Assessment of patient-reported outcome and quality of life improvement following surgery for epiphora

Abstract

PurposeTo assess and compare the subjective improvement in symptoms and quality of life in adult patients who underwent commonly performed oculoplastic surgical interventions to treat epiphora.Materials and methodsA prospective study was undertaken involving all adult patients undergoing dacryocystorhinostomy (DCR), lid tightening (lateral tarsal strip or lateral wedge resection), and punctoplasty surgery at our institution. We assessed severity of epiphora preoperatively using the Munk score. At 3 months postoperatively, all patients were sent postal questionnaires comprising of Munk score, 'social impact score' from validated Lac-Q questionnaire ranging from 0 (no impact) to 5 (maximal negative impact) and Glasgow Benefit Inventory (GBI) score, ranging from -100 (maximal detriment) to +100 (maximal benefit).ResultsA total of 134 questionnaires were sent with an overall response rate of 74.6%. For the purpose of data analysis, patients were divided into four groups: DCR, lid tightening, punctoplasty, and combined group (lid tightening plus punctoplasty). There was statistically significant improvement in subjective epiphora postoperatively, as assessed by Munk score (P<0.001) in all groups. The total GBI scores were +42.67 (95% CI: 33.42-51.91) for DCR, +19.65 (95% CI: 10.33-28.97) for lid tightening, +16.06 (95% CI: 2.65-29.48) for punctoplasty, and +26.53 (95% CI: 13.15-39.90) for the combined group, demonstrating a positive change in health status for all groups. There was negative correlation between total GBI and post-operative Munk scores (r=-0.58, P<0.001), and positive correlation between Lac-Q and Munk scores (r=0.65, P<0.001).ConclusionPatients derived significant improvement in symptoms and health-related quality of life benefit following all surgical interventions for epiphora.

Intubationssysteme in der Tränenwegchirurgie – eine aktuelle Übersicht

“…For isolated intubation of the puncta lacrimalia, perforated punctum plugs may be used, while pure monocanalicular intubation can be performed using a Mini-Monoka. The monocanaliculonasal intubation systems include the Monoka (Wide Collarette type), Monoka of Fayet (Crawford type), the self-threading [1,2]. Neben Tränenfilmveränderungen, Lidfehlstellungen und Hypersekretion sind Störungen der ableitenden Tränenwege, insbesondere Tränenwegstenosen und Tränenwegverletzungen, eine der Hautpursachen für Epiphora [3,4].…”

Application of a symptoms score questionnaire after conjunctivodacryocystorhinostomy: outcomes

“…Furthermore, different fixation techniques have been proposed 7,8 . The success rate of JT-CDCR varies from 57% to 98% in different studies 4,9 and there is great heterogeneity among outcomes evaluated to define the effectiveness of the procedure 3 . In our series, there were significantly more females subjected to CDCR (75%) with a mean age, similar to other studies, of 53 years 10,11 .…”

“…Endoscopically-assisted placement of the JT gives the surgeon a chance to assess the proper position of the device and, later, tailor its length and angle to avoid painful mucosal contact or decubitus. Considering the presence of a permanent foreign body in the lacrimal canaliculum, it is mandatory to investigate patient discomfort and the ability of the JT to resolve symptoms related to the underlying pathology; while the majority of the published articles on JT conjunctivodacryocystorhinostomy (JT-CDCR) outcomes have focused on the primary surgery and initial success rate 3 , few studies have reported results exceeding one year postoperative and have not considered patient satisfaction and improvement of quality of life (QoL) 4 ; therefore, the purpose of this study was to evaluate results after a medium/long period of time and patient satisfaction through relief of symptoms and improved QoL using the Naso Lacrimal Duct Obstruction symptom-score (NLDO-SS).…”

Assessment of Lacrimal Duct Patency in Patients Undergoing Endoscopic Medial Maxillectomy

“…On the other hand, patency assessment based solely on Munk score can be misleading. Sipkowa et al [ 22 ], in post-operative assessment of patients after DCR without evident epiphora (0—Munk score), demonstrated very divergent Glasgow Benefit Inventory (GBI) scores. There is no consensus on the use of more detailed questionnaires because minor symptoms in some patients may not have a negative impact on their assessment of general or social status [ 22 , 23 ].…”