Conventional dacryocystorhinostomy versus endonasal dacryocystorhinostomy-a comparative study

The objective of present study was to compare the results of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. It was a prospective non-randomized study. Forty consecutive patients having complaints of watering with complete naso lacrimal duct obstruction were selected for the study. Dacryocystography was done in all the cases. Selection of type of operation was left to the patient’s choice. All patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Twenty patients underwent endonasal dacryocystorhinostomy and twenty had external dacryocystorhinostomy. Silicon intubation was done in all cases of endonasal dacryocystorhinostomy for three months after surgery. The final follow-up was done at 12 months after surgery. The patency of lacrimal passage was confirmed by syringing and patients were questioned about their symptoms. There was no significant difference in the results of both surgeries. The complication rate in both groups was almost equal. Thus we came to the conclusion that these two different dacryocystorhinostomy techniques are acceptable alternatives.     

Endoscopic dacryocystorhinostomy vs KTP 532 laser-assisted endoscopic dacryocystorhinostomy

Objectives

Advances in endoscopy and lasers have improved surgical management of chronic nasolacrimal duct obstruction. This is a preliminary comparison between standard and laser assisted endoscopic dacryocystorhinostomy (DCR).

Study Design

Combined retrospective and prospective study.

Setting

Tertiary referral hospital.

Patients and Methods

Thirty-eight cases of chronic nasolacrimal duct obstruction underwent endoscopic DCR (26 standard and 12, laser-assisted) and were assessed at 3 and at 6 months postoperatively by nasal endoscopy.

Results

Three months postoperatively (n=38), total relief of epiphora among the nonlaser group was 80.76 vs 75% in the laser group (P=0.982). At 6 months (n=19), the laser group had recorded 100% symptomatic relief compared to 85.71% in the nonlaser group (P=0.964). The laser group suffered fewer complications (33.33 vs 46.15% for nonlaser group).

Conclusion

Lasers show promise in long-term management of duct obstruction and are associated with fewer complications. A larger study is required before and generalization is made.     

Endonasal endoscopic dacryocystorhinostomy: our experience

Objectives

To study the outcome of endonasal endoscopic dacryocystorhinostomy (DCR) with or without mucosal flap preservation, without mitomycin local application, silicon tube stenting or laser assistance. To determine the duration of the surgical procedure of DCR, influence of simultaneously performed endonasal endoscopic procedures for concomitant sinonasal diseases.

Methods

Combined retrospective and prospective study in our tertiary referral center. 24 patients with chronic dacryocystitis underwent 25 standard endonasal endoscopic DCR procedures, 10 with and 15 without mucosal flap preservation. 6 of these had concomitant sinonasal diseases for which they underwent septoplasty or functional endoscopic sinus surgery (FESS) or both, simultaneously or as staged procedures. Relief from epiphora and patency of the nasolacrimal fistula was assessed by nasal endoscopy and syringing of the lacrimal apparatus at 1 week, 3 weeks and 3 months postoperatively.

Results

Out of 18 patients who underwent only DCR, 17 patients (94.44%) had complete relief from epiphora. Out of 6 patients who underwent 7 DCRs with concomitant sinonasal surgery, 5 patients (85.71%) had complete relief from epiphora. Overall 23 out of 25 DCRs (92%) had complete relief. In 15 of the 25 procedures, mucosal flap was excised completely. In remaining 10 procedures, flap was trimmed, repositioned to cover exposed bone around the newly created nasolacrimal fistula. In either situation, only one patient each had partial block of the nasolacrimal fistula. Average duration of the surgical procedure of DCR was 18 min.

Conclusion

Endonasal endoscopic DCR is a viable alternative to external DCR, co-existing sinonasal diseases can be managed simultaneously, as may be required in 25% of cases. It can be performed under 20 min without mucosal flap preservation, mitomycin local application, silicon tube stenting or laser assistance and can still provide a good success rate (92%) with less complications.     

Primary Endonasal DCR Without Stent: Our Experience and Case Series Analysis

Endonasal dacryocystorhinostomy is widely accepted and effective treatment option for nasolacrimal duct obstruction. It can be done with or without the use of stents. This study was carried out to evaluate the results of endonasal DCR surgery and to access efficacy of this procedure without stenting. This is a prospective clinical study conducted in Departments of ENT and Ophthalmology, L.N. Medical College and J.K. Hospital, Bhopal from October 2008 to April 2012. A total of 90 patients with epiphora as evidenced by nasolacrimal duct blockage on syringing were included in the study. These patients underwent endoscopic DCR without stenting. The cases were followed up to 18 months postoperative. Surgical success was defined as anatomical patency and symptomatic relief at the end of the follow up period. Failure was defined as no symptomatic relief, and/or acute dacryocystitis, and/or non patent lacrimal drainage system. Surgical success was observed in 80 of 90 (88.89 %) patients. Incidence of complication was low as only 6 patients had minor complication of bleeding, synechie and granulation tissue formation. It was concluded that high success rates could be achieved in case of nasolacrimal duct obstruction by endoscopic DCR. Thus, we can minimize complications, discomfort, the cost of stenting and follow up visits after endonasal DCR surgery.     

Double Posterior Based Flap Technique in Primary Endoscopic Dacryocystorhinostomy With and Without Using Powered Instrument

To demonstrate the surgical technique and outcomes of double posterior based flap technique in primary endoscopic dacryocystorhinostomy (DCR) with and without use of powered instrument. 28 patients of nasolacrimal duct obstruction were included in the study from September 2012 to February 2015. All underwent endoscopic dacryocystorhinostomy with double posterior based nasal and lacrimal flap technique. In patients of group A (14 patients), bone removal was done with the help of Smith–Kerrison punch forceps and in patients of group B (14 patients), powered drill has been used for the same. Patients were visited the endoscopic clinic at 1, 3, 6 months and 1 year after the surgery for post operative evaluation. Of 28 patients, 26(92.85%) were found free of symptoms at the end of 1, 3 and at 6 months. One from each group had recurrence of symptoms. At the end of 12 months of 25 patients, 3(12%) patients were found to have recurrence of symptoms of which 1(8.33%) patients was from group A and 2(15.38%) were from group B and failures were because of granulation tissue and stomal stenosis. Patients assisted with powered drill had more postoperative complications compared to cold instrument. Double posterior based flap technique in primary endoscopic DCR without the assistance of powered drill could be an effective surgical option for the patients of chronic nasolacrimal duct obstruction enabling early epithelisation by preventing peristomal granulation tissue resulting in encouraging surgical outcome with least postoperative complication.     

Powered Endoscopic Endonasal Dacryocystorhinostomy with Mucosal Flaps and Trimming of Anterior End of Middle Turbinate

Endoscopic endonasal dacryocystorhinostomy (DCR), when compared to external techniques, has always had guarded acceptance primarily due to inconsistent success rates. The most common cause of surgical failure in endoscopic DCR is very high/very low mucosal incision, obstruction of neo-ostium by granulation tissue, infolding of flap or formation of synechiae between middle turbinate and the neo-ostium site post-operatively. Several techniques and modifications have been suggested by various authors over the years since the first introduction of endoscopic endonasal DCR. With the newer techniques and advancements, the success rates have become comparable or even higher than external DCR. The aim of our study was to determine the success of endoscopic endonasal DCR using the classical Wormald technique with a few modifications. A total of 37 cases of epiphora secondary to nasolacrimal duct obstruction were operated using endoscopic endonasal DCR technique. The surgical technique included classical Wormald principle of mucosal flap, removal of the overlying bone using Kerrisons punch & chisel-hammer followed by vertical incision on the sac. The medial wall of lacrimal sac was then trimmed using microdebrider, thus apposing it to the nasal mucosal flaps. The anterior end of middle turbinate was also trimmed prophylactically to prevent synechiae formation. The outcome and long term patency of the cases were evaluated. Of the 37 cases, 35 cases (94.6 %) had complete resolution of the epiphora at the end of 1 year follow up period. The two cases of failure were due to canaliculitis in one patient and extensive granulation around the neo-ostium in another. Thus the above method has very good success rate comparable to previous studies and very less chances of granulation tissue formation and blockage of neo-ostium by synechiae/flap infolding.     

Blockage of the lacrimal drainage apparatus as a side effect of docetaxel therapy

BACKGROUND: The current study was conducted to report the severity and management of canalicular and nasolacrimal duct stenosis as a side effect of docetaxel therapy and to report the outcomes of surgical intervention for this condition. METHODS: The records of 148 patients with epiphora associated with docetaxel therapy who were evaluated at the Ophthalmology Service at The University of Texas M. D. Anderson Cancer Center were reviewed. The frequency of docetaxel administration, the dose intensity, the cumulative dose of docetaxel, and any concomitant chemotherapeutic agents were recorded. Each patient underwent an ophthalmologic examination and in-office probing and irrigation. The patients either were treated with topical steroids or offered a surgical procedure for canalicular stenosis- (silicone intubation, dacryocystorhinostomy [DCR] with the placement of silicone tubes, or DCR with the placement of Pyrex glass tubes), depending on the severity of the canalicular stenosis. RESULTS: Docetaxel was given weekly in 71 patients, every 2 weeks in 5 patients, and every 3 weeks in 72 patients. Thirty patients (59 eyes) who received weekly docetaxel underwent surgery to correct epiphora. Twenty-three patients (39 eyes) were treated with temporary silicone tube placement, 9 patients (13 eyes) were treated with DCR with temporary silicone tube placement, and 4 patients (7 eyes) were treated with DCR with permanent Pyrex glass tube placement. Twenty-nine of the 30 patients who underwent surgery reported improvement or total resolution of epiphora after the procedure. Ten additional patients (20 eyes) who received weekly docetaxel had complete closure of their canaliculi but elected not to undergo surgery. Of special note were two patients who received weekly docetaxel in the neoadjuvant setting and developed complete closure of the canaliculi. Of the patients who received docetaxel every 2 or 3 weeks, only 3 required a surgical intervention to correct epiphora; none required Pyrex glass tube placement. CONCLUSIONS: Canalicular and nasolacrimal duct obstruction is a common side effect of weekly docetaxel therapy and can occur even when this drug is used in the neoadjuvant setting. The results of the current study indicate that early temporary silicone intubation in symptomatic patients receiving weekly docetaxel can prevent further closure of the lacrimal drainage apparatus and obviate more involved surgical interventions and permanent Pyrex glass tube placement. Cancer 2003;98:504-7.     

Improving the Results of Endonasal Dacryocystorhinostomy with Mitomycin C Application: A Prospective Case–Control Study

Many surgical advancement paved to surgical success in endonasal endoscopic dacryocystorhinostomy. Mitomycin C is a systemic chemotherapeutic agent derived from Streptomyces caespitosus that inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts. The objective of the study was to evaluate the advantage of mitomycin C in primary endoscopic endonasal dacryocystorhinostomy without stenting. Randomised case control design. Tertiary academic centre in central India. 112 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups with or without mitomycin C intraoperative application. 112 eyes underwent endoscopic-dacryocystorhinostomy. Additional surgeries were done according to necessity. Mitomycin C was applied in concentration of 0.4 mg/dl for 5 min. Patients were followed up on OPD-basis at the end of 1st week, 1st month, 3rd month and over phone call at end of 1 year. Symptomatic improvement assessed by verbal enquiry and clinically by syringing by ophthalmologist. 8 patients underwent septal surgery in case group and 4 in control group along with 1 concha bullosa correction in the case group (p?<?0.05). Nil intraoperative complications (p?<?0.05) and nil postoperative complication noted (p?<?0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96.5% at 3rd month in case group and 96.4% and 92.9% at 1 month and 3 month respectively in control group. Nasal endoscopy of all surgical failures showed restenosis in both case group and control group except 1 patient with granulation in control group. Eventhough intraoperative mitomycin C application is effective in increasing the success rate of endonasal DCR surgery in standard nasolacrimal duct obstruction, and with no significant complications from its use, the study did not show added benefit in the primary endoscopic endoscopic dacryocystorhinostomy without stenting.     

Analysis of 104 Cases of Endonasal Dacryocystorhinostomy in a Tertiary Care Hospital: A Prospective Study

To evaluate the results of endoscopic endonasal dacryocystorhinostomy performed in a tertiary care hospital. Prospective, nonrandomized, interventional clinical study. A prospective interventional study was performed on 104 patients presenting with epiphora between January 2006 and January 2010. All patients were operated by one surgeon. Out of 104 cases, 08 cases were of revision endonasal dacryocystorhinostomy (DCR). Bicanalicular silicon intubation was performed in all cases of revision endonasal DCR. Twelve patients had concomitant sinonasal disease for which septoplasty or FESS was done. The patency of nasolacrimal duct was assessed by doing syringing of lacrimal passage weekly for 1 month, monthly for 3 month, then at 6 month and 1 year. Out of 104 patients 10 patients lost follow up after surgery. Ninety four patients were followed for 1 year. On syringing, rhinostomy site was found patent in 80 patients (85.10 %), therefore they were fully satisfied. In 6 cases (6.38 %) minimal block was seen with clear fluid regurgitation, were to some extent symptomatically relieved and were found to be satisfied, whereas in 08 cases (8.51 %) syringing showed complete block. They required further management. Success rate of our study is comparable to other studies on endonasal DCR as well as external DCR, with advantages of less intra-operative bleeding, shorter operative time, better cosmesis, preservation of lacrimal pump mechanism. Other nasal pathology can be treated at the same time. Our results are clinically as well as statistically highly significant (P value < 0.0001).     

A study of 272 cases of endoscopic dacryocystorhinostomy

272 Patients with obstruction in nasolacrimal duct were treated by endoscopic nacryocystorhinostomy (DCR). The results were compared with that of external DCR and Endoscopic DCR without stent. In our study Endoscopic DCR with stening had better results. Endoscopic DCR with stenting has several advantages over the more conventional external approach and Endoscopic DCR without stenting. Results at 4 years of follow up have been good that is 98.6% patients were relieved of symptoms completely.     

Concept of foreign body-its past and present

Endoscopic endonasal dacryocystorhinostomy [EDCR] is considered to be a superior alternative technique to the conventional external dacryocystorhinostomy [DCR], both in primary and secondary cases. It is of particular value in children and young adults as it avoids an external scar. Sixteen cases of chronic dacryo-cystitis were treated by the endoscopic technique, including 8 revision cases of failed external approach. In all cases except one, a patent nasolacrimal fistula was noted, with a success rate of 93.7%. The authors share their experience in EDCR and review the relevant literature.     

Endoscopic dacryocystorhinostomy with conventional instruments: results and advantages over external dacryocystorhinostomy

Background

The aim of study is to evaluate the Endoscopic dacryocystorhinostomy (DCR) with conventional instruments, its results and advantage over external dacryocystorhinostomy (DCR).

Methods

The study group comprised of 127 patients who underwent consecutive endoscopic dacryocystorhinostomy. The cases operated by one team were included in the study to make the uniform analysis and its result. There were 48 males and 79 female in this study and male female ratio was 1:1.6. The mean age of the patient was 37 years (range from 16 years to 58 years). There were wide variety of cases like epiphora, lacrimal sac abscess, lacrimal sac fistula, acute dacryocystitis and road vehicular accident. All the patients had undergone non-laser, non-powered conventional instruments surgery under local anesthesia. The lighted probe was not used in any case for sac identification. The free flow of saline through newly created stoma during sac syringing was considered as successful criteria. The stent was used in two cases of road vehicular accident and in remaining 125 cases no stent was used. There were 66 cases of epiphora, 30 cases of lacrimal sac abscess, 26 cases of acute dacryocystitis, 3 cases of lacrimal fistula and 2 case of road traffic accident with multiple fractures. The average follow up period was 17 months (maximum follow up 3 years and minimum 4 months.)

Results

The success rate was 96 %.

Conclusion

The endoscopic DCR with conventional instruments is safe with very high success rate without any complications. It can be done in acute cases and very much suited for lacrimal sac abscess and lacrimal sac fistula.     

Endoscopic Endonasal Dacryocystorhinostomy: Best Surgical Management for DCR

EEDCR is a highly rewarding Endoscopic procedure for management of dacryocystitis when epiphora does not respond to medications or repeated syringing of nasolacrimal duct. It is a simple, less time consuming, safe but skilful, highly satisfying surgery both for the patients as well as the surgeons. There is very big advantage of EEDCR, it is close 100% successful procedure, even if there is recurrence of epiphora it is again correctable fully with no residual affects. EEDCR is far more superior to External DCR/Laser DCR and there are definite reasons for it. A total number of 578 cases have been operated by me from April 1, 2005 to March 31, 2011, only very few reoccurrences were there and they were corrected easily so much so that it can be said that it is a close 100% successful procedure and best surgical management of DACRYOCYSTITIS up to date. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing at the end of procedure and on follow up of patient.     

Management of Traumatic Dacryocystitis and Failed Dacryocystorhinostomy Using Silicone Lacrimal Intubation Set

The aim of this work is to study the management and success rate of traumatic dacryocystitis and failed dacryocystorhinostomy (DCR) using Silicone lacrimal intubation set. A prospective study was conducted at a tertiary eye care hospital, India from February 2006 to January 2008. This study material comprised 50 patients of traumatic dacryocystitis and failed dacryocystorhinostomy. Anterior single flap external dacryocystorhinostomy with Silicon intubation was performed in all the patients. The patients were followed up at weekly intervals for 1 month and thereafter every 2 months for 1 year post operatively. Criteria determining success were based on resolution of epiphora and patency on syringing. In traumatic dacryocystitis, 21(91.3%) cases fulfilled these criteria while 23(85.2%) cases of failed DCR were successful. The overall success rate (88%) was determined with an average follow-up of 1 year. Globally, the technique was effective in 85% of cases. The results were comparable with other similar studies. This study concludes that performing a DCR in traumatic dacryocystitis and failed DCR taking into consideration the complications and chances of failure is a challenge for the surgeon. We opine that External dacryocystorhinostomy with Silicon Intubation is one of the most effective modality in dealing with such cases.     

A comparative study of external and endoscopic endonasal dacryocystorhinostomy — a preliminary report

This prospective study was done ta compare the results of external and endonasal dacryocys-torhinostomy (DCR). 6 patients were studied under each group. Success rate for external DCR was 93.3% and endonasal was DCR 100%. The technique, merits and disadvantages of both the procedures are discussed as well as the advantages of endonasal DCR highlighted.     

Pediatric Endoscopic DCR: The Outcome in 50 Patients

Congenital nasolacrimal duct obstruction is a very common condition affecting 20 % of infants. Pediatric DCR is indicated when there is no response to previous therapy like probing, or is associated with recurrent dacryocystitis. This is a retrospective case series study of 50 pediatric patients who underwent endoscopic DCR in two centers, Jordan University Hospital/Jordan, and Mosul teaching and private hospitals/Iraq. The age ranged from 3 to 12 years with a mean of 6.2 years. The overall success rate of endoscopic DCR was 90 %, and failed cases were mainly due to presaccal obstruction. No major complications were reported, but minor complications occurred in about 60 % of cases. As a conclusion, endoscopic DCR is a safe and effective procedure in pediatric age group.     

Endoscopic DCR: How To Improve The Results

Since Toti described the initial dacryocystorhinostomy (DCR) operation in 1904 many technical modifications have evolved (Becker in Ophthalmic Surg 19:419–427, 1988). Overall, three groups of procedures are currently practised; external DCR, endoscopic DCR with contact laser, and surgical endoscopic DCR without laser (Woog et al. in Am J Ophthalmol 116:1–10, 1993; Jokinen and Karja in Arch Otolaryngol 100:41–44, 1974. Many factors influence the outcome of these different approaches. The purpose of this study was to improve the long term surgical outcome in endonasal DCR. A retrospective analysis of more than 1,500 patients, who underwent primary endoscopic DCR, was done and specific small modifications were identified and applied in the next 108 cases showing an improvement in the results.     

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.     

Should Silicone Lacrimal Stenting be a Better Choice for Primary Endoscopic Powered Dacryocystorhinostomy?

Objective: To compare endoscopic dacryocystorhinostomy (EnDCR) with and without silicone lacrimal stenting through subjective (patients’) and objective (surgeons’) outcome parameters. Methodology: Following defined selection criteria, EnDCR was performed on patients with primary chronic dacryocystitis with post-saccal stenosis. Every alternate patient had silicone lacrimal stenting (group A: no stenting; group B: with stenting); stents were removed at three months. At six months (minimum follow-up period), patients’ responses on symptom relief (through a five-point score) and naso-endoscopic evaluation (visualization of rhinostome; presence of granulations and synechiae; lacrimal drainage patency by estimating methylene blue flow pattern) were compared between the groups. Results: Each group had 20 patients. There was no statistically significant difference in group-wise follow-up periods. Five-point score at six months revealed 85% and 95% of patients in groups A and B, respectively, experienced “success”; among them, 60% and 75% were “symptom-free”. The majority (75%) in group B experienced no discomfort from stenting. Naso-endoscopy revealed 80% patients in group A and 65% in group B had well-delineated rhinostome, albeit with granulations in 25% and 50%, respectively. Spontaneous dye flow was achieved, respectively, in 75% and 90%. The difference in none of the subjective and endoscopic parameters achieved statistical significance. None had synechia; fibrosis was seen in the four patients with no dye flow even with pressure/massaging. Conclusion: There was no statistically significant difference in EnDCR with and without silicone lacrimal stenting in the overall outcome of symptomatic improvement and endoscopic assessment of the surgical site.