Self-regurgitation on pressure over lacrimal sac in cases of primary-acquired nasolacrimal duct obstruction: Correlation with physician examination and patients' perceptions

Alam, MdS; Singh, Parinita; Amitava, AbadanK; Ali, MohammadJ

doi:10.4103/sjopt.sjopt_87_21

Cited by 3 publications

(4 citation statements)

References 8 publications

(8 reference statements)

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“…This study also mentions situations when ROPLAS can be negative even in the presence of NLDO, like when it is not done correctly, or in cases of encysted mucocele, fibrosed lacrimal sac, or if the patient has emptied the sac him/herself just before the examination. [ 11 ] These reasons are most likely the cause of low sensitivity rate of ROPLAS as noted in our study.…”

Section: Discussionmentioning

confidence: 72%

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Regurgitation on pressure over the lacrimal sac versus lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries

Kim

Vardhan

Datta

et al. 2022

Indian Journal of Ophthalmology

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Purpose: To determine the diagnostic accuracy of manual regurgitation on pressure over the lacrimal sac (ROPLAS) versus lacrimal irrigation for screening nasolacrimal duct obstruction (NLDO) in adults prior to intraocular surgeries. Methods: This cross-sectional study took place in a tertiary eye care hospital in South Tamil Nadu, India. From January to December 2017 and included consecutive patients who presented for routine cataract surgery. Prospective data collection occurred in 8369 eyes of patients who underwent cataract surgery. All patients underwent ROPLAS testing by an ophthalmologist followed by lacrimal irrigation by trained ophthalmic assistants, rechecked or confirmed in equivocal cases by ophthalmologists who were masked to the ROPLAS status. The primary outcome, the sensitivity, specificity, positive, and negative predictive values to detect lacrimal occlusion by ROPLAS compared with lacrimal irrigation with 95% confidence intervals was estimated. Results: A total of 8369 eyes underwent cataract surgery during the time periods of the study. ROPLAS and lacrimal irrigation were performed in all eyes. The sensitivity of ROPLAS to diagnose NLDO correctly was 54.5% (95% CI, 44.8%–63.9%) and its specificity was 100% (95% CI, 100%–100%). The positive and negative predictive values were 75.3% (95% CI, 65.6%-83.0%) and 99.4% (95% CI, 99.2%–99.5%), respectively. Conclusion: We found that ROPLAS when used alone had very low sensitivity and low positive predictive value in detecting NLDO prior to cataract surgery as compared with lacrimal irrigation. Hence, we recommend performing ROPLAS and lacrimal irrigation in every patient as part of the routine preoperative workup prior to cataract surgery.

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Section: Discussionmentioning

confidence: 72%

“…In another study from India, Alam et al . [ 11 ] studied correlation of self-ROPLAS by patients and the presence of NLDO diagnosed by physicians. A total of 134 patients were studied, with history of self-ROPLAS present in 64 patients, whereas the physician examination revealed ROPLAS to be positive in 92 patients.…”

Section: Discussionmentioning

confidence: 99%

Regurgitation on pressure over the lacrimal sac versus lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries

Kim

Vardhan

Datta

et al. 2022

Indian Journal of Ophthalmology

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“…ROPLAS can be used as an alternative test to assess NLDO before cataract surgery [16]. However, relying solely on the ROPLAS test has limited sensitivity and a low positive predictive value due to incorrect technique or sac emptying prior to examination [17]. In contrast, lacrimal syringing can provide more comprehensive details and is therefore recommended as a complementary method for preoperative assessment of NLDO before cataract surgery, ensuring a more comprehensive evaluation [2].…”

Section: Discussionmentioning

confidence: 99%

Advancing Proficiency in Lacrimal Syringing: Comparative study of Two Different Syringing Techniques and Designing of a Self-serve Training Model

Huang,

Li,

Gao

et al. 2024

Preprint

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Aim: This study compares two lacrimal syringing techniques and introduces a simplified self-serve training model for ophthalmology residents to acquire proficient skills. Methods: A cross-sectional survey involved lacrimal syringing novices divided into Group A and Group B. Group A underwent an 8-hour training session covering both techniques and completed post-training questionnaires. Based on Group A's feedback, a simplified self-serve training model was developed. Group B received training, with or without the new model, to assess its effectiveness in improving syringing skills. Results: The study included 92 participants, with 47 in Group A and 45 in Group B. In Group A, 70.2% preferred Technique 1 (Group A1) and 29.8% opted for Technique 2 (Group A2). No significant differences were found between A1 and A2 in baseline skill, practice duration, or mastery levels (p > 0.05). Both techniques had similar perceived difficulty (p > 0.05), but Technique 2 was easier for injection (p < 0.05). Lack of suitable training models (63.8%) and psychological barriers (25.5%) were the main obstacles to proficiency. Group B1, using the training model, showed increased confidence scores (p < 0.05) and a tendency towards better skill assessment, although not statistically significant compared to Group B2 (p > 0.05). Conclusion: Both lacrimal syringing techniques are easily mastered, with Technique 1 preferred by the majority and Technique 2 ideal for pressed irrigation. Our self-serve training model presents a cost-effective means to boost confidence and facilitate lacrimal syringing skill acquisition among ophthalmology residents.

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“…Alam et al . [ 2 ] observed an interesting finding in patients of NLDO, wherein the patient would himself apply pressure over the lacrimal sac to empty it for varying reasons. The authors coined another term “Self ROPLAS” for it and concluded that NLDO is almost certainly present in any patient giving a history of Self ROPLAS, although of course, it needed to be re-confirmed by the treating ophthalmologist.…”

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confidence: 99%

Commentary

Alam

2022

Indian Journal of Ophthalmology

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Self-regurgitation on pressure over lacrimal sac in cases of primary-acquired nasolacrimal duct obstruction: Correlation with physician examination and patients' perceptions

Cited by 3 publications

References 8 publications

Regurgitation on pressure over the lacrimal sac versus lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries

Regurgitation on pressure over the lacrimal sac versus lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries

Advancing Proficiency in Lacrimal Syringing: Comparative study of Two Different Syringing Techniques and Designing of a Self-serve Training Model

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