Jenil Sheth, Suryasnata Rath, Devjyoti Tripathy
Purpose: To compare the efficacy of a single perioperative bolus dose of intravenous antibiotic versus postoperative oral antibiotic prophylaxis for prevention of surgical site infection (SSI) in external dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO). Methods: This was a prospective randomized controlled study with a noninferiority design. Patients undergoing external DCR surgery were randomized into two groups A and B. Patients in group A received a single bolus dose of intravenous cefazolin 1 g at surgery, whereas those in group B received oral cephalexin 500 mg postoperatively twice a day for 5 days. Allocation concealment was ensured by sequentially numbered opaque sealed envelopes (SNOSEs). Both groups were advised identical postoperative local wound care regimens. Any clinical evidence of SSI at 4 weeks of follow-up in either group was the main outcome measure. Results: In all, 338 patients randomized into two groups of 169 patients each participated in this study. At follow-up of 4 weeks, only one patient in group B developed postoperative SSI. None in group A developed postoperative SSI. Other potential risk factors for postoperative SSI were also analyzed by univariate and multivariate analyses but none achieved statistical significance in either group. Conclusion: Our results demonstrate that a single bolus dose of perioperative intravenous antibiotic offers adequate prophylaxis against postoperative SSI and compares favorably with the more commonly used oral antibiotic prophylaxis in external DCR for PANDO in our population and our practice scenario.
Eugene A. Lowry, MD; Evan Kalin-Hajdu, MD; Robert C. Kersten, MD; M. Reza Vagefi, MD
Nasolacrimal duct obstruction may be complicated by acute dacryocystitis. Delayed treatment has been associated with postseptal cellulitis, abscess extension and, rarely, vision loss.1 To our knowledge, no previous report has documented progression to complete vision loss despite prompt and appropriate treatment.
PURPOSE: The purpose of this study is to compare the success rates of endoscopic endonasal dacryocystorhinostomy (EN-DCR) and external DCR (EX-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANLDO). DESIGN: This was a retrospective, comparative, nonrandomized clinical study. METHODS: Reviewed medical records of PANLDO underwent DCR at Far-Eastern Memorial Hospital from May 2011 to June 2017. Data regarding the lacrimal passage system, comorbidities, surgical outcomes, and postoperative complications were analyzed. Anatomical success was defined as patency confirmed by intranasal endoscopic inspection of the ostium and successful lacrimal irrigation; functional success was defined as complete resolution of epiphora and positive fluorescein dye disappearance test, which were assessed at postoperative 6th months. RESULTS: One hundred and seventy patients (37 males, 133 females, mean age 57 years) underwent 178 DCR surgeries for PANLDO. The overall anatomical success rate was 94.4% (93.5% in EN-DCR vs. 95.8% in EX-DCR, P = 0.511) and functional success rate was 90.4% (90.7% in EN-DCR and 90.1% in EX-DCR, P = 0.909). Surgical outcomes were comparable between two groups. Complication rate was low in both groups, including 11 cases of early canalicular stent dislodge (7 in EN-DCR, 4 in EX-DCR), one case of postoperative nasal bleeding in EN-DCR, and two skin wound dehiscence and three cutaneous keloid formation in EX-DCR. None of these cases were concluded into surgical failure at the final visit. The time to symptoms relief was statistical significantly shorter in EN-DCR group (1.7 vs. 3.7 weeks in EX-DCR, P < 0.001). CONCLUSIONS: Success rate of DCR for PANLDO in our study was high, and complication rate was low for both endoscopic and external approaches. There was no statistically significant difference between them. EN-DCR provided higher satisfaction due to quicker recovery and lack of external incision. Endoscopic DCR should be considered as the primary treatment of choice for PANLDO.
Ganguly, Anasua Kapoor; Laghimsetty, Srujana; Bhagyalakshmi, Nirupama
Koebner phenomenon is the development of isomorphic pathologic lesions on a wound of a patient with preexisting cutaneous disease, most commonly psoriasis. An elderly male with palmoplantar psoriasis developed periocular psoriasis in the form of blepharitis and conjunctivitis following an external dacryocystorhinostomy as a manifestation of Koebner phenomenon. Immediate diagnosis and treatment with topical steroids led to complete recovery. Thus, the authors report the first case of Koebner phenomenon in ophthalmic literature, with a review of previously published postsurgical cases of Koebnerization in psoriasis patients. All surgeons should be aware of its existence and warn susceptible patients regarding its occurrence.
Swati Singh, Mohinder Singh, Vikas Mittal
Instrumentation failure during any surgery creates a panicky state and triggers our reflexes. A 46-year-old male with right nasolacrimal duct obstruction was undergoing endoscopic dacryocystorhinostomy as per described standard technique under general anesthesia. While making the lacrimal sac flaps, the endoscopic light source (120 W, Hospiline Equipments Private Limited, Delhi, India) suddenly got extinguished and stopped working. With no standby light source, we thought of using surgical microscope’s (Carl Zeiss Meditec AG, Germany) LED light source. The light cable could be easily detached from microscope and plugged into 0° telescope after removing its black tip at the end of the cable.
Deepesh Mourya & Roshija Khanal Rijal
This article compares the efficacy of transcanalicular laser assisted dacryocystorhinostomy (TL DCR) with conventional external dacryocystorhinostomy (Ex DCR). All patients were randomly divided into two groups – Group A included patients who underwent TL DCR and Group B included patients who underwent Ex DCR. 168 operations were done in a total of 163 patients; 79 patients in group A and 84 patients in group B. The overall success rate was 90.12% in group A and 95.40% in group B. The mean total surgical time was 17.41 min in group A and 49.49 min in group B. The duration of stay in hospital was about 3 hours for group A and about 48 hours for group B. Intra and post operative complications were more in group B than in group A. TL DCR can offer a minimally invasive technique with comparable results and better patient satisfaction than Ex DCR.
Upender Wali, Buthaina Sabt, Yahya Al Badaai, Abdullah Al-Mujaini
Dacryocystorhinostomy (DCR) means creation of anastomosis for direct communication between the lacrimal sac and the nasal cavity through a bony ostium. There are different surgical techniques available for DCR. These include external DCR, endomechanical laser DCR, endonasal laser DCR, and transcanalicular laser-assisted DCR. Diode laser-assisted DCR offers many and specific advantages over conventional DCR.
We present our experience with 23 patients who underwent transcanalicular laser-assisted DCR without stent at a single institution for a variety of indications….
Nandini Bothra, Raashid M Wani, Anasua Ganguly, Devjyoti Tripathy, Suryasnata Rath
Purpose: The aim is to compare the outcome of nonendoscopic endonasal dacryocystorhinostomy (NEN DCR) with external DCR (EXT-DCR) in the treatment of nasolacrimal duct obstruction (NLDO) in children. Methods: A retrospective, comparative chart analysis of all consecutive children <16 years after EXT-DCR or NEN-DCR between June 2012 and February 2016. Results: Seventy-one children (79 eyes) underwent DCR in the study, of which 37 children (40 eyes) underwent EXT-DCR and 34 (39 eyes) NEN-DCR. Mean age of both groups (8.7 vs. 7.7 years) was comparable. Etiologically, persistent congenital NLDO was the most common indication (50% vs. 72%), followed by acquired and secondary NLDO. Mean duration was shorter for NEN-DCR (47 vs. 37 min; P = 0.0021). Mitomycin C 0.04% was used more often in NEN-DCR (10% vs. 56.41%). Success after primary EXT-DCR was 100% as compared to 75% for primary NEN-DCR at median follow-up of 12 and 16 months respectively. At revision, the main cause of failure was granuloma (60%). After revision, all eyes were symptom-free at a median follow-up of 9.5 months. Conclusion: Primary NEN-DCR has a poorer outcome than EXT-DCR in the treatment of NLDO in children and is more likely to need a revision procedure.
Ganguly, Anasua; Kaza, Hrishikesh; Kapoor, Aditya; Sheth, Jenil; Ali, Mohammad Hasnat; Tripathy, Devjyoti; Rath, Suryasnata
Purpose: The purpose of this study was to compare the characteristics of the ostium after external dacryocystorhinostomy and nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR).
Methods: This cross-sectional study included patients who underwent a successful external dacryocystorhinostomy or NEN-DCR and had ≥1 month follow up. Pictures of the ostium were captured with a nasal endoscope (4 mm, 30°) after inserting a lacrimal probe premarked at 2 mm. Image analyses were performed using Image J and Contour softwares.
Results: Of the 113 patients included, external dacryocystorhinostomy group had 53 patients and NEN-DCR group had 60 patients. The mean age of patients in the NEN-DCR group (38 years) was significantly (p < 0.05) lower than the external dacryocystorhinostomy group (50 years). There was no statistically significant difference (2 sample t test, p > 0.05) in mean follow up (6 vs. 4 months), maximum diameter of ostium (8 vs. 7 mm), perpendicular drawn to it (4 vs. 4 mm), area of ostium (43 vs. 36 mm2), and the minimum distance between common internal punctum and edge of the ostium (1 vs. 1 mm) between the external and NEN-DCR groups.
Conclusions: Image processing softwares offer simple and objective method to measure the ostium. While ostia are comparable in size, their relative position differs with posteriorly placed ostia in external compared with inferior in NEN-DCR.
Ben Limbu, Sulaxmi Katwal, Nicole S. Lim, Michelle L. Faierman, Anna G. Gushchin & Rohit Saiju
We determine whether age is a prognostic factor for surgical outcomes of external dacryocystorhinostomy (Ex-DCR). This retrospective cohort study conducted at Tilganga Institute of Ophthalmology (Kathmandu, Nepal) compared pediatric Ex-DCR procedures (age ≤ 15 years) to adult Ex-DCR procedures (age > 15 years) and was performed between January 2013 and December 2013, with a minimum follow-up period of 6 months. Primary outcome measure was rate of success, defined as complete resolution of subjective symptom(s) of epiphora (subjective success), combined with patent lacrimal passage on syringing (anatomical success) at last follow-up visit. Other outcome measures included clinical presentation, diagnosis, intraoperative complications and post-operative complications. In total, 154 Ex-DCR procedures were included, with an age range of 8 months to 81 years (mean age 36.4 ± 21.0 years). In all, 38 pediatric Ex-DCR procedures were compared to 116 adult procedures. Success rates were 97% in the pediatric group and 95% in the adult group, with no clinically or statistically significant difference in success rate or complication rate between groups (p > 0.05). Our study yielded high success rates of Ex-DCR in both pediatric and adult age groups suggesting that Ex-DCR remains an optimal treatment choice for all age groups. With no difference in surgical outcomes between pediatric and adult patients, including complication rate, we conclude that age is not a prognostic factor for Ex-DCR failure. We do not recommend adjuvant therapy for pediatric patients.