Intra-Operative Mitomycin-C as Adjuvant Therapy in External and Endonasal Dacryocystorhinostomy: Systematic Review and Meta-Analysis

Nonis

European Journal of Ophthalmology

et al. 2021

Distal acquired lacrimal obstruction is a common adulthood pathology whose primary treatment is represented by EXT-DCR and END-DCR. When considering their influencing factors, the role of the type of anaesthesia applied during these surgeries has a major role. The aim of this study is to systematically analyse the influence of general and local/regional anaesthesia on the final success rates of EXT-DCR and END-DCR. Primary EXT-DCR and END-DCR articles published later than 2000 with at least 50 single clinician procedures were selected. Exclusion criteria included acute dacryocystitis, tumours, studies focussing on revision surgeries, surgeries with adjunctive procedures, not clearly demarcated surgeons, mixed cohort study of acquired and congenital disorders. This systematic review was conducted in accordance with MOOSE guidelines; where feasible, a meta-analysis of the collected results was conducted. As a result, 11,445 articles were selected of which 2741 were examined after screening, and 16 included after full text review (0.6% of the initial papers). Among all papers included, the number of EXT-DCR was not enough to provide a solid analysis of the effect of anaesthesia; conversely, a significant difference of success rate was noted between local anaesthesia + sedation (85.1%, IC 77.8%–90.4%), and general anaesthesia (90.8%, IC 88.8%–92.4%) in END-DCR ( p = 0.048). In conclusion, END-DCR performed with general anaesthesia should be considered as the solution of choice; however, local anaesthesia, eventually associated with a sedation, can be used as an alternative in selected cases. No meaningful conclusions could be drawn for EXT-DCR, due to the lack of data.

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases

Nonis

European Journal of Ophthalmology

et al. 2021

“…mitomycin C, oral antibiotics (ABT), nasal steroids or ocular steroids). [33][34][35] As a result, in our cohort, we did not apply mitomycin C, but we do prescribe post-operative antibiotic-steroid eye drops and bicanalicular stenting in all cases.…”

Section: Discussionmentioning

confidence: 99%

The importance of clinical presentation on long-term outcomes of external dacryocystorhinostomies: Our experience on 245 cases

European Journal of Ophthalmology

Bordato

et al. 2021

Purpose External dacryocystorhinostomy (EXT-DCR) is a surgical approach commonly used to treat post-canalicular acquired lacrimal obstruction whose success rate has been described, equally with endoscopic DCR, to be superior to other available treatments. Methods At San Raffaele Hospital, Milan (Italy), from January 2008 to December 2020, 245 EXT-DCRs were performed. All patients underwent routine pre-operative work-up including Jones tests and probing and irrigation of the lacrimal pathway; when necessary, a multidisciplinary approach with nasal endoscopy was performed. The surgical approach was followed by positioning of a bicanalicular stent which was left in place for 6 months. Success was defined as resolution of clinical signs/symptoms and free lacrimal flow on functional test. Results Of the cases enrolled, 26.9% were treated for recurrent epiphora (group 1), and 73.1% for epiphora associated with chronic dacryocystitis (group 2). After a median follow-up of 71 months, group 1 had success at T0 (1 month) and T1 (long-term) of 81.8% and 60.6%, respectively, compared to 93.8% and 77.7% in group 2. Statistical analysis showed a significant association with surgery both at T0 ( p = 0.018) and T1 ( p = 0.012) with group 2 showing better outcomes. Additionally, the cosmetic outcome of the external scar was defined as invisible in 91.8% of cases and slightly visible in 8.2%. Conclusions External dacryocystorhinostomy provides long-term reliable results particularly in case of chronic dacryocystitis. Moreover, the optimal esthetic outcome of the external scar should be no longer considered the only guiding principle of treatment modality, particularly in the elderly.

“…Finally, considering post-surgical therapy, different possibilities have been discussed in the literature, both for postoperative medical therapy and bicanalicular stenting. Nevertheless, with the current data available regarding END-DCR, no difference is noted regarding either lacrimal stenting [34][35][36] or medical therapies (e.g., mitomycin C, oral antibiotics (ABT), nasal steroids or ocular steroids) [37][38][39][40]. As a result, in our series, we do not apply mitomycin C, but we do prescribe post-operative oral ABT and antibiotic-steroid eye drops; bicanalicular stenting was placed in only selected patients (2/14) in which extensive fibrosis was noted as failure of the primary surgical approach.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies

Indelicato

Eur Arch Otorhinolaryngol

et al. 2021

Purpose Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction. Methods At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test. Results Among 14 patients included and after a mean follow-up of 19.5 months (range 13-51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported. Conclusion Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.