Hannah M Timlin1, Swan Kang2, Kailun Jiang3, Daniel G Ezra2,4,5. 1. Moorfields Eye Hospital NHS Trust, 162 City Road, London, EC1V2PD, UK. hannahtimlin@nhs.net. 2. Moorfields Eye Hospital NHS Trust, 162 City Road, London, EC1V2PD, UK. 3. Department of Surgery, Division of Ophthalmology, University of Calgary, Calgary, Alberta, T2N 1N4, Canada. 4. UCL Institute of Ophthalmology, Bath Street, London, EC1V 9LH, UK. 5. NIHR Biomedical Research Centre for Ophthalmology, City Road, London, EC1V 2PD, UK.
Abstract
BACKGROUND: To investigate the aetiopathology of recurrent epiphora or stickiness after dacryocystorhinostomy (DCR) surgery, identifiable on dacryocystography (DCG), and to assess the success rates of secondary corrective surgeries. METHODS: Consecutive post-DCR DCG images from patients with recurrent symptoms were reviewed between 2012 and 2015. RESULTS: One hundred fifty-nine eyes of 137 patients were evaluated. Fifty-eight DCGs showed normal postoperative findings, 4 an upper/lower canalicular block, 13 a common canalicular block, 31 a completely closed anastomosis, 50 a narrow anastomosis, and 3 an anastomosis draining into a nasal sinus. The most successful corrective procedures for each failure category were: Lester Jones Tube (LJT) for a normal post-operative DCG (17/18 success), Sisler trephination with tubes for upper/lower canalicular block (1/2 success), redo-DCR with tube for common canalicular blockage (5/6 success), redo-DCR +/- tube for completely closed anastomosis (12/16 success), LJT followed by redo-DCR +/- tube for narrow surgical anastomosis (1/1 and 17/27 success respectively), and redo-external-DCR with tube for anastomosis into a nasal sinus (1/1 success). Redo-DCR was ineffective in patients who had good post-DCR anatomical patency (22% success). CONCLUSION: This is the first study to report success rates of redo-DCR surgery according to anatomical findings confirmed by DCG. The outcome flow diagram help clinicians recommend procedures that are most likely to be successful for their patient's specific anatomical abnormality. It also provides a visual tool for the shared decision-making process. Notably, symptomatic patients with a normal DCG post DCR are unlikely to benefit from redo-DCR, with a LJT being the recommended next step.
BACKGROUND: To investigate the aetiopathology of recurrent epiphora or stickiness after dacryocystorhinostomy (DCR) surgery, identifiable on dacryocystography (DCG), and to assess the success rates of secondary corrective surgeries. METHODS: Consecutive post-DCR DCG images from patients with recurrent symptoms were reviewed between 2012 and 2015. RESULTS: One hundred fifty-nine eyes of 137 patients were evaluated. Fifty-eight DCGs showed normal postoperative findings, 4 an upper/lower canalicular block, 13 a common canalicular block, 31 a completely closed anastomosis, 50 a narrow anastomosis, and 3 an anastomosis draining into a nasal sinus. The most successful corrective procedures for each failure category were: Lester Jones Tube (LJT) for a normal post-operative DCG (17/18 success), Sisler trephination with tubes for upper/lower canalicular block (1/2 success), redo-DCR with tube for common canalicular blockage (5/6 success), redo-DCR +/- tube for completely closed anastomosis (12/16 success), LJT followed by redo-DCR +/- tube for narrow surgical anastomosis (1/1 and 17/27 success respectively), and redo-external-DCR with tube for anastomosis into a nasal sinus (1/1 success). Redo-DCR was ineffective in patients who had good post-DCR anatomical patency (22% success). CONCLUSION: This is the first study to report success rates of redo-DCR surgery according to anatomical findings confirmed by DCG. The outcome flow diagram help clinicians recommend procedures that are most likely to be successful for their patient's specific anatomical abnormality. It also provides a visual tool for the shared decision-making process. Notably, symptomatic patients with a normal DCG post DCR are unlikely to benefit from redo-DCR, with a LJT being the recommended next step.
Entities:
Keywords:
Dacryocystography; Dacryocystorhinostomy; Epiphora; Lester Jones tube; Nasolacrimal duct obstruction
Authors: Elina Penttilä; Grigori Smirnov; Juha Seppä; Kai Kaarniranta; Henri Tuomilehto Journal: Am J Rhinol Allergy Date: 2011 Nov-Dec Impact factor: 2.467