Albert Wu , David S Curragh , Rebecca Morrow , Dinesh Selva & Garry Davis
Sebaceous carcinoma (SC) is the third most common eyelid malignancy in Australia, and is potentially fatal. It usually presents as a nodule or diffuse eyelid thickening, and is commonly misdiagnosed. We describe a case of SC with lacrimal sac involvement, presenting with clinical features of nasolacrimal duct obstruction. At the time of endoscopic dacryocystorhinostomy (DCR), nasal endoscopy revealed a polypoid mass of the opened lacrimal sac. Biopsy of the mass showed poorly differentiated SC. The lacrimal drainage apparatus was later excised via a combined external and endoscopic approach. Conjunctival map biopsies showed extensive intraepithelial disease, which was treated with topical mitomycin C. At three-month follow-up, there was no evidence of residual disease on nasal endoscopy or repeat conjunctival biopsy.
Shay Keren, Avraham Abergel, Amir Manor, Amir Rosenblatt, Dvir Koenigstein, Igal Leibovitch & Ran Ben Cnaan
Endoscopic dacryocystorhinostomy (DCR) is a widely performed and safe procedure for the treatment of nasolacrimal duct obstruction manifested as epiphora or dacryocystitis. Current success rates are above 90%. Data on causes for failure of the procedure are sparse. We investigated the influence of several preoperative parameters on surgery outcome and to establish that parameters are linked with failure.
A retrospective analysis of the medical records of all consecutive patients who underwent endoscopic DCR in the Tel-Aviv Medical Center, a tertiary referral center, between January 2010 and August 2016 were retrospectively examined and data on the occurrence of surgical failure and reasons for failure were retrieved.
A total of 165 patients (183 eyes) were included. The overall success rate for the surgery was 94.7%. The parameters that correlated significantly with failure were coexisting diabetes mellitus (P = 0.037), allergy to medications (P = 0.034), and prior ocular surgery (P = 0.043). There was no correlation between the surgical failure rates and facial trauma, previous nasal or lacrimal surgery, or the usage of a stent.
Endoscopic DCR is a safe and effective surgical procedure. Diabetes mellitus, allergies, and previous ocular surgery may lead to surgical failure. Patients with these risk factors should be aware of increased failure rates.
Ali, Mohammad Javed F.R.C.S., Ph.D.
The aim of this study was to examine the endoscopic anatomy of the valve of Rosenmüller in real-time and its potential functional implications.
High-definition endoscopic documentation of the valve of Rosenmüller (VOR) during 50 powered endoscopic dacryocystorhinostomy over a period of 2 years were reviewed. The presence or absence of the valves were assessed and when present, each of the valves were studied for their anatomical configuration, shape, precise location, and changes with opening and closing of the internal common opening (ICO) and with the presence and absence of the probe.
VOR was noted in 68% of the subjects studied and 2 distinct subtypes were noted with type I being more common. The Type 1 VOR was a stand-alone, freely mobile, elliptical valve arising from the superior or postero-superior portion of the medial edge of the ICO. The Type II VOR was a group of a superior and inferior mucosal fold, arising from the superior and inferior portions of the medial edge of the ICO. When the ICO opens slowly, the valve tends to fall outwards towards the lacrimal sac. When the ICO slowly closes back, the valve moves inward towards the common canaliculus.
This is the first study to demonstrate the in-vivo presence of VOR. Two different types of VOR were noted with characteristic shapes, locations, and movements of each. Where present, VOR fulfills the criteria of a true valve. The study proposes that the term “valve of Huschke” is a misnomer and when present, is actually part of the overall anatomical and functional unit of VOR.
Detailed anatomical features of the valve of Rosenmϋller can help our understanding of the focal anatomy and tear rheology.
Dong Ju Kim, Sehyun Baek, Minwook Chang
To evaluate the clinical usefulness of the dacryoscintigraphy in patients with nasolacrimal duct obstruction prior to endoscopic dacryocystorhinostomy.
One hundred thirty-five lacrimal views of endoscopic dacryocystorhinostomy (DCR) with a single surgeon for primary nasolacrimal duct obstruction (PANDO) were included. These were assigned into three groups according to the type of dacryoscintigraphy. Group 1 was a pre-sac obstruction pattern. Group 2 was an intra-sac obstruction pattern. Group 3 was post-sac obstruction pattern. Each group was evaluated for an anatomical and functional surgical success, presence of complications including granuloma, synechiae, and tube-induced inflammation at least 12 months after the surgery.
Both anatomical and functional success rate showed no significant difference among the three groups (P = .297 and .472 linear by linear association). Functional failure rate (functional failure/total failure) also showed no clinically significant differences between groups. Logistic regression analysis was performed to determine the factors associated with functional success. There were no statistically significant factors in age, sex, scintigraphy type, pre-operative endoscopic grade, post-operative granuloma, and synechiae.
In patients with nasolacrimal duct obstruction, preoperative evaluation of obstruction level using dacryoscintigraphy may be not useful for predicting the functional success of the endoscopic dacryocystorhinostomy.