Altered Surfactant Protein Expression in Primary Acquired Nasolacrimal Duct Obstruction

28 Nov 2019

Ali, Mohammad Javed; Bráuer, Lars; Schicht, Martin; Paulsen, Friedrich

Purpose: To investigate the presence and distribution patterns of 6 surfactant proteins in lacrimal drainage tissues of patients with primary acquired nasolacrimal duct (NLD) obstruction.

Methods: The presence and distribution of surfactant proteins (SP)-G and SP-H was first assessed in normal cadaveric lacrimal systems. The study was then performed in 10 samples of lacrimal sac and the respective NLDs obtained from patients suffering from primary acquired NLD obstruction who underwent either a dacryocystorhinostomy or a dacryocystectomy. The lacrimal sac samples were further divided into fundus and body, soon after their removal. Immunohistochemical labeling was performed for assessing the presence and distribution of SPs: SP-A, SP-B, SP-C, SP-D, SP-G/SFTA2, and SP-H/SFTA3. The results were then scored as positive or negative and the distribution pattern, if any, within the lacrimal sac and NLDs was assessed. Human lung tissues were used as controls.

Results: SP-H was demonstrated in the lining epithelia of the normal lacrimal drainage systems, whereas SP-G was uniformly negative. Immunohistochemical labeling revealed wide variations in the staining patterns of different SPs in different regions of the lacrimal sac and the NLD. SP-D and SP-G revealed uniformly negative immunoreactivity. Variable staining patterns were also noted between the superficial and basal layers of the lining epithelia. However, the goblet cells and intraepithelial mucous glands did not express any of the SPs.

Conclusions: This study provides a proof of principle for the presence of SP-H and absence of SP-G in the normal lacrimal drainage systems. In cases of primary acquired nasolacrimal duct obstruction, there were alterations or loss of SP expression in the lining epithelia of the lacrimal sac and NLDs, reflecting their possible role in the etiopathogenesis of primary acquired nasolacrimal duct obstruction.

In cases of primary-acquired nasolacrimal duct obstruction, the expression of multiple surfactant proteins was either deranged or lost in the lining epithelium of the lacrimal sac and nasolacrimal ducts.

https://journals.lww.com/op-rs/Abstract/2019/11000/Altered_Surfactant_Protein_Expression_in_Primary.6.aspx

Categories: OPRS

Tags: Lacrimals PANDO

Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings

28 Nov 2019

Timlin, Hannah M.; Keane, Pearse A.; Ezra, Daniel G.

Purpose: To characterize the anatomical anomaly of congenital double puncta, identify factors contributing to epiphora and its treatment.

Methods: Retrospective review of patients presenting with epiphora and a double lacrimal punctum over a 6-month period.

Results: Five consecutive patients (3 female) were identified. The median age was 50 years (range 34–76). Investigations included punctum optical coherence tomography, dacryocystography, and canalicular endoscopy. The medial punctum was more morphologically abnormal when compared with healthy puncta, with optical coherence tomography showing no vertical canalicular component in 80% (4/5) of patients, and a more superficial than usual horizontal canaliculus in 80% (4/5). Dacryocystography and canalicular endoscopy showed the junction of the 2 inferior canaliculi, which was very proximal in 1, mid canalicular in 2, and at the level of the common canaliculus in 2. In 1 patient, the only abnormality identified was the double lower punctum, with a high tear meniscus and delayed fluorescence dye disappearance test. They underwent endonasal dacryocystorhinostomy with improvement of epiphora. In the other 4 patients, causes of epiphora were nasolacrimal duct stenosis with mucocoele, punctal stenosis, common canalicular stenosis with nasolacrimal duct stenosis, upper canaliculitis, and blepharitis. Their treatments included endonasal dacryocystorhinostomy, punctoplasty, canaliculotomy, and blepharitis treatment. All had improvement of epiphora following treatment.

Conclusions: These findings suggest that the underlying canalicular anomalies are varied and that the clinical manifestation is also heterogenous. Optical coherence tomography imaging suggests that the medial of the 2 puncta is the more morphologically abnormal one, with dacryocystography and canalicular endoscopy demonstrating different accessory canaliculi lengths.

Double puncta coexist with a range of other nasolacrimal pathologies. OCT suggests that the medial of the 2 double puncta is the abnormal one, with DCG and endoscopy demonstrating a range of accessory canaliculus lengths.

https://journals.lww.com/op-rs/Abstract/2019/11000/Characterizing_Congenital_Double_Punctum.5.aspx

Categories: OPRS

Tags: Canalicular Endoscopy Dacryocystography Double punctum Epiphora Lacrimals

A Review of Diagnostic and Therapeutic Dacryoendoscopy

27 Nov 2019

Singh, Swati; Ali, Mohammad Javed

https://journals.lww.com/op-rs/Abstract/2019/11000/A_Review_of_Diagnostic_and_Therapeutic.1.aspx

Categories: OPRS

Tags: Dacryoendoscopy Dacryoplasty Epiphora Lacrimals

A Comparison of Endonasal Dacryocystorhinostomy and External Dacryocystorhinostomy

18 Nov 2019

Rachel K. Sobel, Vinay K. Aakalu, Edward J. Wladis, Jurij R. Bilyk, Michael T. Yen, Louise A. Mawn

Purpose

To assess the efficacy of endonasal dacryocystorhinostomy (DCR) compared with external DCR.

Methods

A literature search was conducted in the PubMed database in March 2016 and updated in October 2017 and February 2019. The search strategy was designed to update the first Ophthalmic Technology Assessment on endonasal DCR from 2001 by identifying new peer-reviewed human studies reported since 2000 in the English language that compare results of endonasal DCR with those of external DCR. The searches yielded 169 articles. Of these, 13 met the inclusion criteria and were assigned a level of evidence rating.

Results

Six of the 13 studies included in this assessment were rated level II and 7 were rated level III. Three of the 13 studies drew conclusions based on statistically significant results, but all of these were level III evidence. Two of these significant studies demonstrated lesser efficacy of endonasal laser DCR (63%–64%) compared with external DCR (94%; P = 0.0002, 0.024). The third study reported that nonlaser endonasal DCR was superior to external DCR (84% vs. 70%; P = 0.03). The remainder of the studies did not find statistically significant differences in success rates between the 2 techniques.

Conclusions

Limited data suggest that laser endonasal DCR may be less effective than external DCR. Existing data are inadequate to draw conclusions about whether endonasal DCR is superior to, equivalent to, or inferior to the gold standard external DCR.

The American Academy of Ophthalmology prepares Ophthalmic Technology Assessments to evaluate new and existing procedures, drugs, and diagnostic and screening tests. The goal of an Ophthalmic Technology Assessment is to review the available research systematically for clinical efficacy, effectiveness, and safety. After review by members of the Ophthalmic Technology Assessment Committee, other Academy committees, relevant subspecialty societies, and legal counsel, assessments are submitted to the Academy’s Board of Trustees for consideration as official Academy statements. The purpose of this assessment by the Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel is to compare the efficacy of endonasal dacryocystorhinostomy (DCR) with external DCR.

https://www.aaojournal.org/article/S0161-6420(19)31518-0/fulltext

Categories: Ophthalmology

Tags: Endonasal DCR Epiphora External DCR Lacrimals