Success Rate of External Dacryocystorhinostomy With and Without Stent.

Dacryocystorhinostomy (DCR) is a procedure that bypasses an obstruction in the nasolacrimal duct system. DCR can be categorized into two primary techniques: external and endoscopic. This review aims to assess the success rate of external DCR procedures, both with and without the use of a stent. This study compared the outcomes of primary DCR with and without silicone intubation in multiple studies. The reviewed studies consistently showed that silicone intubation significantly improves the success rates of DCR, with success rates ranging from 80% to 95%. The involved studies suggest that silicone intubation offers specific advantages in complex cases involving distant and common canaliculus blockages and recurrent DCR surgeries. This review emphasizes that multiple studies have documented higher success rates of external dacryocystorhinostomy (DCR) when silicone tubes are utilized as stents. Furthermore, external DCR has been identified as the preferred procedure among medical professionals.

Anatomical requirements for dacryocystorhinostomy ostium patency.

PURPOSE: To identify anatomical factors affecting the outcome of dcryocystorhinostomy (DCR). METHODS: The study included the results of dacryocystography in 73 patients after DCR: 37 cases of failed DCR and 36 cases of successful DCR. Biometric characteristics of the formed ostium were evaluated: the horizontal size of the bony "window" and the soft tissue part of the ostium, the vertical size of the bony "window" and soft tissue ostium, the height of the fragment of the remaining bone above and below the line of the common canaliculus, and the height of the "pocket" formed below the lower edge of the ostium. Statistical analysis was performed using parametric and non-parametric statistical methods. Differences were considered significant at p ≤ 0.05. RESULTS: Intergroup differences were identified in the values of the maximum horizontal size of the bony "window" (p = 0.015), the maximum horizontal size of the soft tissue "window" (p < 0.001), the maximum vertical size of the soft tissue "window" (p < 0.001), and the height of the fragment of the remaining bone below the level of the common canaliculus to the edge of the formed ostium (p = 0.004). CONCLUSION: The stage of forming the bony "window" influences the success of DCR. Not only the position of the "window" is important, but also the geometric properties of the formed ostium.

Application of articaine in endoscopic endonasal dacryocystorhinostomy: a retrospective study.

Background: To investigate the comparative effects of local anesthesia using lidocaine with adrenaline vs. articaine with adrenaline in endoscopic endonasal dacryocystorhinostomy (EN-DCR). Methods: This retrospective study included a total of 180 patients. These patients were categorized into two groups: the lidocaine group, which received 2% lidocaine (1:100,000 adrenaline), and the articaine group, which received 4% articaine (1:100,000 adrenaline) for local anesthesia. The study compared anesthesia efficacy, intraoperative pain levels, intraoperative bleeding, as well as differences in heart rate and blood pressure between the two groups. Results: The articaine group demonstrated a significantly lower visual analog scale (VAS) pain score when compared to the lidocaine group, measuring at 4.4 ± 0.6 cm vs. 5.0 ± 1.0 cm, respectively (P < 0.0001). Additionally, the articaine group exhibited a higher anesthesia efficacy compared to the lidocaine group (89.0% vs. 76.6%, p = 0.0487). Notably, the articaine group experienced less nasal mucosal bleeding during the surgery in contrast to the lidocaine group (p = 0.004). However, there were no statistically significant differences in changes in blood pressure and heart rate between the two groups (p > 0.05). Conclusion: This study demonstrated that 4% articaine (1:100,000 adrenaline) has superior clinical effectiveness in comparison to 2% lidocaine (1:100,000 adrenaline) in EN-DCR.

Assessing the relationship of agger nasi pneumatization to the lacrimal sac: a dynamic computed tomography-dacryocystography analysis.

Background: An understanding of the anatomical structure is crucial for completing successful endoscopic dacryocystorhinostomy (DCR) surgery. This study aimed to precisely delineate the spatial relationship between the lacrimal sac and the agger nasi cell (ANC) and evaluate the impact of ANC on surgical strategies in endoscopic DCR. Methods: This retrospective cross-sectional study included 110 Han Chinese patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO) from January 2021 to June 2023. This study was conducted in Eye, Ear, Nose, and Throat Hospital of Fudan University and involved inpatient participants who were scheduled for DCR surgery under general anesthesia. Patients were consecutively enrolled. The patients underwent preoperative computed tomography-dacryocystography (CT-DCG), and contrast-enhanced images were used to locate the positions of the lacrimal sac and the common canaliculus. A dynamic approach was adopted to analyze the multiplanar CT imaging, facilitating a detailed assessment of the morphology of the lacrimal drainage system and potential overlap of the lacrimal sac. Patient ages and measured values are presented as the mean ± standard deviation, which were measured three times by the same observer and averaged for statistical analysis. Results: The prevalence of ANC in this study was 90.9% (100/110). Dynamic examination revealed that only 42.7% (47/110) of ANCs appeared as discrete cells, while the majority were connected to nearby sinus openings. Spatial analysis showed that in 57 out of 110 cases, ANCs were situated below the common canaliculus and not posterior to the lacrimal sac, indicating an overlap rate of 51.8%. Notably, our dynamic approach identified five critical cases of overlap below the level of the common canaliculus, which might have been missed by prior studies that used different methodologies. Conclusions: More than half of the ANCs exhibited overlap with the lacrimal sac, suggesting a significant proportion may necessitate opening during endoscopic DCR procedures. ANCs are often interconnected with adjacent nasal sinuses, necessitating careful consideration in the decision to open the ANCs during surgery. The dynamic evaluation employed in CT-DCG effectively assessed the extent of ANC coverage over the lacrimal sac.

Role of paranasal abnormalities and systemic inflammation on primary acquired nasolacrimal duct obstruction.

BACKGROUND: To determine the paranasal changes and inflammatory markers that may cause primary acquired nasolacrimal duct obstruction (PANDO) and to determine their relationship with success rates on different types of surgeries. MAIN BODY: We retrospectively reviewed the blood sample and computed tomography (CT) results on 92 patients who underwent dacryocystorhinostomy (DCR) surgery for PANDO and 82 healthy controls. Age, gender, paranasal abnormalities, hemogram values, International Normalized Ratio (INR) values, type of surgery, and recurrence rate were recorded; systemic Immune-inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), monocytes-to- lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) were calculated in both groups. In the case group, total white blood cells, monocytes, and INR values were significantly lower (p < 0.05). Platelet, lymphocyte, neutrophil, PLR, MLR, NLR, and SII values did not differ significantly between the control and case groups (p > 0.05). There was no significant difference in the CT results between the groups (p > 0.05). No correlation was found between CT findings and inflammatory markers. Dacryocystitis (DC) was seen in 20% of patients and they were all in the case group. No correlation was found between recurrence rate and age, gender, type of surgery, CT findings, and blood results (p > 0.05). The recurrence rate was significantly higher in patients with bilateral PANDO and with DC (p < 0.05). SHORT CONCLUSION: The incidence of PANDO may not be directly related to paranasal abnormalities and systemic inflammation. Low INR values may cause obstruction in the nasolacrimal duct. Age, gender, type of surgery, CT findings, and inflammation level do not affect the success of the surgery.

Pre-Operative Planning of a DCR Surgery Using Virtual Reality.

PURPOSE: To assess a novel Virtual Reality (VR) tool designed to enhance understanding of the nasal anatomy in patients eligible for DCR surgery. METHODS: Preoperative Computed Tomography (CT) scans of the orbit were obtained and loaded as DICOM (Digital Imaging and Communications in Medicine) files onto the D2P software (3D Systems Inc. Littleton, CO) for tissue segmentation and 3D model preparation. Segmentation was performed on several anatomical structures, including the skull, lacrimal sac, nasal septum, inferior and middle turbinate. The resulting 3D model was visualized using a VR headset. After completing the segmentation procedure, ten cases were evaluated by a panel of six surgeons, including both senior and resident physicians from ENT and oculoplastic specialties. RESULTS: The dataset under examination comprised images from 10 preoperative CT scans of the orbits of patients eligible for Endo-DCR. When evaluating the CT using the VR tool, in 73.3% of the cases ENT surgeons were right about the side of pathology, while only 43.3% ophthalmologists were right (chi-square, p = .018). In 72.8% of the cases ENT surgeons were evaluated right that there is a septum deviation, while only in 47.2% of the cases the ophthalmologists were right (chi-square, p = .094).When evaluating the CT using the VR tool, in 60% of the cases consultants were right about the pathology, while 57.7% of the residents were right (chi-square, p = .853). In 81.7% of the cases consultants were evaluated right that there is a septum deviation, while only in 58.3% of the cases the ophthalmologists were right (chi-square, p = .198). DISCUSSION: ENT surgeons, as well as consultants, interpreted the CT better than the ophthalmologists and residents. Surprisingly, the VR system did not help them to interpret the CT better. Further, more extensive studies should be done to build a VR system that assists in the correct interpretation of the preoperative CT before DCR surgery as well as during DCR surgery.

Classical vs. Retrograde Endoscopic Dacryocystorhinostomy: Analyses and Comparison of the Results.

Background: In endoscopic dacryocystorhinostomy (DCR), surgical landmarks such as the maxillary line (ML) and the axilla of the middle turbinate (MT) guide the surgeon in identifying the lacrimal sac. The primary surgical risk associated with the classical technique, which involves directly opening the lacrimal sac, is the height of the bone drilling on the projection of the lateral wall of the nasal fossa. This poses a significant risk of damaging the orbit, the floor of the frontal sinus, and the anterior skull base. Furthermore, the anatomical variability in size and location of the lacrimal sac poses a risk for difficult and precise surgical identification. Recently, a 'retrograde' technique has been introduced to safely identify and expose the lacrimal sac. The aim of this study is to compare the results of retrograde DCR (rDCR) to a classic technique (clDCR), in terms of clinical recurrence and complications. Methods: A retrospective study on a cohort of 35 patients who underwent DCR at the ENT Department of the Modena University Hospital between January 2010 and October 2022 (18 clDCR and 17 rDCR) was performed. Minimum postoperative follow-up for inclusion was 12 months. We used the Fisher's exact test to compare the two techniques, comparing functional outcomes and clinical recurrence rates. Results: Clinical recurrence of nasolacrimal stenosis in clDCR patients was 50%, compared to 6% in those who underwent rDCR (p-value 0.005). Postoperative surgical complications were not significantly different between the two groups (p > 0.05). Conclusions: rDCR is a safe technique and has been shown to be a statistically more effective surgical technique than clDCR in reducing clinical recurrence rates.

Regression course of ostium granulomas under topical intranasal steroids coverage after endoscopic dacryocystorhinostomy.

This study aimed to elucidate the regression process of ostium granulomas under the usage of intranasal steroid after primary endoscopic dacryocystorhinostomy (DCR). The authors retrospectively reviewed 57 patients (a total of 72 ostia) who had ostium granulomas after primary endoscopic DCR between 2011 and 2015. Topical intranasal steroid spray was applied in all the patients since postoperative day 1. Adjunctive intralesional triamcinolone acetonide injections were administered for extensive and large-sized granulomas that caused impending ostium blockage. Sequential regression of the ostium granulomas and success rates of DCR were assessed using endoscopic photos. The granulomas completely disappeared in 69 (95.8%) ostia, and the average time interval from the surgery to the disappearance was 6.9 ± 2.8 months. Anatomical and functional surgical success rates were 90.3% and 84.7%, respectively. Intralesional steroid injections for ostium granulomas did not alter the outcomes compared to topical intranasal steroid usage significantly (p = 0.445). In conclusion, we observed that, by continuing the usage of intranasal steroids, ostium granulomas disappear gradually at postoperative 6 months. The intranasal surgical manipulation of granulomas, which results in more mucosal cicatricial change and impedes patient satisfaction, can be successfully avoided.

Retrospective study in 1020 cases on the rate of surgical site infections after lacrimal surgery without prophylactic systemic antibiotics.

BACKGROUND/AIMS: Data regarding the effectiveness of prophylactic systemic antibiotics (PSA) in lacrimal surgery is scarce. Therefore, we determined the postoperative surgical site infection (SSI) rate in lacrimal surgery without PSA. METHODS: We retrospectively analysed files of patients who underwent external (extDCR) or endoscopic endonasal dacryocystorhinostomy (endoDCR). We excluded patients with incomplete data (n = 68), acute a priori infection with the need for antibiotics (n = 15) and PSA post-operatively for other reasons (n = 28). Indications for surgery were canalicular stenosis (n = 51, 18.6% endoDCR vs n = 131, 19.5% extDCR), nasolacrimal duct obstruction (n = 118, 43.2% endoDCR vs n = 480, 64.3% extDCR) and mucocele/chronic dacryocystitis (n = 52, 19.0% endoDCR vs n = 187, 25.0% extDCR). RESULTS: In this study, 1020 DCR surgeries were performed in 899 patients. Postoperative SSI was diagnosed in eight patients (0.8%); exclusively after extDCR (1.1% of all extDCR). No SSIs were found in endoDCR cases. The prevalence between SSI in extDCR versus endoDCR did not prove significant (n = 8/747 0.8% vs n = 0/273 0%, p = 0.13). All patients diagnosed with SSI were successfully treated with systemic oral antibiotics. CONCLUSION: The prevalence of SSI after DCR is low and was effectively treated with oral antibiotics. In our study, SSI occurred rarely after extDCR and was not observed after endoDCR. We conclude that lacrimal surgery is safe without the routine administration of PSA.

Management and outcomes of congenital nasolacrimal duct obstruction in trisomy 21 patients vs. non-trisomy 21 patients within a paediatric population: a 5-year follow-up.

PURPOSE: To assess the management of patients with congenital nasolacrimal duct obstruction (CNLDO) in a paediatric population and review the long-term outcomes over a 5-year interval, with particular emphasis on the difference between patients with trisomy 21 and those without trisomy 21. METHODS: This single-centre, retrospective, cross-sectional, case review study included patients suffering from CNLDO at Alder Hey Children's Hospital NHS foundation Trust. Patients were divided into two groups: Non-trisomy 21 and trisomy 21. Patients were followed-up for a 60-month interval. Patients aged <12 months at the time of surgery, patients with <60 months of follow-up data and patients with acquired nasolacrimal duct obstruction were excluded. The main outcome measures were discharge rates in patients undertaking primary intervention with syringe and probe (S&P), number of patients requiring further treatment with lacrimal intubation or dacryocystorhinostomy (DCR) and overall symptom-free periods post-treatment. RESULTS: Ninety-three patients (142 eyes) were included. The mean number of surgical interventions was 1.53 ± 0.65. The mean interval between the 1st and 2nd intervention was 15.54 ± 16.33 months. There was a trend towards greater success rates non-trisomy 21 patients versus patients with trisomy 21 (p = 0.1352). The average symptom-free period after the final intervention was 44.31 ± 20.68 months, significantly longer in the non-trisomy 21 group compared to the trisomy 21 group (p = 0.0074). CONCLUSIONS: The overall success rate after primary S&P was 55.9%. Our results suggest that in trisomy 21 patients suffering from CNLDO, a one-stage intervention with primary monocanalicular intubation should be considered instead of sequential approach.

Efficacy of adjuvant mitomycin-C and triamcinolone-impregnated nasal packing for endoscopic dacryocystorhinostomy.

AIM: To compare the success rate and complications of adjuvant use of mitomycin C and triamcinolone-impregnated biodegradable nasal packing (TABP) in endoscopic dacryocystorhinostomy (DCR). And to evaluate the efficacy of combining intraoperative mitomycin C and TABP for endoscopic DCR. METHODS: A total of 198 eyes of 148 patients who underwent endoscopic DCR for acquired nasolacrimal duct obstruction were retrospectively analysed. The patients were randomly divided into three groups: Group A included patients treated without intraoperative mitomycin C but with TABP, Group B included patients treated without triamcinolone but with intraoperative mitomycin C and normal saline-impregnated nasal packing, and Group C included patients treated with intraoperative mitomycin C and TABP. RESULTS: The results revealed no significant difference in the overall success rates between Groups A (86.8%) and B (89.2%; P=0.377). However, Group C (97.5%) showed a significantly higher overall success rate than Groups A and B. The incidence of granulomas was significantly lower in group C (5%) than in Groups A (20.8%) and B (15.2%; P=0.009). Other complications, such as crust, synechiae, and revision surgery, did not differ significantly among the three groups. CONCLUSION: The combination of intraoperative mitomycin C and TABP effectively prevents granulomas and enhances surgical success rate. Additionally, there is no statistically significant difference observed between the use of mitomycin C or TABP alone.

Congenital Nasolacrimal Duct Obstruction - Early Diagnosis and Graded Therapeutic Approach as Key Points for Successful Management.

PURPOSE: Epiphora in childhood is a frequent symptom that is typically associated with Congenital nasolacrimal duct obstruction (CNLDO). Nevertheless, inflammatory pathologies of the ocular surface as well as inside the eye, or even congenital glaucoma, must be considered in the differential diagnosis. METHODS: A comprehensive literature review concerning CNLDO was conducted. Different therapeutic steps are categorized and summarized in order to reflect the existing staged therapeutic concept. RESULTS: For CNLDO, a staged therapeutic concept is applicable, resulting in a cure rate of approximately 95% with only conservative or minimally invasive intervention. This concept includes five steps that encompass therapeutic interventions with increasing complexity. It includes conservative techniques, followed by probing and syringing, transcanalicular approaches without or with lacrimal intubation, and dacryocystorhinostomy which is the ultima ratio. CONCLUSION: To preserve the topographic anatomy as much as possible, therapeutic recommendations enable stepwise and individualized management of children with CNLDO.

Exclusive or combined endoscopic approach to tumours of the lower lacrimal pathway: review of the literature.

A literature review was conducted to assess the role of minimally-invasive endoscopic treatments for lacrimal pathway neoplasms. The study involved the analysis of 316 patients with benign or malignant tumours affecting the lacrimal drainage system. Histologically, the analysis revealed a prevalence of squamous cell carcinoma, followed by lymphatic neoplasms and melanomas. In terms of treatment, minimally-invasive endoscopic approaches, such as endoscopic dacryocystorhinostomy, play a predominant role in managing early-stage tumours, rather than merely obtaining samples for histological analysis. For more extensive tumours, which constitute the majority of cases, more aggressive external approaches are required, along with the use of adjuvant radiotherapy and chemotherapy. The lack of universally shared staging systems poses a limitation in standardisation and comparison of results. Treatment of these tumours remains complex due to their rarity and histological heterogeneity. A multidisciplinary approach is mandatory to optimise outcomes.

[Pharmacological prevention of fibrosis in dacryosurgery]. / Medikamentoznaya profilaktika fibrotizatsii v dakriokhirurgii.

Chronic inflammatory process in the lacrimal drainage system is the main etiological factor leading to dacryostenosis and consequent obliteration - partial and total nasolacrimal duct obstruction. Prevention of this process is an urgent problem in dacryology. Currently, there is very little research on the development and use of conservative methods for treating dacryostenosis using anti-inflammatory, as well as anti-fibrotic drugs. In this regard, the main method of treating lacrimal drainage obstruction is dacryocystorhinostomy. However, the problem of recurrence after this operation has not been resolved. The causes of recurrence can be cicatricial healing of dacryocystorhinostomy ostium, canalicular obstruction, formation of granulations and synechiae in its area. Surgical methods of recurrence prevention are associated with possible complications, and there is conflicting data on the feasibility of their use. Based on this, the development of pharmacological methods for the prevention of fibrosis in dacryology is promising, among which the antitumor antibiotic Mitomycin C is the most studied. However, there are no specific scientifically substantiated recommendations for the use of this drug, and the data on its effectiveness vary. This has prompted researchers to look for and study alternative anti-fibrotic agents, such as antitumor drugs, glucocorticoids, hyaluronic acid, small molecule, biological, immunological and genetically engineered drugs, as well as nanoparticles. This review presents the current data on the efficacy and prospects of the use of these drugs in dacryology.

[Dacryocystorhinostomy with a counteropening in the treatment of secondary nasolacrimal duct obstruction after radioiodine therapy]. / Dakriotsistorinostomiya s nalozheniem kontrapertury pri vtorichnoi obliteratsii slezootvodyashchikh putei vsledstvie terapii radioaktivnym iodom.

Among secondary forms of nasolacrimal duct obstruction caused by radioactive iodine therapy, its distal forms localized in the area of the Hasner's valve are predominant. In this regard, during dacryocystorhinostomy (DCR) there is a high probability of developing the sump syndrome, for which the anatomical prerequisite is that the lower edge of the DCR ostium is above the level of obstruction. In such cases, we propose to supplement DCR with a counteropening in the area of the Hasner's valve. PURPOSE: This study analyzes the clinical effectiveness of dacryocystorinostomy with a counteropening. MATERIAL AND METHODS: The outcomes of 49 surgeries (49 patients) with secondary acquired nasolacrimal duct obstruction due to radioactive iodine therapy were analyzed, including 34 DCR and 15 DCR with a counteropening. The clinical outcomes were analyzed over the longest possible period after surgery. The analysis included the severity of tearing on the Munk scale, the characteristic of the formed ostium on the M. Ali scale and the height of the tear meniscus. Differences were considered significant at a confidence level of 95% (p≤0.05). RESULTS: Analysis of the results of the performed surgeries showed that DCR was clinically effective in 30 (88%) cases, DCR with a counteropening - in 15 (100%) cases. The differences were not statistically significant in the total sample, but were statistically significant when comparing the results of surgeries in patients with distal obliteration. CONCLUSION: The developed and clinically tested method of DCR with a counteropening in the area of the Hasner's valve was completely effective in 15 patients with secondary nasolacrimal duct obstruction caused by radioiodine therapy.

Primary Dacryocystorhinostomy for Acute Dacryocystitis: A Systematic Review.

INTRODUCTION: Acute dacryocystitis is a common condition occurring secondary to nasolacrimal duct obstruction. We aim to assess the efficacy of primary dacryocystorhinostomy for the management of acute dacryocystitis. METHODS: A systematic search of the databases PubMed/MEDLINE, Embase, and CENTRAL was performed to December 2023. Data extraction and risk of bias analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Fourteen articles fulfilled inclusion criteria. The results demonstrated that for the treatment of acute dacryocystitis, primary dacryocystorhinostomy (DCR) is anatomically and functionally efficacious, with low complication rates and minimal risk of recurrence. The anatomical success rates for primary endonasal DCR (EnDCR) were 81.8-100%, 83.8-87.5% in delayed EnDCR and 66-100% in delayed external DCR (ExDCR). Functional success was generally defined as a subjective absence of epiphora, which was achieved in 86.4-92.0% of primary EnDCR, and 0-89.5% of the delayed ExDCR cohorts. Two randomized controlled trials established equivalent rates of functional success between primary versus delayed EnDCR (87.5% vs 87.5% and 91.3% vs 92.3%). Increased perioperative bleeding was recorded in 27.8% of primary EnDCR cases in 1 study. ExDCR was infrequently associated with postoperative fistula and scar formation and cicatricial punctal ectropion. The mean length of admission trended to be shorter when the procedure was performed closer to the acute presentation. The admission time for all primary EnDCR cases varied between 1 and 7 days. CONCLUSION: Primary dacryocystorhinostomy is an efficacious and safe management option for acute dacryocystitis. Further analyses of health-economics are required.

External dacryocystorhinostomy: A critical overview of the current evidence.

PURPOSE: External dacryocystorhinostomy (ext-DCR) is still considered the gold standard in the treatment of distal lacrimal duct obstruction. Despite an overall high success rate, some patients do relapse after surgery and the ideal perioperative management has not been identified yet. The purpose of this study is to critically discuss the published evidence in the last five years on the medical and surgical management of external dacryocystorhinostomy. Furthermore, the drawbacks of the available literature and the perspectives in this field will be also highlighted. METHODS: Systematic review of the literature in the last 5 years by using PubMed and Google Scholar. RESULTS: A total of 64 articles were included. Many technical modifications and surgical refinements have been proposed but a formal comparison among the various techniques is hampered by methodological heterogeneity. The use of local anesthesia, and the perioperative adjunctive techniques to reduce the risk of restenosis are also gaining popularity but the level of evidence remains weak. CONCLUSION: Ext-DCR offers satisfactory clinical outcomes even though there are many gray areas that need to be addressed in future high-quality studies.

Alterations of lacrimal sac vasculature in lacrimal disorders: Chromo endoscopic assessment with changes in effective spectral response.

PURPOSE: To study the structural and dynamic alterations in the lacrimal sac vasculature of patients with congenital, primary, and secondary acquired nasolacrimal duct obstructions (CNLDO, PANDO, SANDO) and patients with acute dacryocystitis (AD) and failed dacryocystorhinostomy (DCR). METHODS: A prospective study was performed on 65 consecutive lacrimal sacs following their complete exposure during endoscopic dacryocystorhinostomy. High magnification chromo endoscopy and changes in effective spectral response was achieved using the Storz professional image enhancement system (SPIES®). Structural characteristics studied include vascular arrangement, superficial and deep vessels, vessel calibers on cut section, abnormal branching, localized and generalized dilatations and pathologies like varices. Flow characteristics in different caliber vessels and their alterations were assessed in Spectra A mode of SPIES®. RESULTS: Distinct vascular alterations were noted in several lacrimal disorders. Vascular dilatations differed between the fundus and the body segments of the lacrimal sac, except in cases of traumatic SANDO and prior failed DCRs. 23% (7/30) of PANDO sacs showed peri sac varices and severe tortuosity. The flow in the dilated vessels was either very slow or showed intermittent backflow. Moderate dilatation of peri sac venous plexus with distinct surface linear vessels was noted in CNLDO. The cut surface of the sac wall and luminal surface differentially demonstrated several vascular patterns like speckled, scattered, branched loops, and skip areas in various diseased states. CONCLUSION: The present study found distinct alterations of lacrimal sac vasculature in several lacrimal drainage disorders and provides impetus to the vascular theory for pathogenesis of PANDO.

A Comparative Study of Endoscopic Endonasal Dacryocystorhinostomy Using an Inferiorly Based Flap Versus a Posteriorly Based Flap.

To evaluate the outcome and complications of Endoscopic endonasal Dacryocystorhinostomy (DCR) using an inferiorly based mucosal flap as compared to a conventional posteriorly based mucosal flap with flap preservation and no stenting. 36 patients presenting with nasolacrimal duct obstruction were divided into two groups: the first group underwent endoscopic DCR using an inferiorly based mucosal flap, and the other group used a posteriorly based mucosal flap. In both groups, the mucosal flap was preserved, and bone was removed using Kerrison's punch. No stenting was done in any of the cases. The patency of the ostia was determined by syringing, and nasal endoscopy was done to look at the neo-ostium at follow-up visits to determine success and complications in each group. All 18 cases in the inferiorly based flap group had patent ostia with good mucosalization of the neo-ostium at 6-month follow-up. 3 of the 18 cases in the conventional posteriorly based flap group had failure due to granulation tissue formation around the neo-ostium. The use of an inferiorly based mucosal flap is easy to fashion and reposition at the end of the surgery. This technique has a good outcome with patent ostia during the follow-up period of 6 months.

Endoscopic and External Dacryocystorhinostomy: Long Term Result from a Tertiary Center in Portugal.

Dacryocystorhinostomy is the gold-standard for distal lacrimal obstructions. This study aims to report the demography, clinical presentation, influence of agger nasi opening, uncinectomy and septoplasty, the use of silicone stent tubes, complications and success of endoscopic and external dacryocystorhinostomy over a period of 11 years. Retrospective review of clinical records, from January 2012 to December 2022, at a tertiary center in Portugal. A total of 249 procedures, 6 external and 243 endoscopic, were performed, including 39 revision cases. There was a female predominance (79.9%) with a mean age at diagnosis of 66.4 years. Recurrent acute dacryocystitis, reported by 33.3%, was associated with higher success (p = 0.053). Agger nasi opening, uncinectomy and septoplasty were performed in 17.7%, 6.0% and 15.3% respectively, although associated with higher success rates, no statistically significant difference was found. Minor complication rates for both external and endoscopic approach was 33.3% and 32.1% respectively. Functional and anatomical success was 100% and 83.3%, respectively, for external dacryocystorhinostomy, and 91.4% and 85.1%, respectively, for endoscopic dacryocystorhinostomy. Revision surgery was associated with a worse anatomical success (p = 0.05). Endoscopic dacryocystorhinostomy is an effective and safe alternative to the external approach. Minor procedures can increase the success rate, but multicentre studies need to be performed for a statistically significant result.