods: This cross-sectional study was conducted on 541 newborns in Shahidan Mobini hospital, Sabzevar, Iran from January to February 2015 after obtaining informed consent from their parents. Data were collected by interviewing mothers, filling out checklists, and physical examination of the newborns. Data analysis was carried out in Stata software using a logistic regression test at a 95% confidence interval. Results: The prevalence of CNLDO was 22.6%. Purulent ocular discharge was the most common symptom (16.82%). There was a significant relationship between the neonate’s head circumference and the incidence of CNLDO (P= 0.01); nonetheless, CNLDO in the newborns showed no significant association with weight, height, and Apgar score (P>0.05). Conclusion: Considering the significant prevalence of CNLDO in preterm and term neonates, as well as its variable prevalence rates reported in different studies and the absence of overlapping of various risk factors of such disorder, it is recommended to carry out more thorough studies from birth to 1 year of age.