Adjunctive use of mitomycin C on endoscopic lacrimal surgery

AIMS—Endoscopic endonasal dacryocystorhinostomy (DCR) has some advantages over external DCR as a less invasive method with no skin incisions. But the success rate of the operation has not reached the level of external method. In this study, a wound healing inhibitor mitomycin C was used intraoperatively to prevent the closure of the osteum after the operation.
METHODS—Endoscopic endonasal DCR was performed on 40 eyes of 39 patients (26 female, 13 male). Mitomycin C was applied to the ostium in 14 of 23 patients who had undergone primary endoscopic DCR by means of a microdrill and in eight of 17 patients who had a revision endoscopic DCR secondary to a previously failed external DCR.
RESULTS—The postoperative follow up period was 9-27 (mean 18.2) months. The success rate of endoscopic DCR with intraoperative mitomycin C was 77.3%, whereas the success rate of endoscopic DCR without mitomycin C was 77.8%. The statistical analysis did not show a difference between the two groups according to the ostium size and their success rates.
CONCLUSIONS—Adjunctive use of a wound healing inhibitor is considered to increase the success rate of endoscopic endonasal DCR. Its intraoperative use seems to be easy and safe. But the study of this limited series shows no benefit in using it.

Keywords: mytomycin C; lacrimal surgery; dacryocystorhinostomy     

Anterior suspended flaps: a modified approach for external dacryocystorhinostomy

BACKGROUND/AIMS—External dacryocystorhinostomy (DCR) is a reliable but difficult surgical technique for the treatment of any obstruction of the lacrimal drainage system lying distal to the internal opening of the common canaliculus. In this prospective study, a simplified external DCR procedure and the results obtained on a series of 45 consecutive patients, in which traditional external DCR was indicated, are described.
METHODS—In this modified procedure only very large and mobile anterior flaps of the lacrimal sac and nasal mucosa are created. Thanks to the large size and the great motility the two flaps can be easily sutured. Two double armed 6/0 polyglycolic acid sutures are used to join the two flaps, to elevate them anteriorly in order to avoid adhesions with underlying tissues, and to approximate the deep planes of the wound. The mean operative time was measured.
RESULTS—At the end of follow up period (mean 17 months, range 14-24 months) all patients had no sign or symptoms of tearing and normal Jones I dye test. The mean operative time was 28.6 minutes (range 23-44 minutes)
CONCLUSION—We believe that our modified technique can be used to simplify and speed up traditional external DCR without decreasing its well known reliability.

Keywords: external dacryocystorhinostomy; anterior mucosal flaps     

丝裂霉素C在外路泪囊鼻腔吻合术中的应用

目的　探讨丝裂霉素C(mitomycinC ,MMC)在外路泪囊鼻腔吻合术 (externaldacryocystorhinostomy ,EXT-DCR)中的临床效果及安全性。方法　将 5 1例 5 1眼慢性泪囊炎患者随机分成 2组 ,MMC组 2 6例 ,对照组 2 5例 ,MMC组术中将浸有 0 .5g/LMMC棉片充分接触鼻黏膜、泪囊黏膜及造骨孔 5分钟 ,对照组未用MMC。术后平均随访 (2 7.8± 3.9)个月。结果　MMC组手术成功率为 2 5 / 2 6 (96 .2 % ) ,对照组手术成功率为 2 1/ 2 5 (84 % ) ,MMC组与对照组差别有显著性 (P <0 .0 5 ) ,无药物引起的并发症。结论　MMC组在EXT -DCR术中使用 ,能安全有效提高远期手术成功率。     

泪囊鼻腔吻合术中联合应用丝裂霉素C的临床研究

目的 :评价泪囊鼻腔吻合术联合应用丝裂霉素C(mitomycinc ,MMC)的临床疗效。方法 :采取随机对照临床试验方法 ,将 36例 ,4 2只眼慢性泪囊炎患者随机分为MMC组和对照组 ,每组 2 1只眼 ,其中 6例为左右眼对照。所有患者年龄在2 0～ 5 6岁之间 ,均为首次手术。两组手术方式相同 ,其中 ,MMC组术中置一含 0 2mg/mlMMC棉片于泪囊鼻腔粘膜吻合口内 ,30分钟后自鼻腔抽出。术后随访 10个月 ,观察并记录溢泪症状改善情况、下睑缘角膜间泪液弧高度 (theheightoftearmeniscus)以及泪道冲洗情况 ,并作统计分析。结果 :MMC组有 2 0只眼 (95 2 % )溢泪症状完全消失 ,1只眼症状无改善 ;对照组有 14只眼 (6 6 7% )症状消失 ,4只眼 (19 0 % )症状好转 ,3只眼 (14 3% )无效。两组差异有显著性 (x2 =6 0 5 84 ,P <0 0 5 ) ;随访期间 ,测量下睑缘角膜间泪液弧高度 ,MMC组正常者 19只眼 (90 5 % ) ,偏高 1只眼 (4 8% ) ,较高 1只眼 (4 8% ) ;而对照组正常者 12只眼 (6 3 2 % ) ,偏高 6只眼 (2 8 6 % ) ,较高 3只眼 (14 3% ) ,两组间有显著性差异 (x2 =6 14 88,P <0 0 5 ) ;随访期间泪道冲洗 ,MMC组 1只眼 (4 8% )阻塞 ,对照组 3只眼 (14 3% )阻塞。所有病例切口均一期愈合 ,7日拆线 ,未发现鼻腔出血、鼻粘膜坏死及     

丝裂霉素C在鼻内镜下泪囊鼻腔吻合术中的应用分析

目的：探讨在经鼻内镜泪囊鼻腔吻合术中应用丝裂霉素C治疗慢性泪囊炎的疗效。方法：收集57例63眼慢性泪囊炎患者,在经鼻内镜泪囊鼻腔吻合术中应用丝裂霉素C,观察其临床疗效。结果：术后随访6mo以上,治愈54例59眼（95%）;好转3例4眼（5%）,总有效率100%。结论：在经鼻内镜泪囊鼻腔吻合术中局部应用丝裂霉素C治疗慢性泪囊炎,治愈率高,面部不留瘢痕,出血少,泪囊定位准确,同时丝裂霉素C能有效抑制创面肉芽组织生长和纤维瘢痕形成,减少术后吻合口闭锁,提高手术成功率,是一种安全有效的治疗方式。     

关于鼻内窥镜下鼻腔泪囊造孔术骨孔大小的探讨

目的:探讨鼻内窥镜下鼻腔泪囊造孔术中骨孔的大小对手术效果的影响,以寻求最合适的骨孔大小.方法:采用随机、单盲、平行研究方法.选取2010-01/10在株洲三三一爱尔眼科医院欲行鼻内窥镜下鼻腔泪囊造孔术治疗的慢性泪囊炎患者200例200眼随机分成两组:A组100眼:骨孔大小6mm×6mm(±2mm),B组100眼:骨孔大小10mm×10mm(±2mm)以上.手术时按分组做相应大小骨孔,术后观察各种不良反应及手术效果.结果:A组9例因骨壁太厚,3例因骨孔位置不在最佳位置需扩大骨孔,失访4例,最后进入观察病例84例,其中无效2例,有效82例.B组失访3例,最后进入观察病例97例,其中无效3例,有效94例,两组统计学上成功率无明显差别,A组患者术后反应更小效果更好.结论:鼻内窥镜下鼻腔泪囊造孔手术治疗慢性泪囊炎时6mm×6mm(±2mm)的骨孔大小是合适的,具有微创、术中出血少、术后不良反映少、且不影响手术效果的特点.     

鼻内镜下鼻腔泪囊吻合术治疗急性泪囊炎的疗效

目的：探讨鼻内镜下鼻腔泪囊吻合术治疗急性泪囊炎的临床疗效。 方法：回顾分析2008-07/2010-07收治的15例15眼行鼻内镜下鼻腔泪囊吻合术的急性泪囊炎患者的临床资料。 结果：患者15例15眼中,治愈13眼,好转1眼,无效1眼,有效率93％ 。 结论：鼻内镜下鼻腔泪囊吻合术治疗急性泪囊炎可以缩短病程,临床切实可行。     

鼻内镜下泪囊鼻腔吻合术治疗慢性泪囊炎临床分析

目的 ：分析鼻内镜下泪囊鼻腔吻合术治疗慢性泪囊炎的临床疗效。

方法：回顾分析2010-01/2011-03我院17例24眼泪囊鼻腔吻合术的临床资料,总结分析术前准备、手术方法与术后处理可能出现问题的解决方法及治疗效果分析。

结果：即刻手术成功24眼,术后6～18mo随访复诊冲洗泪道通畅,总治愈率达100%。

结论：鼻内镜下泪囊鼻腔吻合术是治疗慢性泪囊炎的理想方法,具有创伤性小、复发率低、治愈率高、不影响美容的特点。     

Patient-reported benefit from oculoplastic surgery

Purpose

It is vital that surgeons undertaking oculoplastic procedures are able to show that the surgery they perform is of benefit to their patients. Not only is this fundamental to patient-centred medicine but it is also important in demonstrating cost effectiveness. There are several ways in which benefit can be measured, including clinical scales, functional ability scales, and global quality-of-life scales. The Glasgow benefit inventory (GBI) is an example of a patient-reported, questionnaire-based, post-interventional quality-of-life scale that can be used to compare a range of different treatments for a variety of conditions.

Methods

A cross-sectional study was undertaken using the GBI to score patient benefit from four commonly performed oculoplastic procedures. It was completed for 66 entropion repairs, 50 ptosis repairs, 41 ectropion repairs, and 41 external dacryocystorhinostomies (DCR). The GBI generates a scale from −100 (maximal detriment) through zero (no change) to +100 (maximal benefit).

Results

The total GBI scores of patients undergoing surgery for entropion, ptosis, ectropion, and external DCR were: +25.25 (95% CI 20.00–30.50, P<0.001), +24.89 (95% CI 20.04–29.73, P<0.001), +17.68 (95% CI 9.46–25.91, P<0.001), and +32.25 (95% CI 21.47–43.03, P<0.001), respectively, demonstrating a statistically significant benefit from all procedures.

Conclusion

Patients derived significant quality-of-life benefits from the four most commonly performed oculoplastic procedures.     

Endonasal dacryocystorhinostomy: a prospective study

Objective  The objectives of this study are to report the results of Endonasal Dacryocystorhinostomy (EnDCR) and the role of silicon intubation in EnDCR in Indian population. Study design  The authors conducted a prospective case series. Methods  290 patients underwent EnDCR between January 2002 and July 2007 — 240 cases without silicon intubation and 50 cases with silicon intubation. Patients were followed up for an average of 18.6 months in first group and 5.2 months in second group. Outcome was evaluated subjectively and objectively. Results  In EnDCR without silicon intubation, the procedure was successful in 93.3% of cases. In EnDCR with silicon intubation, the procedure was successful in 96% of cases. Conclusion  EnDCR is a safe procedure with good success rate and has potential advantages in chronic dacryocystitis cases. The use of silicon intubation in nasolacrimal pathway helps in maintaining the patency of rhinostomy.