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Clinical and Experimental Ophthalmology 2015; 43: 152–155 doi: 10.1111/ceo.12383
Original Article Endoscopic assessment of the dacryocystorhinostomy ostium after powered endoscopic surgery: behaviour beyond 4 weeks Mohammad J Ali FRCS,1 Alkis J Psaltis PhD FRACS,2 Md H Ali MBA3 and Peter J Wormald MD FRACS2 1
Dacryology Service and 3Department of Biostatistics, LV Prasad Eye Institute, Hyderabad, India; and 2Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
95% CI = 9.76–10.53) × 6.45 mm (SD = 1.2; 95% CI = 6.14–6.75). There was no statistically significant decrease in either the ostium size or the area up to 2 years following surgery.
ABSTRACT Background: This study aims to assess the shrinkage of dacryocystorhinostomy (DCR) ostium beyond 4 weeks. Design: Prospective series in a University setting. Participants: Sixty consecutive patients. Methods: Prospectively collected data of 60 consecutive powered endoscopic DCRs performed in 57 patients over a period of 10 years from 2002 to 2011. All patients had regular follow-up of 2 years postsurgery. The ostium size at 4 weeks, 6 months, 1 year and 2 years were evaluated. Analysis of variance was used to compare the differences. Main Outcome measurements.
Measure: Changes
in
ostium
Results: The ostium measured 11.25 mm (standard deviation [SD] = 1.7; 95% confidence intervals [CI] = 10.80–11.69) × 7.07 (SD = 1.4; 95% CI = 6.71– 7.42) at 4 weeks. It measured 10.48 mm (SD = 1.6; 95% CI = 10.06–10.90) × 6.65 mm (SD = 1.2; 95% CI = 6.34–6.95) at 6 months, 10.22 mm (SD = 1.5; 95% CI = 9.81–10.61) × 6.52 mm (SD = 1.2; 95% CI = 6.20–6.80) at 1 year and 10.15 mm (SD = 1.5;
Conclusion: The ostium achieved using the powered endoscopic DCR technique remains stable in size from 4 weeks to 2 years post-surgery. This likely reflects the advantages of this technique which facilitates healing by primary intention. Key words: endoscopic DCR, measurement, ostium, ostium cicatrix.
INTRODUCTION Endoscopic dacryocystorhinostomy (DCR) is a welldescribed and now validated procedure for the management of nasolacrimal duct obstruction. Despite its high level of reported short and long-term success, surgical failure has been reported to be in the range of 4–13%. Postoperative scarring and cicatricial closure of the ostium are noted to be foremost among the major causes of this failure.1–8 The degree to which an ostium constricts from its initial per-operative size is variable with wide reported ranges of 20–98 %.9–17 This variability may not only be influenced by surgical and patient factors
■ Correspondence: Professor Peter Wormald, Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA 5011, Australia. Email: [email protected] Received 28 May 2014; accepted 21 June 2014. Competing/conflicts of interest: Peter Wormald receives royalties from Medtronic for design of instruments and is a consultant to Nielmed. No conflict of interest for other authors. Funding sources: No stated funding sources. Ethics statement: This study has been reviewed by the ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Informed consent was obtained from the patients. © 2014 Royal Australian and New Zealand College of Ophthalmologists
dacryocystorhinostomy ostium
12
Sixty DCR ostia were noted to have measurements at each visit up to 2 years of follow-up and were included in the study. The mean age at surgery was 58.4 years (range 20–91 years). At 4 weeks, the ostia measured 11.25 mm (standard deviation [SD] = 1.7; 95% confidence intervals [CI] = 10.80–11.69) × 7.07 mm (SD = 1.4; 95% CI = 6.71–7.42). The ostia subsequently measured 10.48 mm (SD = 1.6; 95% CI = 10.06–10.90) × 6.65 mm (SD = 1.2; 95% CI = 6.34–6.95) at 6 months, 10.22 mm (SD = 1.5; 95% CI = 9.81–10.61) × 6.52 mm (SD = 1.2; 95% CI = 6.20–6.80) at 1 year and 10.15 mm (SD = 1.5; 95% CI = 9.76–10.53) × 6.45 mm (SD = 1.2; 95% CI = 6.14–6.75) at 2 years. The mean diameter values and corresponding surface area at specified time points are summarized in Table 1. There was no statistically significant decrease beyond 4 weeks in either the ostium size (P = 0.13) or the area (P = 0.18). Figure 1 reflects the mean change in
9
10
11
Vertical Horizontal
8
A retrospective review of prospectively collected data of consecutive powered endoscopic DCRs performed over a period of 10 years from 2002 to 2011 was performed. The study was conducted with institutional review board approval. Powered endoscopic DCR was performed using the previously published technique.1–6 This technique ensures complete lacrimal sac exposure, full-length marsupialization of sac and nasal mucosa to lacrimal mucosa apposition, allowing healing by primary intention.1–6 All patients had sequential measurement of their postDCR ostium at 4 weeks, 6 months, 1 year and 2 years. Measurement was performed using 4 mm olive tip suction, and measurements were taken of the maximal vertical and horizontal diameters. Demographic data, clinical profiles and surgical notes were also recorded.
RESULTS
7
METHODS
from a mixed effect model with Tukey’s contrast were performed. Adjusted P values were obtained by Bonferroni correction. A P value of
Clinical and Experimental Ophthalmology 2015; 43: 152–155 doi: 10.1111/ceo.12383
Original Article Endoscopic assessment of the dacryocystorhinostomy ostium after powered endoscopic surgery: behaviour beyond 4 weeks Mohammad J Ali FRCS,1 Alkis J Psaltis PhD FRACS,2 Md H Ali MBA3 and Peter J Wormald MD FRACS2 1
Dacryology Service and 3Department of Biostatistics, LV Prasad Eye Institute, Hyderabad, India; and 2Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
95% CI = 9.76–10.53) × 6.45 mm (SD = 1.2; 95% CI = 6.14–6.75). There was no statistically significant decrease in either the ostium size or the area up to 2 years following surgery.
ABSTRACT Background: This study aims to assess the shrinkage of dacryocystorhinostomy (DCR) ostium beyond 4 weeks. Design: Prospective series in a University setting. Participants: Sixty consecutive patients. Methods: Prospectively collected data of 60 consecutive powered endoscopic DCRs performed in 57 patients over a period of 10 years from 2002 to 2011. All patients had regular follow-up of 2 years postsurgery. The ostium size at 4 weeks, 6 months, 1 year and 2 years were evaluated. Analysis of variance was used to compare the differences. Main Outcome measurements.
Measure: Changes
in
ostium
Results: The ostium measured 11.25 mm (standard deviation [SD] = 1.7; 95% confidence intervals [CI] = 10.80–11.69) × 7.07 (SD = 1.4; 95% CI = 6.71– 7.42) at 4 weeks. It measured 10.48 mm (SD = 1.6; 95% CI = 10.06–10.90) × 6.65 mm (SD = 1.2; 95% CI = 6.34–6.95) at 6 months, 10.22 mm (SD = 1.5; 95% CI = 9.81–10.61) × 6.52 mm (SD = 1.2; 95% CI = 6.20–6.80) at 1 year and 10.15 mm (SD = 1.5;
Conclusion: The ostium achieved using the powered endoscopic DCR technique remains stable in size from 4 weeks to 2 years post-surgery. This likely reflects the advantages of this technique which facilitates healing by primary intention. Key words: endoscopic DCR, measurement, ostium, ostium cicatrix.
INTRODUCTION Endoscopic dacryocystorhinostomy (DCR) is a welldescribed and now validated procedure for the management of nasolacrimal duct obstruction. Despite its high level of reported short and long-term success, surgical failure has been reported to be in the range of 4–13%. Postoperative scarring and cicatricial closure of the ostium are noted to be foremost among the major causes of this failure.1–8 The degree to which an ostium constricts from its initial per-operative size is variable with wide reported ranges of 20–98 %.9–17 This variability may not only be influenced by surgical and patient factors
■ Correspondence: Professor Peter Wormald, Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA 5011, Australia. Email: [email protected] Received 28 May 2014; accepted 21 June 2014. Competing/conflicts of interest: Peter Wormald receives royalties from Medtronic for design of instruments and is a consultant to Nielmed. No conflict of interest for other authors. Funding sources: No stated funding sources. Ethics statement: This study has been reviewed by the ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Informed consent was obtained from the patients. © 2014 Royal Australian and New Zealand College of Ophthalmologists
dacryocystorhinostomy ostium
12
Sixty DCR ostia were noted to have measurements at each visit up to 2 years of follow-up and were included in the study. The mean age at surgery was 58.4 years (range 20–91 years). At 4 weeks, the ostia measured 11.25 mm (standard deviation [SD] = 1.7; 95% confidence intervals [CI] = 10.80–11.69) × 7.07 mm (SD = 1.4; 95% CI = 6.71–7.42). The ostia subsequently measured 10.48 mm (SD = 1.6; 95% CI = 10.06–10.90) × 6.65 mm (SD = 1.2; 95% CI = 6.34–6.95) at 6 months, 10.22 mm (SD = 1.5; 95% CI = 9.81–10.61) × 6.52 mm (SD = 1.2; 95% CI = 6.20–6.80) at 1 year and 10.15 mm (SD = 1.5; 95% CI = 9.76–10.53) × 6.45 mm (SD = 1.2; 95% CI = 6.14–6.75) at 2 years. The mean diameter values and corresponding surface area at specified time points are summarized in Table 1. There was no statistically significant decrease beyond 4 weeks in either the ostium size (P = 0.13) or the area (P = 0.18). Figure 1 reflects the mean change in
9
10
11
Vertical Horizontal
8
A retrospective review of prospectively collected data of consecutive powered endoscopic DCRs performed over a period of 10 years from 2002 to 2011 was performed. The study was conducted with institutional review board approval. Powered endoscopic DCR was performed using the previously published technique.1–6 This technique ensures complete lacrimal sac exposure, full-length marsupialization of sac and nasal mucosa to lacrimal mucosa apposition, allowing healing by primary intention.1–6 All patients had sequential measurement of their postDCR ostium at 4 weeks, 6 months, 1 year and 2 years. Measurement was performed using 4 mm olive tip suction, and measurements were taken of the maximal vertical and horizontal diameters. Demographic data, clinical profiles and surgical notes were also recorded.
RESULTS
7
METHODS
from a mixed effect model with Tukey’s contrast were performed. Adjusted P values were obtained by Bonferroni correction. A P value of
