[Self-adjusting monocanalicular intubation for congenital lacrimal obstruction]. / Intubación monocanalicular autoajustable para la obstrucción lagrimal congénita.

OBJECTIVE: To present our work with the Masterka self-adjusting monocanalicular intubation without nasal recuperation in congenital lacrimal obstruction in children over 12-months old. METHODS: A total of 40 children between the ages of one and seven (average age 2.6 years) were consecutively operated on. The Masterka catheter has a flexible metal guide inside the silicone tube that covers it completely. The proximal end is fixed onto the lacrimal punctum by pushing it with a dilator or forceps. Its correct position was monitored and visually checked in real time during surgery in all cases. RESULTS: The average surgery time, excluding anaesthetic, was 1.56min, ranging from 1.05 to 4min. The final success was 97.5%, considering absence of epiphora, disappearance of colouring in lacrimal meniscus, and mucopurulent secretion. The average follow-up time was 15 months (ranging from 7 to 21 months). CONCLUSIONS: Masterka intubation is an effective primary treatment. It is no more difficult than a simple catheter, since the surgical technique is similar, but with better functional results. It avoids the possibility of having to repeat the catheterization and it is easier to carry out than bicanalicular intubation, since there is no need to manipulate repeatedly or use surgical instruments in the inferior meatus, thus simplifying the process.

Comparación entre la anestesia tópica con cocaína y lidocaína con adrenalina en la dacriocistorrinostomía con láser / Comparison between topical anaesthesia with cocaine versus lidocaine plus adrenaline for outpatient laser dacryocystorhinostomy

OBJETIVO: Comparar el uso de anestesia tópica de cocaína al 4% con la utilización de una mezcla de lidocaína al 2% y adrenalina al 1/100.000 para la dacriocistorrinostomía con láser (TCLDCR) y sedación consciente, sin infiltración local. MÉTODOS: En un estudio prospectivo, aleatorizado, a doble ciego, 46 pacientes fueron intervenidos tras la aplicación nasal de un apósito impregnado con cocaína al 4% y 46 pacientes fueron intervenidos tras emplear lidocaína al 2% y adrenalina 1/100.000 de idéntica forma. Se evaluó el bienestar intraoperatorio mediante la escala análogo visual, la presencia de alteraciones cardiovasculares (controlando la frecuencia cardiaca y la presión sanguínea) y la resolución de epífora con escala de Munk y control endoscópico. RESULTADOS: Los pacientes de ambos grupos estuvieron confortables durante la intervención, en el postoperatorio inmediato y a las 24 h tras la intervención. Los efectos secundarios cardiovasculares durante la cirugía fueron más frecuentes en el grupo de la cocaína. En el grupo 1, 16 pacientes tuvieron cifras tensionales elevadas frente a 2 del grupo 2, riesgo relativo (RR) 8. En el grupo 1, 12 enfermos presentaron frecuencia cardiaca por encima de 100 frente a uno del grupo 2, RR = 6. Un total de 12 pacientes del grupo 1 tuvieron un sangrado mayor de 5 ml (media 6,1 ml) frente a 2 del grupo 2 (media 2,1 ml) RR = 6. Las diferencias entre el grupo 1 y el 2, en cuanto a estas 3 complicaciones, fueron significativas (p = 1,1 × 10-9). En ningún grupo hubo casos de sangrado posquirúrgico que precisaran de taponamiento por más de 3 h. Los éxitos quirúrgicos fueron similares en ambos grupos 86,96 y 89,13% a los 6 meses de seguimiento. CONCLUSIONES: La combinación de lidocaína y adrenalina es efectiva para la dacriocistorrinostomía endoscópica con láser bajo anestesia tópica y sedación consciente. Esta combinación provee una adecuada anestesia y visualización del campo quirúrgico con menor sangrado e hipertensión arterial que la cocaína

OBJECTIVE: To evaluate the effectiveness of topical anaesthesia with cocaine versus lidocaine plus adrenaline for outpatient transcanalicular and endonasal dacryocystorhinostomy (TCLDCR) with diode laser under sedation. METHODS: A double blind randomised clinical trial was designed using topical anaesthesia for outpatient TCLDCR in the treatment of adult epiphora. A total of 92 patients were enrolled, and randomly allocated to be operated on under sedation and topical anaesthesia with cocaine 4% pledgets versus sedation and topical anaesthesia with lidocaine 2% plus 1/100.000 adrenaline pledgets. Main outcome measures were postoperative comfort, evaluated by a visual analogue scale, presence of secondary effects (blood pressure, heart rate), and resolution of epiphora, evaluated by Munk's scale and endoscopic control. RESULTS: Patients in both groups reported being comfortable during and immediately after TCLDCR. Visualization of the operative field was adequate, and surgery was successfully completed in all cases. Complications were more common in the cocaine group: Sixteen patients from the cocaine group had high blood pressures, versus 2 patients from the lidocaine group (RR = 8). Mean blood loss was 6.09 ml in cocaine group, versus 2.05 ml in lidocaine group (RR = 6). Both parameters were statistically significant (p = 1,1 × 10−9). There were no cases of postoperative epistaxis requiring nasal packing or hospital admission in any group. Success rate was similar in the 2 groups (86.96% group 1 and 89.13% group 2), after 6 months of follow-up. CONCLUSIONS: The combination of topical lidocaine and adrenaline is more effective for outpatient transcanalicular and endonasal dacryocystorhinostomy than topical cocaine. Patient comfort was adequate in both groups, but high blood pressure and blood loss more common after cocaine

[Comparison between topical anaesthesia with cocaine versus lidocaine plus adrenaline for outpatient laser dacryocystorhinostomy]. / Comparación entre la anestesia tópica con cocaína y lidocaína con adrenalina en la dacriocistorrinostomía con láser.

OBJECTIVE: To evaluate the effectiveness of topical anaesthesia with cocaine versus lidocaine plus adrenaline for outpatient transcanalicular and endonasal dacryocystorhinostomy (TCLDCR) with diode laser under sedation. METHODS: A double blind randomised clinical trial was designed using topical anaesthesia for outpatient TCLDCR in the treatment of adult epiphora. A total of 92 patients were enrolled, and randomly allocated to be operated on under sedation and topical anaesthesia with cocaine 4% pledgets versus sedation and topical anaesthesia with lidocaine 2% plus 1/100.000 adrenaline pledgets. Main outcome measures were postoperative comfort, evaluated by a visual analogue scale, presence of secondary effects (blood pressure, heart rate), and resolution of epiphora, evaluated by Munk's scale and endoscopic control. RESULTS: Patients in both groups reported being comfortable during and immediately after TCLDCR. Visualization of the operative field was adequate, and surgery was successfully completed in all cases. Complications were more common in the cocaine group: Sixteen patients from the cocaine group had high blood pressures, versus 2 patients from the lidocaine group (RR=8). Mean blood loss was 6.09 ml in cocaine group, versus 2.05 ml in lidocaine group (RR=6). Both parameters were statistically significant (p=1,1×10(-9)). There were no cases of postoperative epistaxis requiring nasal packing or hospital admission in any group. Success rate was similar in the 2 groups (86.96% group 1 and 89.13% group 2), after 6 months of follow-up. CONCLUSIONS: The combination of topical lidocaine and adrenaline is more effective for outpatient transcanalicular and endonasal dacryocystorhinostomy than topical cocaine. Patient comfort was adequate in both groups, but high blood pressure and blood loss more common after cocaine.

[Ballon dacryocystoplasty (DCP) for treatment of pediatric patients with congenital nasolacrimal duct obstruction after failed primary probing]. / Dacriocistoplastia con balón catéter en niños con obstrucción nasolagrimal congénita en los que ha fracasado el sondaje.

PURPOSE: To determine the efficiency of lacrimal balloon catheter dilatation to treat congenital nasolacrimal duct obstruction in children who had failed two lacrimal system probings. METHODS: Between October 2004 and June 2006 we performed a prospective study of balloon catheter dilatation for congenital nasolacrimal duct obstruction in 30 lacrimal systems. The mean age was 32.4 months (range 18-72 months). The patients were divided into 3 types of obstructions: partial, proximal and simple membranous at the valve of Hasner and into 2 age categories: category 1 (18-36 months) and category 2 (> 36 months). The patients were evaluated 2 weeks, 3 months and 6 months after balloon catheter dilatation, with Munk's score and ophthalmic evaluation using a dye disappearance test being assessed. Clinical patency was defined as a complete resolution of signs and symptoms (Munk 0) and a negative disappearance test (grade 0). We used the chi-squared test with Yates' correction for statistical analysis. RESULTS: The procedure was successful in 83.33% of the cases and there were no complications. Statistical analysis showed no significant difference between the 3 types of obstructions treated, and age at treatment did not affect the outcome. CONCLUSION: DCP is a safe, effective therapy, easy and fast to perform and should be used in the treatment of congenital nasolacrimal duct obstruction after failure of two lacrimal system probings.

Intubación lagrimal en casos complicados / Lacrimal intubation in complicated cases

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