Transcanalicular Diode Laser Assisted Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction
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To evaluate the success rate of 980 nm transcanalicular diode laser-assisted dacryocystorhinostomy (TDL-DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO) and to consider the time and the reasons of failure.Hundred and thirty eyes of 125 patients who underwent of TDL-DCR for the treatment of PANDO are included in this retrospective, noncomparative, nonrandomized, interventional study. The mean follow-up time was 24.29 months (range 8-34 months). Functional success was described as disappearance of epiphora and presence of a patent ostium on lacrimal irrigation. Anatomical success was described as a patent ostium to irrigation but continuing epiphora. Patients with persistent epiphora and a closed ostium were classified as a surgical failure.At third month follow up, 85.4% of cases had complete resolution of their symptoms. The functional success rate decreased to 67.7% at 6 months, to 63.3% at first year, and to 60.3% at second year, while the patency of the lacrimal drainage system was restored in 93.1%, 74.6%, 69.5%, and 68.2% of the cases, respectively. The average total amount of delivered laser energy was 1322.7 J. No correlation could be found between the age of the patient, delivered laser energy, and the surgical success (p = 0.38, p = 0.62).Transcanalicular diode laser-assisted DCR is a fast and relatively easy alternative surgical method, which avoids a facial skin scar, to treat PANDO. The functional success rate is higher in the first months but decreases to low 60 %'s at the end of first year and remains the same at the second-year follow up.Keywords:
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Purpose: To evaluate the surgical results of endoscopic modified dacryocystorhinostomy (DCR). Methods: The authors operated on patients with upper punctal and canalicular obstruction associated with nasolacrimal duct obstruction and performed endoscopic modified DCR. One end of a lacrimal tube was passed into the nasal cavity through an excision site of the caruncle and internal ostium and the other end of the tube was inserted into the nasal cavity through a patent punctum and the newly created intranasal ostium. The two ends were tied together in the nasal cavity in modified DCR. Results: The primary success rate of modified DCR was 71.0%. Of the four failed cases, one underwent CDCR using Jones tube. Conclusions: The author's modified DCR may be a suitable alternative method to CDCR or DCR using monocanalicular silicone tube to relieve epiphora in patients with NLD obstruction associated with upper punctal and canalicular obstruction.
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This paper presents modifications to powered endoscopic dacryocystorhinostomy without stenting for the management of acquired nasolacrimal duct obstruction.A retrospective, non-randomised review.A total of 105 patients with epiphora secondary to acquired nasolacrimal duct obstruction were operated on by our modified powered endoscopic dacryocystorhinostomy approach.Of 105 patients, 100 (95.2 per cent) have remained asymptomatic. One patient with a narrow ostium had improved symptoms, while four patients continued to experience persistent symptoms (treatment failures).The modified powered endoscopic dacryocystorhinostomy approach led to excellent results, without bone exposure and granulations, and with early mucosalisation.
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A modification of the standard dacryocystorhinostomy (DCR) techniques using a self-retaining nasolacrimal catheter to act as a stent to improve the success rate of nasal ostium patency is described. A series of 21 DCRs performed on 19 patients is presented that includes eight procedures on previously failed DCRs, nine procedures on primary idiopathic obstruction of the nasolacrimal duct, and four procedures where trauma was the etiology. This technique has had no failures except for two procedures that failed because the catheter was too short. This prospective study over 3 years using this technique has resulted in no other cases of closure of the nasal ostium.
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This study aimed at determining the effect and safety of endoscopic dacryocystorhinostomy (ENDO-DCR) in initial 100 cases of nasolacrimal duct obstruction. This study was done in Kirkuk general hospital from 2010 to 2017 with a total of 100 cases. A standardized method was applied to all cases through employing an endonasal technique to the lachrymal sac. Then, an operative resection was applied to the mucosa of nose, lacrimal bone and a part of the anterior maxilla. Next, a complete removal of the medial wall of the lacrimal sac was done. A tube of canalicular silicone intubation was placed for 6 months after operation. The key results of such measures were epiphora resolution, lack of discharge and clearness of the ostium. The success of ENDO-DCR method with adjunctive tube of canalicular silicon intubation was demonstrated in 80 cases (80%) and 10 cases represented acceptable improvements. However, there were minor complications faced during or after operation period. Finaly Endoscopic dacryocystorhinostomy is a safe and effective method for treating nasolacrimal duct obstruction in adults and children with nasolacrimal duct obstruction and epiphora.
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<p class="abstract"><strong>Background:</strong> This study critically evaluates the effectiveness of mitomycin-C in conventional endoscopic dacryocystorhinostomy (ENDODCR) that minimizes the reclosure of a neo-ostium by retaining an enlarged marsupialized lacrimal sac.</p><p class="abstract"><strong>Methods:</strong> The combined retrospective and prospective study included 24 patients in the study group, who underwent endoscopic dacryocystorhinostomy in the Department of Otorhinolaryngology and Ophthalmology in a period of 1.5 years (June 2006 to January 2008). </p><p class="abstract"><strong>Results:</strong> An 83.33% primary success rate was observed, without any serious complications. Obstruction of the neo-ostium with granulation tissue was observed in 20.83% cases. Overall, the success rate of group I was 91.67% as compared to 75% in group II.</p><p class="abstract"><strong>Conclusions:</strong> Intra operative mitomycin-C application is effective in increasing the success rate of DCR surgery in standard nasolacrimal duct obstruction, and no significant complications resulted from its use.</p>
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ABSTRACT Purpose To determine the outcome and safety of endoscopic dacryocystorhinostomy (ENDO-DCR) with the use of silicon stents in nasolacrimal duct obstruction (NLDO). Materials and methods This study was done in the Department of Otorhinolaryngology and Head and Neck Surgery, Navodaya Medical College, Raichur, from January 2013 to June 2015, with a total of 82 cases (10 cases with bilateral disease) who underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely and canalicular silicone intubation tube was placed for 6 weeks postoperatively. Main outcome measures were resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation and endoscopic evaluation of neo-ostium at 6 weeks. Results The ENDO-DCR procedure with adjunctive canalicular silicone intubation tube was successful in 78 (95%) cases. No significant complications were encountered during or after the operative period. Conclusion Endoscopic dacryocystorhinostomy with canalicular silicon intubation for shorter duration (6 weeks) is a safe and successful procedure for the treatment of NLDO in adults as well as in children, with a success rate of 95%. How to cite this article Chavadaki JA, Manvikar AK, Shrikrishna BH. Endoscopic Dacryocystorhinostomy: Our Experience. Clin Rhinol An Int J 2017;10(2):49-52.
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Dacryocystorhinostomy, or DCR, is among the common oculoplastic surgeries for managing epiphora due to nasolacrimal duct obstruction [1–6]. It is a bypass procedure that creates an anastomosis between the lacrimal sac and the nasal mucosa via a bony ostium. The indication for the surgery includes persistent congenital nasolacrimal duct obstruction (CNLDO) unresponsive to previous therapies, primary acquired nasolacrimal duct obstruction (PANDO), and secondary acquired nasolacrimal duct obstruction (SALDO). There are two clear goals of a DCR procedure. One is to make a sizeable bony ostium into the nasal cavity, and that remains so. The second is to have a mucosal-lined anastomosis. Since both these purposes are equally well served by an external route, it can be one of the approaches with predictable and high success rates in primary and secondary nasolacrimal duct obstructions [1–6].
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Today's gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.
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<p class="abstract"><strong>Background:</strong> The purpose of the study was to determine the outcome and safety of endoscopic dacryocystorhinostomy (ENDO-DCR) with the use of silicon stents in nasolacrimal duct obstruction.</p><p class="abstract"><strong>Methods:</strong> This study was done in the department of otorhinolaryngology and head and neck surgery, Navodaya Medical College and Research Centre, Raichur, from January 2013 to June 2015, with a total of 82cases (10 cases with bilateral disease) underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely and canalicular silicone intubation tube was placed for six weeks post operatively. Main outcome measures were resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation and endoscopic evaluation of neo osteum at 6 weeks.</p><p class="abstract"><strong>Results: </strong>The ENDO-DCR procedure with adjunctive canalicular silicon intubation tube was successful in 78 (95%) cases. No significant complications were encountered during or after operative period</p><p><strong>Conclusions:</strong> Endoscopic dacryocystorhinostomy with canalicular silicon intubation for shorter duration (6 weeks) is a safe and successful procedure for the treatment of nasolacrimal duct obstruction in adults as well as in children with a success rate of 95%.</p>
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