[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.

[Disorders of lacrimal drainage: the way from theory to practice]. / Narushenie slezootvedeniya: put' ot teorii k praktike.

The article summarizes the results of research conducted over the past decade concerning the current problems of dacryology, analyzes the improvements made to the methods of diagnostics used in disorders of lacrimal passages on the basis of modern imaging and functional studies, describes the techniques aimed at improving the clinical effectiveness of the intervention, as well as drug and non-drug methods of intraoperative prevention of excessive scarring in the area of the artificial ostium. The article also analyzes the experience of using balloon dacryoplasty in relapses of tear duct obstruction after dacryocystorhinostomy, and presents the modern minimally invasive surgical techniques, including nasolacrimal duct intubation, as well as balloon dacryoplasty and endoscopic plastic surgery of the ostium of the nasolacrimal duct. Additionally, the work lists the fundamental and applied tasks of dacryology and outlines promising directions of its development.

[Optical coherence tomography in the diagnosis of pathologies of the horizontal portion of the lacrimal drainage system]. / Opticheskaya kogerentnaya tomografiya v diagnostike patologii gorizontal'nogo otdela slezootvodyashchikh putei.

This article reviews literature on the use of optical coherence tomography in studying the anatomical structure of the proximal lacrimal drainage system, as well as in diagnosing its pathological changes. Determining the reference values of the parameters of the lacrimal punctum and the lacrimal canaliculus remains an important issue. The review describes the advantages and disadvantages of this method, as well as the prospects for its application in clinical practice.

[Punctal stenosis: etiology, diagnosis, treatment]. / Stenoz sleznoi tochki: etiologiya, diagnostika, lechenie.

This article reviews etiological factors in the development of lacrimal punctal stenosis, modern diagnostic techniques, as well as both conservative and surgical treatment methods. The presented analysis is based on data from 67 literary sources, which provide information on conventional and high-tech examination and treatment methods of patients with lacrimal punctal stenosis. Particular attention is paid to various aspects of punctoplasty - the most common surgical intervention used to treat this pathology.

[Experimental investigation of the efficacy of pirfenidone in prevention of ostium cicatricial closure after dacryocystorhinostomy]. / Eksperimental'noe obosnovanie effektivnosti pirfenidona v predotvrashchenii rubtsovogo zarashcheniya iskusstvennogo soust'ya posle dakriotsistorinostomii.

One of the main reasons of failure of dacryocystorhinostomy (DCR) is cicatricial closure of the ostium. Finding a way to prevent this outcome remains one of the leading aims of research in dacryology. The effectiveness of the most widespread methods is often considered contradictory by various researchers. Pirfenidone is a small-molecule agent that demonstrated good antifibrotic effect and low toxicity in previous in vitro research. There haven't been any in vivo studies of its intraoperative use in DCR.Purpose - to determine the in vivo efficacy of pirfenidone in prevention of ostium cicatricial closure following dacryocystorhinostomy in an animal experiment. MATERIAL AND METHODS: The study was conducted on 18 Chinchilla rabbits. They were divided into 3 groups and each animal underwent modified dacryocystorhinostomy. On the final stage of surgery rabbits of group 1 were injected 1 ml of 0.15 mg/ml pirfenidone solution, rabbits of group 2 - 0.3 mg/ml pirfenidone solution. No injections were performed in group 3. Animals were terminated on days 7 (6 rabbits), 14 (6 rabbits) and 28 (6 rabbits) following surgery. Lacrimal stoma patency was evaluated in vivo by irrigation, and morphologically postmortem. Tissue samples obtained from the stoma area were examined histologically for signs of fibrosis. RESULTS: Failure of dacryocystorhinostomy was observed in 4 out of 18 cases: all rabbits of group 3 terminated on days 14 and 28. The most pronounced morphological signs of fibrosis were also noted in group 3. No topical or systemic adverse effects of the medication were observed in groups 1 and 2. CONCLUSION: Pirfenidone demonstrated high antifibrotic efficacy and low toxicity in experimental dacrycystorhinostomy in rabbits. These results provide grounds for further research into the use of pirfenidone in dacrycystorhinostomy.

[Modern methods in treatment of lacrimal system vertical part obliteration]. / Sovremennye metody lecheniya obliteratsii vertikal'nogo otdela slezootvodyashchikh putei.

A review of the literature is devoted to the description of modern methods in treatment of lacrimal system vertical part obliteration. Particular attention is paid to various aspects of the most common surgical intervention - endonasal endoscopic dacryocystorhinostomy.

[Endonasal balloon dacryoplasty in partial and complete obstruction of dacryocystorhinostomy ostium]. / Endonazal'naya ballonnaya dakrioplastika pri chastichnom i polnom zarashchenii dakriostomy.

Despite the success of dacryocystorhinostomy (DCR) in the treatment of lacrimal drainage system (LDS) obliteration and the use of medical and surgical methods to prevent its recurrence, the number of relapses reaches 37%. The main etiological factor leading to this pathology is partial (stenosis) or complete obstruction of the ostium. PURPOSE: To study the effectiveness of endonasal balloon dacryoplasty in partial or complete obstruction of dacryocystorhinostomy ostium. MATERIAL AND METHODS: The study involved 122 patients (127 cases) with relapse after endonasal endoscopic dacryocystorhinostomy performed 6 months to 3 years ago to treat partial or complete obstruction of lacrimal sac neck. Patients of the 1st group (41 cases) underwent endonasal balloon dacryoplasty, patients of the 2nd group (42 cases) underwent endonasal balloon dacryoplasty with bicanalicular silicone stenting, patients of the 3rd group (44 cases) underwent revision endonasal endoscopic dacryocystorhinostomy with bicanalicular silicone stenting. RESULTS: After 12 months follow-up, positive results were observed in 85.7% of cases with ostium stenosis and 80.0% of cases with complete obstruction of the ostium among group 1 patients; in 86.4% of cases with ostium stenosis and 85.0% of cases with complete obstruction of the ostium among group 2 patients; and in 81.0% of cases with ostium stenosis and 82.6% of cases with complete obstruction of the ostium among group 3 patients. CONCLUSION: The obtained results give grounds to recommend inclusion of endonasal balloon dacryoplasty in the standards of treatment for patients with partial (stenosis) and complete obliteration of dacryocystorhinostomy ostium.

[Transcanalicular balloon dacryoplasty for the treatment of post-dacryocystorhinostomy recurrent stenoses]. / Transkanalikulyarnaya ballonnaya dakrioplastika ­ metod lecheniya retsidiva posle dakriotsistorinostomii.

PURPOSE: To compare the effectiveness of minimally invasive techniques used for the treatment of common canalicular (CC) ostium stenosis (or obliteration) in post-dacryocystorhinostomy (post-DCR) patients. MATERIAL AND METHODS: The study included 121 patients (127 cases), of which 61 patients (64 cases) had stenosis of the CC ostium and 60 patients (63 cases) had CC ostium obliteration. All stenoses and obliterations were recurrent and developed 6 months to 5 years after primary endonasal endoscopic DCR. Patients were divided into 3 groups. Group 1 included 20 patients (20 cases) with stenosis and 21 patients (22 cases) with CC ostium obliteration who underwent transcanalicular balloon dacryoplasty (DCP), group 2 - 20 patients (21 cases) with stenosis and 20 patients (21 cases) with CC ostium obliteration who underwent transcanalicular DCP and bicanalicular intubation, and group 3 - 21 patients (23 cases) with stenosis and 19 patients (20 cases) with CC ostium obliteration who received bicanalicular intubation alone. Results were evaluated 12 months after the intervention. RESULTS: The treatment was effective in as many as 80% and 68.2% of cases (respectively) in group 1, 76.2% and 66.7% of cases (respectively) in group 2, and 56.5% and 50% of cases (respectively) in group 3. CONCLUSION: The study proves transcanalicular DCP effective alone and shows no need in potentially complicated lacrimal ducts intubation.

[Conjunctival dacryocystorhinostomy in the treatment of proximal lacrimal drainage obstruction]. / Lakotsistorinostomiya v lechenii obliteratsii gorizontal'nogo otdela slezootvodyashchikh putei.

The problem of reconstruction of the lacrimal drainage system in cases of obliteration of both lacrimal points and/or both lacrimal canaliculi remains one of the most difficult in dacryology. The most common and effective operation for this pathology is Conjunctival dacryocystorhinostomy using tubes developed by L. Jones in 1962. However, wearing the tube for a long time and the complications associated with it can cause dissatisfaction with the treatment, even if the surgery was successful. The surgery technique and the tubes design have undergone numerous modifications to increase the amount of positive outcomes and reduce the number of complications. The results of original studies on this problem were analyzed revealing a lack of knowledge about the optimal design and material of the implant. There are few studies aimed at developing methods that ensure persistent preservation of the anastomosis after tube removal.

[Meatoplasty - an effective method for surgical treatment of patients with nasolacrimal duct ostium stenosis]. / Meatoplastika - éffektivnyi sposob khirurgicheskogo lecheniia patsientov so stenozom ust'ia nososleznogo protoka.

The authors proposed a novel approach to the surgical correction of distal nasolacrimal duct stenosis - the meatoplasty of the nasolacrimal duct. AIM: To evaluate the effectiveness of the developed surgical technique in cases of nasolacrimal duct ostium stenosis. METHODS: 78 patients (90 cases) with nasolacrimal duct stenosis at the level of it's ostium were included and divided into three comparable groups depending on the type of performed surgery: - the meatoplasty of the nasolacrimal duct in group 1, the meatoplasty with concomitant recanalization and bicanalicular silicone intubation of nasolacrimal duct by Ritleng in group 2 and recanalization with bicanalicular silicone intubation of nasolacrimal duct by Ritleng in group 3. A comparative analysis of the surgical treatment effectiveness of the patients of three groups was carried out. RESULTS: The best effectiveness of treatment was noted in group 2 (positive outcomes in 90.0% of cases). The positive outcomes were obtained in 76.7% of cases in group 1 and in 66.7% of cases in group 3. CONCLUSION: The developed surgical technique of meatoplasty with concomitant recanalization and bicanalicular silicone intubation of nasolacrimal duct is a highly-efficient and safe minimally invasive method for treatment of nasolacrimal duct ostium stenosis and it can be recommended in a wide clinical practice.

[Influence of fibrosis mediators on the outcomes of endoscopic endonasal dacryocystorhinostomy]. / Vliianie mediatorov fibroza na rezul'taty éndonazal'noi éndoskopicheskoi dakriotsistorinostomii.

INTRODUCTION: Fibrosis is the most important pathologic condition involved in undesirable outcomes of dacryocystorhinostomy. A number of biochemical factors are currently known to have an effect on wound healing by promoting excessive scarring. Isoforms of transforming growth factor ß (TGF-ß1) are considered the 'main' pro-fibrotic factor, but wound healing is also affected by other cytokines such as connective tissue growth factor (CTGF), which stimulates fibrosis, and fibroblast growth factor (FGF-2), which acts as antagonist to it. PURPOSE: To investigate correlations between endoscopic endonasal dacryocystorhinostomy outcomes and certain mediators of fibrosis. MATERIAL AND METHODS: The study included 45 cases of endoscopic endonasal dacryocystorhinostomy. The patients were grouped according to surgery outcome: patients with unsuccessful surgical treatment were assigned to group 1 (n=10); patients with successful surgical treatment - to group 2 (n=34). One patient was excluded from the study. Full-layer biopsy specimen were taken from patients' nasal mucosa before the surgery. TGF-ß1, TGF-ß2, TGF-ß3, CTGF, FGF-2 concentrations were evaluated using ELISA and normalized by total protein concentration. RESULTS: Surgical failure was observed in 10 cases (22.72%). CTGF concentration was significantly correlated with negative outcome (p<0.05) and was elevated in most specimen obtained from group 1. No significant correlation was noted between the concentrations of other evaluated cytokines in nasal mucosa specimens and the surgical outcome. CONCLUSION: The study found a correlation between CTGF concentration in nasal mucosa and dacryocystorhinostomy outcome, which supports the hypothesis suggested by several authors linking dacryocystorhinostomy failure with chronic inflammation in nasal mucosa.

[Intraoperative prevention of dacryocystitis relapse]. / Intraoperatsionnye sposoby profilaktiki retsidivov dakriotsistita.

The article reviews the literature devoted to modern intraoperative methods of preventing cicatricial process at the site of dacryostoma after endonasal endoscopic dacryocystorhinostomy. Despite the constant improvement of the surgery technique, complications in the postoperative period still occur. They include the formation of granulation tissue at the sites of dacryostoma, synechiae in the nasal cavity, or narrowing of the dacryostoma, which ultimately leads to a relapse of the disease. The main prevention methods are construction of flaps from the medial wall of the lacrimal sac, from mucosa of the nasal cavity, and intubation of the dacryostoma with the lacrimal implant. They are used separately and in various combinations.

[Mitomycin C after endoscopic endonasal dacryocystorhinostomy]. / Primenenie mitomitsina-S pri éndoskopicheskoi éndonazal'noi dakriotsistorinostomii.

Mitomycin-C (MMC) is the most frequently used agent for prevention of excessive scarring at the osteotomy site after endoscopic endonasal dacryocystorhinostomy (EEDCR), which, however, being applied during the final stage of the surgery, shows questionable effectiveness. AIM: to evaluate the effectiveness of a new administration route of mitomycin C in EEDCR. MATERIAL AND METHODS: The study included 86 patients (95 cases) in the age range of 62.3±9 years with primary acquired nasolacrimal duct obstruction. All patients underwent P.J. Wormald modification of EEDCR and were further divided into 2 groups. In group 1, MMC was injected into the nasal cavity and lacrimal sac mucosa, while in group 2 it was applied locally according to the standard procedure. To measure tissue concentrations of MMC, mucosal biopsies were taken in patients of Group 1. Systemic absorption of MMC was studied through blood samples in both groups. Clinical efficacy was assessed in 14±5 months after surgery. RESULTS: immediately after injection, the average tissue concentration of mitomicyn C in patients of Group 1, was 390±10 µg/g and 30 minutes later - 120±20 µg/g. No mitomycin C was found in Day 1 tissue samples and in any of the blood samples. Positive clinical results were reported in 97.9% of cases from Group 1 and in 87.2% of cases from Group 2. CONCLUSION: The method of injecting MMC during the final stage of EEDCR has proved clinically effective and safe and can be recommended for use in clinical practice.

[Treatment choice in dacryostenosis based on single-photon emission computed tomography and X-ray computed tomography findings]. / Vybor metoda lecheniya patsientov s dakriostenozom na osnove odnofotonnoi emissionnoi komp'yuternoi tomografii, sovmeshchennoi s rentgenovskoi komp'yuternoi tomografiei.

AIM: To develop surgical indications in dacryostenosis within the vertical portion of lacrimal pathways that would consider findings of single-photon emission computed tomography (SPECT) combined with X-ray computed tomography (CT). MATERIAL AND METHODS: A total of 96 patients with isolated vertical-portion dacryostenosis (127 cases) were enrolled. The examination included collecting Munk's scores for epiphora, optical coherence tomography of the lower tear meniscus, lacrimal scintigraphy, and SPECT/CT. Group 1 (40 cases) was composed of patients with lacrimal obstruction on CT, group 2 (87 cases) - of those whose lacrimal pathways proved passable. There were also 3 patients (4 cases) from group 1, whose lacrimal pathways, despite being blocked on CT, were still passable on SPECT. Surgeries performed in group 1 were endoscopic endonasal dacryocystorhinostomy (DCR) (36 cases) and pathways recanalization with bicanalicular intubation and balloon dacryoplasty (DCP) (4 cases). In group 2, all patients (87 cases) underwent recanalization with bicanalicular intubation (supplemented with balloon DCP in 32 cases). Surgical results were evaluated 8-12 months after the treatment. In group 2, particular attention was paid to the concordance in locations of dacryostenosis provided by CT and SPECT scans. RESULTS: Favorable outcomes of endoscopic endonasal DCR were obtained in as many as 32 cases from group 1 (88.9%), while in 4 cases (12.1%) the condition relapsed. Of those patients whose stenosis was not complete on SPECT, 3 cases (75.0%) improved, 1 (25.0%) - relapsed. In group 2, favorable outcomes were obtained in 65 cases (74.7%), relapses were 22 (25.3%). A high concordance in stenosis locations by CT and SPECT was noted in 60 cases of those who improved (92.3%) and 3 cases of those who relapsed (13.6%). CONCLUSION: The value of information provided by SPECT/CT has proved high in patients with nasolacrimal duct stenosis or obstruction. A combined scan allows to establish causal relationships between anatomical changes and functional failure of lacrimal pathways and to make an optimal treatment choice.

[Use of optical coherence tomography based lacrimal meniscometry in dacryology]. / Primenenie lakrimal'noi meniskometrii na osnove opticheskoi kogerentnoi tomografii v dakriologii Obzory literatury.

Optical coherence tomography (OCT) based lacrimal meniscometry is currently the most accurate method used to determine dimensions of tear meniscus. According to related literature, the latter gets reliably reduced after treatment of nasolacrimal duct obstructions. However, the relationship between morphometric parameters of tear meniscus and the intensity of epiphora has not been established. Even an adequate study parameter has not been yet identified. AIM: To investigate the significance of OCT based lacrimal meniscometry in determining the extent of insufficiency of lacrimal drainage. MATERIAL AND METHODS: A total of 108 measurements of the lower tear meniscus were taken. Of them, 23 measurements were taken in healthy volunteers, who had no complaints of epiphora, 59 - in patients with epiphora of different intensity, and 26 - in patients after surgical intervention. Meniscometry was performed with RTVue-100-2 (Optovue, USA) optical coherence tomograph. The tear meniscus 'height', 'depth', and coefficient were evaluated. Munk's scores for epiphora were also collected. Spearman's correlation was applied to assess the morphometry results and Munk's scores. A separate analysis was performed for patients who were examined before and after dacryological treatment. Differences were evaluated with the Kruskal-Wallis H test. RESULTS: Statistically reliable differences were found between the meniscus 'height' and 'depth' values at different epiphora intensities (p<0.001 for both parameters; H=25.35 and 22.01, respectively), however, the meniscus coefficients showed no significant difference in these patients (p=0.8, H=1.57). Moreover, there was a highly reliable (p<0.001) medium strength direct correlation between the meniscus 'height' and 'depth' and the Munk's scores (R=0.46 and R=0,48, respectively), while the correlation between the meniscus coefficient and the Munk's scores appeared weak and lowly reliable (p=0.20, R=0.14). CONCLUSION: Lower meniscus morphometry with 'depth' measurement is a comprehensive method to assess the state of lacrimal drainage system. However, it should not be used alone due to significant variations in morphometric parameters, particularly in patients with intensive epiphora.

[Morphological analysis of reparative process at osteotomy site after endoscopic endonasal dacryocystorhinostomy]. / Morfologicheskii analiz protsessovreparatsii v oblasti dakriostomy posle endoskopicheskoi endonazal'noi dakriotsistorinostomii.

Ostium closure due to local reparative processes is the most common cause of recurrence after endoscopic endonasal dacryocystorhinostomy (DCR), but as yet poorly studied. AIM: To perform morphological study of reparative processes at osteotomy site after endoscopic endonasal DCR. MATERIAL AND METHODS: The study included 18 patients (18 women) aged 62.59±10.07 years with nasolacrimal duct obstruction, who underwent endoscopic endonasal DCR (P.J. Wormald modification). Osteotomy site biopsies were taken on days 2, 5, 7, 10, 14, 21, 28, and 60 after the surgery. All the samples were stained with haematoxylin and eosin. For further details on cellular composition of inflammatory infiltrate, 54 samples were also processed into semi-thin sections. The slides were then viewed under Leica DM-2500 (Leica, Germany) photomicroscope. Leica DFC320 digital camera and ImageScope Color software were used for image acquisition and analysis. RESULTS: Morphological examination revealed the predominance of inflammatory cells in biopsy material on day 1 after DCR. On day 14, the number of cells would usually be reduced indicating the completion of the exudative phase of inflammation. Since then, activated fibroblasts prevailed over the rest of cellular elements. Twenty eight days after DCR, proliferating fibroblasts and collagen fibers were present. Sixty days after the surgery, fibrillar component prevailed over cells and showed compaction. CONCLUSION: Our results demonstrate that the reparation process nears completion before day 60 after the surgery. A series of morphological examinations of biopsy material from osteotomy sites has revealed individual features of reparation in nasal and lacrimal sac mucosa after endoscopic endonasal DCR.

[Comparative analysis of the results of balloon dacryoplasty for stenoses at different levels of the vertical portion of lacrimal pathways].

AIM: to compare the effectiveness of balloon dacryoplasty (DCP) for stenoses at different levels of the vertical portion of lacrimal pathways and to establish the necessity of consequent intubation. MATERIAL AND METHODS: A total of 120 clinical cases in 85 patients (66 females and 19 males with the mean age of 53.61 ± 11.82 years) have been analyzed. Patients with cervical stenosis of the lacrimal sac constituted two groups: group 1 (19 patients, 30 balloon DCP surgeries) and group 2 (22 patients, 30 balloon DCP surgeries with Ritleng intubation). Two other groups consisted of patients with nasolacrimal orifice stenosis: group 3 (21 patients, 30 balloon DCP surgeries) and group 4 (23 patients, 30 balloon DCP surgeries with Ritleng intubation). Besides routine examinations, the assessment included collection of Munk's scores for epiphora, evaluation of health-related quality of life, lacrimal meniscometry, lacrimal scintigraphy, contrast enhanced multi-slice spiral computed tomography of lacrimal pathways, and single-photon emission computed tomography. The follow-up period was 6 months. RESULTS: In group 1 a complete recovery was achieved in 18 (60.00%) cases, improvement--in 9 (30.00%) cases, while a relapse occurred in 3 (3.00%) cases; in group 2, there were 18 (60.00%) recoveries, 10 (33.33%) improvements, and 2 (6.67%) relapses; in group 3--12 (40.00%) recoveries, 5 (16.66%) improvements, and 13 (43.34%) relapses; in group 4--19 (63.33%) recoveries, 8 (26.67%) improvements, and 3 (10.00%) relapses. CONCLUSION: Balloon dacryoplasty is effective in restoring patency of occluded lacrimal pathways. Success rate is higher in cervical stenoses of the lacrimal sac than in nasolacrimal orifice stenoses. Ritleng intubation after balloon DCP favors better outcomes in patients with nasolacrimal orifice stenosis.