Estudio retrospectivo de tasa de éxito y factores asociados de dos técnicas de dacriocistorrinostomía láser, en un hospital de tercer nivel / Retrospective study of success rate and associated factors of two laser dacryocystorhinostomy techniques, in a third-level hospital

Objetivo Comparar la tasa de éxito de dos técnicas de dacriocistorrinostomía láser (DCRL). Materiales y métodos Se realizó un estudio retrospectivo de pacientes intervenidos por obstrucción adquirida de la vía lagrimal (OAVL) entre los años 2000 y 2021 en un hospital de tercer nivel, mediante DCRL con mitomicina intraoperatoria (DCRL + MMTC) y de DCRL asociada a ampliación de ostium con endoscopio y MMTC (DCRLend-amp + MMTC). Se analizaron hallazgos intraoperatorios, complicaciones y tasa éxito anatómico y funcional de las dos técnicas. El tiempo de seguimiento fue de un año. Resultados Incluimos 92 vías lagrimales con OAVL. 71,7% mujeres, 84,8% unilaterales y edad media de 62,77 ± 13,08 años. En 61 vías lagrimales se realizó DCRL + MMTC (66,3%) y en 31 (33,6%) DCRLend-amp + MMTC. La tasa de éxito anatómica/funcional al año de la DCRLend-amp + MMTC fue de 71%/64,5%; la DCRL + MMTC obtuvo una menor tasa de éxito, 65,6%/60,7% (p = 0,391). No existen diferencias a lo largo del seguimiento entre las tasas de éxito anatómicas ni funcionales de las dos técnicas, ni en las distintas visitas (p > 0,05). La tasa de hallazgos intraoperatorios fue de 1,63% en DCRL + MMTC y 32,26% en DCRLend-amp + MMTC. La tasa de complicaciones postoperatorias fue de 3,27% en DCRL+MMTC y de 3,23% en DCRLend-amp + MMTC. Conclusiones La DCRLend-amp + MMTC obtiene una tasa de éxito ligeramente más alta que la DCRL + MMTC. Debemos tener en cuenta el tiempo-coste quirúrgico aumentado de la DCRLend-amp + MMTC, curva de aprendizaje, y destreza del cirujano, sin un beneficio claro en la tasa de éxito (AU)

Background and objective To compare the success rate of two laser dacryocystorhinostomy (L-DCR) techniques. Materials and methods A retrospective study of patients who underwent surgery for acquired nasolacrimal duct obstruction (NLDO) between 2000 and 2021, carried out in a third level hospital, using L-DCR and modifications of this technique. Intraoperative findings, complications, and anatomical and functional success rate of the 2 techniques were analyzed. The follow-up time was 1 year. Result We included 92 lacrimal ducts with NLDO. 66 (71.7%) were women. 78 (84.8%) underwent unilateral surgery. The mean age was 62.77 ± 13.08 years. 61 (66.3%) underwent intraoperative laser dacryocystorhinostomy with MMTC (L-DCR + MMTC) and 31 (33.6%) L-DCR associated with endoscopic ostium enlargement (L-DCRend-amp). The one-year anatomical/functional success rate of the L-DCRend-amp + MMTC was 71%/64,5%. L-DCR + MMTC obtained a lower success rate, 65.6/60,7% (P = .391). There were no differences throughout the follow-up between the anatomical or functional success rates of the 2 techniques, nor between the different visits (P > .05). Intraoperative findings rate was 3.63% in L-DCR + MMTC, and 32.26% in L-DCRend-amp + MMTC. Postoperative complication rate was 3.27% in L-DCR + MMTC, and 3.23% in L-DCRend-amp + MMTC. Conclusions The L-DCRend-amp + MMTC gets a higher success rate than the L-DCR + MMTC. We must consider the surgical time-cost of the L-DCRend-amp + MMTC, as well as the learning curve of endoscopy techniques, and the skill of the surgeon, without a clear benefit in the success rate (AU)

Retrospective study of success rate and associated factors of two laser dacryocystorhinostomy techniques, in a third-level hospital.

BACKGROUND AND OBJECTIVE: To compare the success rate of two laser dacryocystorhinostomy (L-DCR) techniques. MATERIALS AND METHODS: A retrospective study of patients who underwent surgery for acquired nasolacrimal duct obstruction (NLDO) between 2000 and 2021, carried out in a third level hospital, using L-DCR and modifications of this technique. Intraoperative findings, complications, and anatomical and functional success rate of the 2 techniques were analyzed. The follow-up time was 1 year. RESULTS: We included 92 lacrimal ducts with NLDO. 66 (71.7%) were women. 78 (84.8%) underwent unilateral surgery. The mean age was 62.77 ±â€¯13.08 years. 61 (66.3%) underwent intraoperative laser dacryocystorhinostomy with MMTC (L-DCR + MMTC) and 31 (33.6%) L-DCR associated with endoscopic ostium enlargement (L-DCRend-amp). The one-year anatomical/functional success rate of the L-DCRend-amp + MMTC was 71%/64,5%. L-DCR + MMTC obtained a lower success rate, 65.6/60,7% (P = .391). There were no differences throughout the follow-up between the anatomical or functional success rates of the 2 techniques, nor between the different visits (P > ,05). Intraoperative findings rate was 3.63% in L-DCR + MMTC, and 32.26% in L-DCRend-amp + MMTC. Postoperative complication rate was 3.27% in L-DCR + MMTC, and 3.23% in L-DCRend-amp + MMTC. CONCLUSIONS: The L-DCRend-amp + MMTC gets a higher success rate than the L-DCR + MMTC. We must consider the surgical time-cost of the L-DCRend-amp + MMTC, as well as the learning curve of endoscopy techniques, and the skill of the surgeon, without a clear benefit in the success rate.

Dacriocistorrinostomía láser endocanalicular y sus modificaciones: revisión sistemática de técnicas y tasa de éxito / Endocanalicular Laser Dacryocystorhinostomy and its modifications: A systematic review of techniques and success rates

Objetivo El objetivo principal de este trabajo es revisar los artículos que hacen referencia a la técnica de la dacriocistorrinostomía láser (DCRL) para la obstrucción adquirida de la vía lagrimal (OACN), así como sus modificaciones, a través de una exhaustiva revisión bibliográfica. Material y método Se realizó una revisión sistemática de las publicaciones relacionadas con cirugía láser de la vía lagrimal desde el año 2000 hasta marzo de 2021 en las bases de datos MEDLINE, EMBASE y Cochrane Library. Los términos de búsqueda en idioma español e inglés fueron: «Endocanalicular laser», dacryocystorhinostomy or «primary DCR-L» or «laser» and «tear ducts». Resultados Tras someter los artículos a los criterios de inclusión y exclusión, obtuvimos 49 artículos: 21 estudios retrospectivos y 28 estudios prospectivos. El resultado bibliométrico obtenido garantiza, para la presente revisión, una recomendación de nivel C según la escala Scottish Intercollegiate Guidelines Network. Conclusiones Actualmente la DCRL clásica tiene tasas de éxito menores que las DCRL modificadas, por lo que sugerimos el uso de estas últimas. Preferimos la DCRL con MMC-IS o bien la DCRL con técnicas de endoscopia asociadas, sin poder decantarnos por ninguna opción en particular, puesto que las tasas de éxito son muy similares. Dejamos a criterio del cirujano la elección, dependiendo del manejo de las técnicas endonasales. Son necesarios más estudios, con mayor seguimiento, y mejor definidos para clarificar cuál es la mejor técnica DCRL (AU)

Objective The main objective of this work is to review the articles that refer to transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) in acquired nasolacrimal duct obstruction (NLDO), as well as its modifications. Material and methods A systematic review of publications related to TCL-DCR of the lacrimal duct from 2000 to March 2021 was carried out in the MEDLINE, EMBASE and Cochrane Library databases. The search terms in Spanish and English were: «Endocanalicular laser», dacryocystorhinostomy or «primary DCR-L» or «laser» and «tear ducts». Results After subjecting the articles to the inclusion and exclusion criteria, we got 49 articles: 21 retrospective and 28 prospective studies. The bibliometric result obtained guaranteed, for this review, a level C recommendation according to the Scottish Intercollegiate Guidelines Network scale. Conclusions Currently, the classic TCL-DCR has lower success rates than its modifications, so we suggest using the latter. We prefer TCL-DCR with IS-MMC or TCDL associated with endoscopy techniques, without being able to opt for any option, since their success rates are very similar. We leave the choice to the discretion of the surgeon, depending on the management skills of endonasal techniques. More studies, with longer follow-up, and better defined criteria are necessary to clarify which is the best TCL-DCR technique (AU)

Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience.

INTRODUCTION: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. PATIENTS AND METHODS: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. RESULTS: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ±â€¯11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. CONCLUSIONS: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

Factores implicados en el éxito y fracaso de la dacriocistorrinostomía endoscópica desde nuestra experiencia / Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience

Introducción: La dacriocistitis crónica es la patología secundaria a la estenosis del conducto lacrimonasal (ECLN) permanente, generando epífora y conjuntivitis de repetición. La dacriocistorrinostomía endoscópica (DCRE) supone una vía más natural que la vía externa y ofrece tasas de éxito superiores a la técnica láser. Valoramos la experiencia de este centro en este procedimiento. Pacientes y métodos: Se efectuó una revisión retrospectiva de los registros médicos en pacientes adultos sometidos a DCRE por ECLN entre 1995 y 2019 en nuestro centro. El período de seguimiento mínimo requerido después de la cirugía fue de seis meses. Resultados: En 297 meses se efectuaron 167 procedimientos de DCRE sobre 156 pacientes, con una edad media de 65,7±11,6 años y una relación hombre/mujer de 1/1,98. La mejoría funcional fue del 86%, con una tasa de éxito anatómico del 87%. La ausencia de mejoría clínica se correlacionó de forma estadísticamente significativa con la edad del paciente y el tiempo de evolución de la ECLN, la presencia de patología concomitante sistémica (especialmente diabetes mellitus) u oftalmológica, el hallazgo intraoperatorio de un saco lacrimal engrosado y la ausencia de drenaje del mismo al marsupializarlo. Los pacientes con peor respuesta fueron portadores de stents en la rinostomía durante más tiempo. No existieron complicaciones postoperatorias de interés. Conclusiones: La DCRE es una técnica eficaz y segura, fundamentada en referencias anatómicas estables. La incidencia de fracasos parece multifactorial y debe contemplarse en pacientes añosos, pluripatológicos y con largo tiempo de evolución de la enfermedad. (AU)

Introduction: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. Patients and methods: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. Results: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7±11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. Conclusions: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition. (AU)

Efficacy of mitomycin C in modified transcanalicular diode laser dacryocystorhinostomy / Eficácia da mitomicina C na dacriocistorrinostomia transcanalicular com laser diodo modificada

ABSTRACT Objective: To evaluate the efficacy of mitomycin C in anatomical and functional success after modified transcanalicular diode laser dacryocystorhinostomy. Methods: A prospective, double-blinded, randomized placebo-controlled study compared the effect of topical mitomycin C on modified transcanalicular diode laser dacryocystorhinostomy. Group 1 had modified transcanalicular diode laser dacryocystorhinostomy with topical saline, while Group 2 had modified transcanalicular diode laser dacryocystorhinostomy with topical mitomycin C. Success was defined as anatomical patency and relief of symptoms at the end of 6 months. Results: Six months after surgery, Group 1 (30 patients) showed anatomical and functional success rates of 86.7% and 83.3%, respectively. Group 2 (32 patients) showed anatomical and functional success rates of 87.5% and 84.3%, respectively. There was no statistically significant difference between the groups 1 and 2 (p = 1.000). Conclusion: The use of mitomycin C did not improve the anatomical and functional success rates of modified transcanalicular diode laser dacryocystorhinostomy compared to placebo.

RESUMO Objetivo: Avaliar a eficácia da mitomicina C no sucesso anatômico e funcional após dacriocistorrinostomia transcanalicular com laser de diodo. Métodos: Estudo prospectivo, duplo-cego, randomizado e controlado por placebo. Comparou o efeito da mitomicina C tópica na dacriocistorrinostomia transcanalicular com laser de diodo. No Grupo 1, foi utilizada apenas solução salina tópica, enquanto no Grupo 2 foi utilizada mitomicina C tópica. O sucesso foi definido como permeabilidade da via lacrimal e alívio dos sintomas ao final de 6 meses. Resultados: Seis meses após a cirurgia, o Grupo 1 (30 pacientes) apresentou taxas de sucesso anatômico e funcional de 86,7% e 83,3%, respectivamente. O Grupo 2 (32 pacientes) apresentou taxas de sucesso anatômico e funcional de 87,5% e 84,3%, respectivamente. Não houve diferença estatística significante entre os Grupos 1 e 2 (p=1,000). Conclusão: O uso de mitomicina C não melhora as taxas de sucesso anatômico e funcional do dacriocistorrinostomia transcanalicular com laser de diodo em comparação ao placebo.

The role of the rhinostomy ostium size on functional success in dacryocystorhinostomy / O papel do tamanho do óstio da rinostomia no sucesso funcional em dacriocistorrinostomia

Abstract Introduction Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors. Objective To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. Methods The charts of the patients operated in our hospital between May 2017 and January 2019 were analyzed retrospectively (ethical approval number: 2018-12.04). The patients that were operated in the ophthalmology and otolaryngology departments were included in the study. Endoscopic rhinostomy ostium measurements, punctum lavage findings and complications were recorded at 8 weeks postoperative at the earliest. Results When the 64 patient charts were reviewed (76 operations), the mean ostium width was 1.85 ± 1.11 mm in the endonasal approach group and 3.60 ± 2.24 mm in the external approach group. The mean ostium areas in endonasal and external group were 14.61 ± 16.66 mm2 and 56.05 ± 60.41 mm2, respectively. The ostium was anatomically patent and punctum lavages were negative in 11 patients (6 patients in the endonasal approach group and 5 patients in the external approach group) and these cases were considered as functional failures. The rhinostomy ostium was significantly wider in the external approach group, but this was considered ineffective on functional outcomes. Conclusion Lacrimal duct stenosis can be successfully treated with endonasal and external methods. Tear drainage may be insufficient even in the presence of a patent ostium. Therefore, functional success should also be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is definitely required, while it is believed that ostium size does not affect functional surgical success.

Resumo Introdução Dacriocistorrinostomia endonasal e externa têm sido usados para o tratamento de obstrução pós‐sacular do sistema lacrimal. O sucesso funcional dessas cirurgias depende de vários fatores. Objetivo Avaliar o status do óstio da rinostomia nas abordagens endonasal e externa em dacriocistorrinostomias e a importância do tamanho do óstio no sucesso funcional pós‐operatório. Método Os prontuários de pacientes operados em nosso hospital entre maio de 2017 e janeiro de 2019 foram analisados retrospectivamente (número de aprovação ética: 2018-12,04). Foram incluídos no estudo os pacientes operados nos setores de oftalmologia e otorrinolaringologia. Medidas do óstio da rinostomia endoscópica, achados à irrigação do ponto lacrimal e complicações foram registrados a partir da 8ª semana de pós‐operatório. Resultados Foram avaliados prontuários de 64 pacientes (76 operações); a largura média do óstio era de 1,85 ± 1,11 mm no grupo endonasal e de 3,60 ± 2,24 mm no grupo externa. As áreas médias do óstio no grupo endonasal e externa foram 14,61 ± 16,66 mm2 e 56,05 ± 60,41 mm2, respectivamente. O óstio estava anatomicamente pérvio e as irrigações do ponto lacrimal foram negativas em 11 pacientes (6 pacientes no grupo endonasal e 5 pacientes no grupo externa) e esses casos foram considerados como falhas funcionais. O óstio da rinostomia foi significativamente maior no grupo externo, mas sem relação com a eficácia nos resultados funcionais. Conclusão A estenose do ducto lacrimal pode ser tratada com sucesso com métodos endonasais e externos. A drenagem lacrimal pode ser insuficiente mesmo na presença de óstio pérvio. Portanto, o sucesso funcional também deve ser considerado ao avaliar o sucesso do procedimento. Embora um óstio anatomicamente patente seja necessário, o tamanho do óstio não afeta o sucesso cirúrgico funcional.

Nose sinus manometry in evaluating functional outcomes of anterior and posterior endoscopic dacryocystorhinostomy

Objective: The aim of this study is to evaluate the effectiveness of anterior and posterior dacryorhinocystostomy (En-Dcr) by assessing the surgical outcome with a new objective technique, nose sinus manometry.Materials and methodsThirty adult patients presenting nasolacrimal duct obstruction were enrolled in this study and randomly divided in two groups. In group A patients underwent anterior endonasal dacryorhinocystostomy, group B underwent the posterior approach. All patients were evaluated through Nose Sinus Manometry, endoscopic dye disappearance functional test (EDFT) and subjective assessment three months post-op. Pearson test and T-student Test were used for evaluations.ResultsThe mean differences in the pressure values were significantly different in the two groups of treatment, therefore, the patients of group B had strong improvement in pressure values compared with patients of group A.ConclusionThis study confirms a relevant physical distinction between posterior En-Dcr outcomes compared to anterior En-Dcr and reveals a significant success rate difference between the two groups of patients. The posterior surgical technique shows better results than the anterior one, by providing an almost physiological post- operative endonasal outcome. These results also showed the effectiveness of Nose Sinus Manometry in assessing the post- operative outcomes after En-Dcr. (AU)

Antecedentes y objetivo: El objetivo de este estudio es evaluar la efectividad de la dacriocistorrinostomía anterior y posterior (En-Dcr) mediante la evaluación del resultado quirúrgico con una nueva técnica objetiva, la manometría del seno nasal.Materiales y métodosTreinta pacientes adultos que presentaban obstrucción del conducto nasolagrimal se inscribieron en este estudio y se dividieron al azar en dos grupos. En el grupo A, los pacientes se sometieron a dacriocistorrinostomía endonasal anterior, en el grupo B se sometió al abordaje posterior. Todos los pacientes fueron evaluados mediante manometría de seno nasal, prueba EDFT y evaluación subjetiva tres meses después de la operación. Análisis estadístico utilizado: la prueba de Pearson y la prueba t Student se utilizaron para las evaluaciones.ResultadosLas diferencias medias en los valores de presión fueron significativamente diferentes en los dos grupos de tratamiento, por lo tanto, los pacientes del grupo B tienen una fuerte mejora en los valores de presión en comparación con los pacientes del grupo A.ConclusionesEste estudio confirma una distinción física relevante entre los resultados posteriores de En-Dcr, en comparación con los anteriores En-Dcr, y revela una diferencia significativa en la tasa de éxito entre los dos grupos de pacientes. La técnica quirúrgica posterior muestra mejores resultados que la anterior, al proporcionar un resultado endonasal postoperatorio casi fisiológico. Estos resultados también mostraron la efectividad de la manometría de seno nasal para evaluar los resultados postoperatorios después de En-Dcr. (AU)

Nose sinus manometry in evaluating functional outcomes of anterior and posterior endoscopic dacryocystorhinostomy.

OBJECTIVE: The aim of this study is to evaluate the effectiveness of anterior and posterior dacryorhinocystostomy (En-Dcr) by assessing the surgical outcome with a new objective technique, nose sinus manometry. MATERIALS AND METHODS: Thirty adult patients presenting nasolacrimal duct obstruction were enrolled in this study and randomly divided in two groups. In group A patients underwent anterior endonasal dacryorhinocystostomy, group B underwent the posterior approach. All patients were evaluated through Nose Sinus Manometry, endoscopic dye disappearance functional test (EDFT) and subjective assessment three months post-op. Pearson test and T-student Test were used for evaluations. RESULTS: The mean differences in the pressure values were significantly different in the two groups of treatment, therefore, the patients of group B had strong improvement in pressure values compared with patients of group A. CONCLUSION: This study confirms a relevant physical distinction between posterior En-Dcr outcomes compared to anterior En-Dcr and reveals a significant success rate difference between the two groups of patients. The posterior surgical technique shows better results than the anterior one, by providing an almost physiological post- operative endonasal outcome. These results also showed the effectiveness of Nose Sinus Manometry in assessing the post- operative outcomes after En-Dcr.

Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience. / Factores implicados en el éxito y fracaso de la dacriocistorrinostomía endoscópica desde nuestra experiencia.

INTRODUCTION: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. PATIENTS AND METHODS: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. RESULTS: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ± 11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. CONCLUSIONS: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

Aplicación transoperatoria de mitomicina-C en la dacriocistorrinostomía externa: acuerdos y desacuerdos / Intraoperative application of Mitomycin-C in external dacryocystorhinostomy: agreements and disagreements

RESUMEN Introducción: la dacriocistorrinostomía externa es la técnica más empleada por la mayoría de los cirujanos oculoplásticos para tratar a los pacientes con obstrucción del canal nasolagrimal. Es posible que los galenos cometan algunos errores en este tipo de cirugía, a pesar de los grandes avances en las tecnologías ópticas, las técnicas quirúrgicas y el uso de modernos materiales de intubación. La principal causa de los errores es el cierre de la osteotomía por tejido cicatrizal o de granulación, con la formación de sinequias en la cavidad nasal. La mitomicina C es el antibiótico alquilante más estudiado en la prevención del exceso de cicatrización en el área de la osteotomía; sin embargo, existen acuerdos y desacuerdos entre estudiosos del tema sobre la eficacia, dosis y tiempo de exposición de este medicamento. El papel de cada una de estas variables en el resultado final de la cirugía es controversial. Objetivo: brindar evidencias sobre el papel de la aplicación transoperatoria de la mitomicina C en la dacriocistorrinostomía externa. Métodos: se realizó una revisión de la bibliografía actualizada disponible en idioma español e inglés. Se consultaron los textos completos y resúmenes en las bases de datos: PubMed, Ebsco, Google Académico y Scielo. También se revisaron novedosos artículos en prestigiosas revistas especializadas. Conclusiones: la mayoría de los autores coinciden en que este medicamento contribuye a elevar la tasa de éxito de la dacriocistorrinostomía externa; aunque su aplicación es segura, todavía se estudian algunas variables que mejorarían su eficacia.

ABSTRACT Introduction: external dacryocystorhinostomy is the most used technique by oculoplastic surgeons to treat patient with nasolacrimal duct obstruction. Physicians may make some mistakes in this type of surgery despite great advances in optical technologies, surgical techniques and the use of modern materials for intubation, The main cause of errors is the closure of the osteotomy due to scar tissue or granulation with synechia formation in the nasal cavity. Mitomycin-C is the most studied alkylating antibiotic in the prevention of excessive scarring in the osteotomy area; however, there are some agreements and disagreements among scholars on the efficacy, dosage and time of exposure of this drug. The role of each of these variables in the final outcome of the surgery is controversial. Objective: to provide some evidences about the transoperative application of Mitomycin-C in external dacryocystorhinostomy. Methods: a review of the updated bibliography available in Spanish and English languages was carried out. Complete texts and abstracts were consulted in the databases: PubMed, Ebsco, Google Scholar and Scielo. Novel articles were also reviewed in prestigious specialized journals. Conclusions: must authors agree that this drug appears to improve the success rate of external dacryocystorhinostomy. Although its application is safe, some variables are still being studied that would improve its efficacy.

Dacriocistorrinostomia endoscópica transnasal / Transnasal endoscopic dacryocystorhinostomy

Desde hace muchos años la vía lagrimal la han compartido dos disciplinas: la otorrinolaringología y la oftalmología. Con el paso del tiempo se han desarrollado diferentes técnicas encaminadas al manejo de la patología de la vía nasolagrimal desde la tradicional vía externa hasta los procedimientos asistidos con Láser. La DCR (dacriocistorrinostomia) endoscópica es al día de hoy el procedimiento ideal para el manejo de la insuficiencia y la estenosis de la vía lagrimal, derivado de traumas, dacriocistitis o disfunción de la vía nasolagrimal. Presentamos el reporte de nuestra experiencia en el manejo de estos trastornos en conjunto con el servicio de oftalmología en el Hospital de Ecopetrol de Barrancabermeja, dando especial relevancia a la técnica quirúrgica y a los resultados posoperatorios evitando la morbilidad de la dacriocistorrinostomia externa.

During long time, the lacrimal pathway has been studied and treated by two specialties. Otolaryngology and ophthalmology. As time has gone by, different techniques for treating the lacrimal pathway have been developed, such as the traditional external approach and the laser assisted procedures. Nowadays, endoscopic DCR (dacryocystorhinostomy) is the ideal procedure for treating the lacrimal pathway insufficiency and stenosis secondary to trauma, dacryocystitis or dysfunction of the nasolacrimal pathway. We report our experience in the management of these disorders with the Ecopetrol Hospital in Barrancabermeja's Ophthalmology service, giving special relevance to the surgical technique and the postoperative results avoiding the morbidity of the external dacryocystorhinostomy.

Linfoma en fosa nasal encontrado durante una dacriocistorrinostomía / Lymphoma found in nasal cavity during a dacryocystorhinostomy / Linfoma na fossa nasal encontrado durante una dacriocistorrinostomia

Los tumores de características malignas en áreas sinonasales ocupan el 3% - 5% de todos los tumores malignos, de estos, los linfomas no Hodgkin de células B son los más comúnmente encontrados. Se ha descrito el compromiso de la cavidad nasal entre el 1.5% y 15%, se describe mayor presentación en pacientes entre las séptima y octava décadas de la vida, así como una tendencia de afectación más en mujeres que en hombres y predisposición en pacientes de raza asiática. La histología mayormente hallada es de carácter no epitelial primario. Muchos de los pacientes en series revisadas han tenido diagnóstico subyacente de enfermedad linfoide en otros sitios previo a la presentación de síntomas nasales como obstrucción nasal, epistaxis, edema, cefalea y visión borrosa. Se presenta un caso de paciente de sexo masculino con diagnóstico de leucemia linfoide crónica, residente en la ciudad de Buenos Aires, en quien durante una dacriocistorrinostomía se halla un linfoma en fosa nasal sin previa presentación de síntomas nasales, masa palpable o síntomas sistémicos.

Malignant tumors in sinonasal areas constitute 3% ­ 5% of all malignant tumors, of which non­Hodgkin lymphomas developing from B cells are those most commonly found. Nasal cavity involvement is described between 1.5% and 15% and is usually found in patients who are in their seventies or eighties. It is more commonly found in women than in men and there is predisposition in Asians. Its histology has been found as non-primary epithelial tumors. Many patients in case series had been diagnosed with primary tumor in other places prior to the presentation of nasal symptoms such as nasal obstruction, epistaxis, edema, headache, and blurred vision. This article describes the case report of a male patient diagnosed with chronic lymphoid leukemia residing in Buenos Aires. While the patient was undergoing a dacryocystorhinostomy, a lymphoid tissue was found in the right nostril without previous presentation of nasal symptoms, palpable mass, or systemic symptoms.

Os tumores de características malignas em áreas sinonasais ocupam 3% - 5% de todos os tumores malignos, destes, os linfomas não Hodgkin de células B são os mais comumente encontrados. Se há descrito o compromisso da cavidade nasal entre 1.5% e 15%, se descreve maior apresentação em pacientes entre as sétima e oitava décadas da vida, assim como uma tendência de afetação mais em mulheres do que em homens e pré-disposição em pacientes de raça asiática. A histologia maiormente encontrada é de carácter não epitelial primário. Muitos dos pacientes em séries revisadas têm tido diagnóstico subjacente de doenças linfoide em outros lugares prévio à apresentação de sintomas nasais como obstrução nasal, epistaxe, edema, cefaleia e visão distorcida. Se apresenta um caso de paciente de sexo masculino com diagnóstico de leucemia linfoide crónica, residente na cidade de Buenos Aires, em quem durante uma dacriocistorrinostomia se encontra um linfoma na fossa nasal sem prévia apresentação de sintomas nasais, massa palpável ou sintomas sistémicos.

Dacriocistorrinostomía externa: resultados en un año de experiencia en Villa Clara / External dacryocystorhinostomy: outcomes achieved in one-year experience in Villa Clara province

Objetivo: describir los resultados de la cirugía dacriocistorrinostomía externa en un año. Métodos: se realizó un estudio observacional, descriptivo longitudinal prospectivo en 25 pacientes, 28 ojos. Se consideraron las variables sexo, color de piel, edad, lado afectado, etiología, complicaciones y resultados de la cirugía.Resultados: hubo 7 pacientes masculinos y 18 femeninos; de ellos, 16 blancos y 9 no blancos con una diferencia estadísticamente significativa (p= 0,043). La edad promedio fue de 69 ± 11 años. En 13 pacientes (52,0 por ciento) se afectó el lado izquierdo y en el 68,0 por ciento la etiología fue involutiva con significación estadística (p= 0,0003). El sangramiento transoperatorio se presentó como complicación en el 24,0 por ciento de los pacientes. El 92,0 por ciento refirió mejoría de la sintomatología después de operados. Según el criterio del cirujano, la mejoría objetiva se obtuvo en el 88,0 por ciento de los casos. La dacriocistorrinostomía externa fue más frecuente en mujeres blancas encontradas entre su sexta y séptima década de vida. El lado izquierdo fue el más afectado con predominio de la etiología involutiva. Las complicaciones fueron escasas; dentro de ellas predominó el sangramiento transoperatorio. Conclusiones: la mayoría de los pacientes sintieron mejoría después de la cirugía; el criterio del cirujano estuvo a favor de los resultados positivos en la cirugía dacriocistorrinostomía externa(AU)

Objective: to describe the results of external dacryocystorhinostomy surgery in one year. Methods: a prospective, longitudinal descriptive and observational study was conducted in 28 patients from 25 patients. The study variables were gender, race, age, affected side, etiology, complications and surgery outcomes. Results: there were 7 male and 18 female patients, 16 Caucasians and 9 non-Caucasians with statistically significant difference (p= 0,043). The mean age was 69 ± 11 years. The obstruction involved the left side in 13 patients (52 percent) and involution was the main etiology in 68 percent with statistical significance (p= 0,0003). Perioperative bleeding was the main complication (24 percent). In the group, 92 percent said the symptoms had reduced after surgery, and according to the surgeon, objective improvement was attained in 88 percent of cases.Conclusion: external dacryocystorhinostomy was more frequent in Caucasian women aged 60 to 70 years. The left side was the most affected, with prevailing involution etiology. There were minimum complications, being perioperative bleeding predominant. Most of the patients felt better after surgery and the surgeon´s criteria were in favor of the positive results of this surgery(AU)

Dacriocistorrinostomía externa: resultados en un año de experiencia en Villa / External dacryocystorhinostomy: outcomes achieved in one-year experience in Villa Clara province

Objetivo: describir los resultados de la cirugía dacriocistorrinostomía externa en un año. Métodos: se realizó un estudio observacional, descriptivo longitudinal prospectivo en 25 pacientes, 28 ojos. Se consideraron las variables sexo, color de piel, edad, lado afectado, etiología, complicaciones y resultados de la cirugía. Resultados: hubo 7 pacientes masculinos y 18 femeninos; de ellos, 16 blancos y 9 no blancos con una diferencia estadísticamente significativa (p= 0,043). La edad promedio fue de 69 ± 11 años. En 13 pacientes (52,0 por ciento) se afectó el lado izquierdo y en el 68,0 por ciento la etiología fue involutiva con significación estadística (p= 0,0003). El sangramiento transoperatorio se presentó como complicación en el 24,0 por ciento de los pacientes. El 92,0 por ciento refirió mejoría de la sintomatología después de operados. Según el criterio del cirujano, la mejoría objetiva se obtuvo en el 88,0 por ciento de los casos. La dacriocistorrinostomía externa fue más frecuente en mujeres blancas encontradas entre su sexta y séptima década de vida. El lado izquierdo fue el más afectado con predominio de la etiología involutiva. Las complicaciones fueron escasas; dentro de ellas predominó el sangramiento transoperatorio. Conclusiones: la mayoría de los pacientes sintieron mejoría después de la cirugía; el criterio del cirujano estuvo a favor de los resultados positivos en la cirugía dacriocistorrinostomía externa(AU)

Objective: to describe the results of external dacryocystorhinostomy surgery in one year. Methods: a prospective, longitudinal descriptive and observational study was conducted in 28 patients from 25 patients. The study variables were gender, race, age, affected side, etiology, complications and surgery outcomes. Results: there were 7 male and 18 female patients, 16 Caucasians and 9 non-Caucasians with statistically significant difference (p= 0,043). The mean age was 69 ± 11 years. The obstruction involved the left side in 13 patients (52 percent) and involution was the main etiology in 68 percent with statistical significance (p= 0,0003). Perioperative bleeding was the main complication (24 percent). In the group, 92 percent said the symptoms had reduced after surgery, and according to the surgeon, objective improvement was attained in 88 percent of cases. Conclusion: external dacryocystorhinostomy was more frequent in Caucasian women aged 60 to 70 years. The left side was the most affected, with prevailing involution etiology. There were minimum complications, being perioperative bleeding predominant. Most of the patients felt better after surgery and the surgeon´s criteria were in favor of the positive results of this surgery(AU)

Dacriocistorrinostomía endoscópica: experiencia de 4 años del Hospital Clínico de la Universidad de Chile / Endoscopic dacryocystorhinostomy: four years experience at the Clinical Hospital of the University of Chile

Introducción: La dacriocistorrinostomía abierta es el gold estándar para el tratamiento de la obstrucción nasolacrimal, patología manifestada como epífora crónica, dacriocistitis y conjuntivitis recurrente. Desde el desarrollo del abordaje endonasal, se ha considerado como una alternativa terapéutica eficaz con notorias ventajas respecto a la técnica abierta y que además ofrece la posibilidad de corregir otras alteraciones de la nariz y cavidades paranasales en el mismo tiempo quirúrgico. Objetivo: Evaluar los resultados de la técnica quirúrgica endoscópica según la realidad del Hospital Clínico de la Universidad de Chile, durante los años 2010-2014. Determinar la etiología de la obstrucción en los pacientes intervenidos. Material y método: Se realizó un estudio de cohorte retrospectivo con revisión de fichas clínicas de pacientes con diagnóstico de obstrucción de la vía lacrimal sacular y postsacular sometidos a dacriocistorrinostomía endoscópica. Se incluyeron 27pacientes entre los cuales se realizaron 33 cirugías, ya que 22,2% de ellos (6/27) fueron sometidos a intervención bilateral. Resultados: El éxito quirúrgico objetivo y subjetivo se presentó en 75,8% (25/33) y 65,4% (17/26) respectivamente. El 7,4% (2/27) presentaron complicaciones intraoperatorias (falsa vía y extrusión de grasa orbitaria) y 18,5% (5/27) complicaciones posoperatorias (sinequias y fibrosis). Dentro de las causas destacan: idiopática 66,7% (18/27), postraumática 14,8% (4/27), secundaria a utilización de radioyodo 11,1% (3/27), granulomatosis de Wegener3,7% (1/27)y congénita 3,7% (1/27). La sonda instalada se mantuvo por un promedio de 3,5 meses, y el seguimiento se realizó por un periodo de 7,4 meses. Conclusión: La dacriocistorrinostomía endoscópica resulta ser una excelente herramienta quirúrgica para el manejo de pacientes con diagnóstico de obstrucción nasolacrimal, siendo un procedimiento exitoso, seguro, con baja tasa de complicaciones y una muy buena evolución posoperatoria, recomendado para todos aquellos casos con mala respuesta a las terapias médicas.

Introduction: Open dacryocystorhinostomy is the gold standard for the treatment of nasolacrimal obstruction, pathology manifested as chronic epiphora, recurrent dacryocystitis and conjunctivitis. Since the development of endonasal approach, it has been considered as an alternative therapy with notable advantages over the open technique and offers the possibility to correct other abnormalities of the nose and paranasal sinuses in the same surgical time. Aim: To evaluate the results of endoscopic surgical technique according to the reality of the Clinical Hospital of the University of Chile, during the years 2010-2014. Determine the etiology of the obstruction in patients undergoing surgery. Material and method: A retrospective cohort study was performed with review of clinic files of patients diagnosed with lacrimal duct obstruction submitted to an endoscopic dacryocystorhinostomy. 27 patients were included and 33 surgeries were performed, as 22.2% of them (6/27) underwent bilateral intervention. Results: Objective and subjective surgical success occurred in 75,8% (25/33) and 65,4% (17/26) respectively. 7,4% (2/27) had intraoperative complications (false passage and orbital fat extrusion) and 18,5% (5/27) postoperative complications (fibrosis and synechiae). Among the causes are: idiopathic 66,7% (18/27), postraumatic 14.8% (4/27), history of radioiodine use 11.1% (3/27), Wegener's granulomatosis 3.7% (1/27) and congenital 3.7% (1/27). Probe Installed was kept for an average of 3,5 months, and the follow-up was performed for 7,4 months. Conclusions: Endoscopic dacryocystorhinostomy is an excellent surgical tool for the management of patients with nasolacrimal obstruction. It's a successful procedure, with low rate of complications and good postoperative outcome, recommended for those cases with poor response to medical therapies.

Dacriocistocele no adulto / Adult dacryocystocele

A dacriocistocele representa um saco lacrimal dilatado e é frequentemente considerada como tendo uma etiologia congênita. No entanto, dacriocistocele é uma doença rara em adultos. A característica clínica se caracteriza por um abaulamento indolor na região medial da órbita, inferior ao ligamento cantal medial. O teste de excreção lacrimal, endoscopia, tomografia computadorizada e ressonância magnética são utilizados para fazer o diagnóstico de dacriocistocele. Semelhante a pacientes pediátricos, marsupialização endoscópica do cisto nasal e a colocação de stent parece ser a terapêutica adequada. Em alguns casos o tratamento consiste na dacriocistorrinostomia externa.

The dacryocystocele represents a dilated lacrimal sac and is often considered as having a congenital etiology. However, dacryocystocele is a rare disease in adults. The clinical feature is characterized by a painless bulge in the medial region of the orbit, below the medial canthal ligament. The lacrimal excretion test, endoscopy, computerized tomography and magnetic resonance image are used to make the diagnosis of dacryocystocele. Similar to pediatric patients, endoscopic marsupialization of the cyst with nasal stenting seems to be the appropriate therapy. In some cases the treatment consists of external dacryocystorhinostomy.

[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.

[Endoscopic dacryocystorhinostomy: role of the ophthalmologist]. / Dacriocistorrinostomía endonasal: participación del oftalmólogo.

OBJECTIVE: To evaluate the results of endoscopic dacryocystorhinostomy (DCR) with or without support of the ophthalmologist. MATERIAL AND METHODS: A retrospective study of 100 cases of endoscopic DCR surgery conducted by an otolaryngologist between June 2008 and December 2009. Of the 100 cases, 50 were operated with surgical support of the ophthalmologist, who inserted Bowman probes in the upper and lower canaliculi, while in the other 50 cases it was the otolaryngologist who performed this, without support of the ophthalmologist. The evaluation of the results after 2 years included the subjective perception, the lacrimal patency after lacrimal syringing, and lacrimal functional test after modified Jones test. RESULTS: Of the 100 DCR reviewed, more than 50% required complementary treatment by the otolaryngologist, mainly septoplasty. As for the resolution of epiphora, without support of the ophthalmologist, 75% the patients reported an overall subjective improvement, but this reached 92% in the surgical group with support of the ophthalmologist, which was a statistically significant difference. CONCLUSIONS: Endoscopic DCR is effective in the treatment of epiphora, but its results improve when the ophthalmologist inserts the probes in the lacrimal canaliculi during the surgical procedure.

Usefulness of local postoperative care after laser dacryocystorhinostomy.

INTRODUCTION AND OBJECTIVES: Epiphora caused by nasolacrimal drainage system obstruction is the main indication for dacryocystorhinostomy (DCR). So are chronic conjunctivitis and dacryocystitis from the same origin. Nasal endoscopy and the introduction of laser assisted DCR have facilitated the performance of the technique. However, it requires complex and expensive equipment, so there are still supporters of the traditional external procedure. The aim of this work was to study the effectiveness and usefulness of local postoperative care in laser DCR final result. MATERIAL AND METHODS: We studied a group of 96 patients diagnosed with epiphora secondary to stenosis-occlusion of the nasolacrimal duct. Of these, 32 patients underwent surgery in both eyes, making a total of 128 cases. The surgery was performed in a private setting between January 1999 and December 2008. The 128 cases were divided into 2 groups: 59 cases in which between 4 and 6 postoperative cures were given in the 2 months following the surgery, and another group of 69 cases in which a single cure was given approximately 7 days after surgery. The final assessment of the outcome of the intervention was done in all cases between 24-30 months after surgery. RESULTS: In 27 cases out of 128 (79% success), there was a restenosis of tear drainage. No statistically significant differences were found between the 2 groups. CONCLUSIONS: In the sample of patients that were intervened using laser assisted DCR, implementation of postoperative cure was irrelevant in the success of the intervention.