OBJECTIVE: Data regarding the effectiveness of prophylactic systemic antibiotics (PSA) in lacrimal surgery is scarce. Therefore, we determined the postoperative surgical site infection (SSI) rate in lacrimal surgery without PSA.
METHODS: We retrospectively analysed files of patients who underwent external (extDCR) or endoscopic endonasal dacryocystorhinostomy (endoDCR). We excluded patients with incomplete data (n = 68), acute a priori infection with the need for antibiotics (n = 15) and PSA post-operatively for other reasons (n = 28). Indications for surgery were canalicular stenosis (n = 51, 18.6% endoDCR vs n = 131, 19.5% extDCR), nasolacrimal duct obstruction (n = 118, 43.2% endoDCR vs n = 480, 64.3% extDCR) and mucocele/chronic dacryocystitis (n = 52, 19.0% endoDCR vs n = 187, 25.0% extDCR).
RESULTS: In this study, 1020 DCR surgeries were performed in 899 patients. Postoperative SSI was diagnosed in eight patients (0.8%); exclusively after extDCR (1.1% of all extDCR). No SSIs were found in endoDCR cases. The prevalence between SSI in extDCR versus endoDCR did not prove significant (n = 8/747 0.8% vs n = 0/273 0%, p = 0.13). All patients diagnosed with SSI were successfully treated with systemic oral antibiotics.
CONCLUSIONS: The prevalence of SSI after DCR is low and was effectively treated with oral antibiotics. In our study, SSI occurred rarely after extDCR and was not observed after endoDCR. We conclude that lacrimal surgery is safe without the routine administration of PSA.

BACKGROUND: This prospective clinical study evaluates the effect of a silicone stent tube (SST) on the success rate of endonasal-endoscopic dacryocystorhinostomy (EN-DCR) to treat primary acquired nasolacrimal duct obstruction.
METHODS: Patients were randomly assigned to receive EN-DCR with or without SST intubation over a period of 3 months. The surgery was performed using standardized techniques. Patients were assessed at three different timepoints: one day, 12 weeks and 24 weeks after the surgery. The results were compared in order to evaluate statistical differences. Surgical success was determined by means of positive irrigation procedures, as well as by the improvement of symptoms and a high level of patient satisfaction.
RESULTS: A total of 56 randomized cases completed 24 weeks of follow up. 1 Patient dropped out due to malignant genesis of the nasolacrimal duct obstruction. After 24 weeks of follow up no statistically significant differences in levels of epiphora (p > .10) or patency (p > .16) were revealed. Comparisons regarding changes in time did not show levels of significance (p > .28).
CONCLUSIONS: This study could not confirm a statistically significant benefit or disadvantage for SST Insertion in EN-DCR.

UNASSIGNED: To assess the management of patients with congenital nasolacrimal duct obstruction (CNLDO) in a paediatric population and review the long-term outcomes over a 5-year interval, with particular emphasis on the difference between patients with trisomy 21 and those without trisomy 21.
UNASSIGNED: This single-centre, retrospective, cross-sectional, case review study included patients suffering from CNLDO at Alder Hey Children\'s Hospital NHS foundation Trust. Patients were divided into two groups: Non-trisomy 21 and trisomy 21. Patients were followed-up for a 60-month interval. Patients aged <12 months at the time of surgery, patients with <60 months of follow-up data and patients with acquired nasolacrimal duct obstruction were excluded. The main outcome measures were discharge rates in patients undertaking primary intervention with syringe and probe (S&P), number of patients requiring further treatment with lacrimal intubation or dacryocystorhinostomy (DCR) and overall symptom-free periods post-treatment.
UNASSIGNED: Ninety-three patients (142 eyes) were included. The mean number of surgical interventions was 1.53 ± 0.65. The mean interval between the 1st and 2nd intervention was 15.54 ± 16.33 months. There was a trend towards greater success rates non-trisomy 21 patients versus patients with trisomy 21 (p = 0.1352). The average symptom-free period after the final intervention was 44.31 ± 20.68 months, significantly longer in the non-trisomy 21 group compared to the trisomy 21 group (p = 0.0074).
UNASSIGNED: The overall success rate after primary S&P was 55.9%. Our results suggest that in trisomy 21 patients suffering from CNLDO, a one-stage intervention with primary monocanalicular intubation should be considered instead of sequential approach.

暂无摘要。

OBJECTIVE: To study the outcomes of balloon dacryoplasty (BD) or (BDCP) in children with persistent congenital nasolacrimal duct obstruction (pCNLDO) by using new and reused balloon catheters.
METHODS: Our retrospective analysis focused on managing pCNLDO by using the BD or BDCP technique. The study included children aged >1 year to <12 years who underwent single or multiple probings before. Our specific lacrimal workup included a detailed history and examination, as published earlier. We used conventional, straight, 2 mm × 13 mm/3 mm × 15 mm lacrimal balloons (FCI, Ophthacath). We have described a technique to use the same catheter for three BD procedures (1 new + 2 reuse). The outcomes were categorized as complete success, partial success, and failure. The minimum follow-up of each child was 6 months.
RESULTS: We analyzed 64 children (89 eyes) with a mean age of 58 months (15-132 months). All children (100%) had epiphora with discharge and positive FDDT. All children underwent BD under general anesthesia - new balloons in 59 eyes and reused balloons in 30 eyes. The balloons were plasma sterilized akin to vitrectomy cutters and tubings of phaco machines. We noted three leaks from reused balloons (2 from the balloon tip and 1 from the plastic hub). At a mean follow-up of 14.5 months, complete success was noted in 77 eyes (86.5%) (52 new and 25 reuse), while 8 eyes had partial success (8.9%) (4 new and 4 reuse). Failure of BD was noted in four eyes (4.5%) (3 new and 1 reuse). None had significant complications with new or reused balloons.
CONCLUSIONS: BD or BDCP is a quick, safe, easy, and effective procedure that resolves pCNLDO symptoms satisfactorily. Carefully reusing a conventional balloon catheter is possible with comparable efficacy and no additional complications in pCNLDO.

UNASSIGNED: Epiphora in childhood is a frequent symptom that is typically associated with Congenital nasolacrimal duct obstruction (CNLDO). Nevertheless, inflammatory pathologies of the ocular surface as well as inside the eye, or even congenital glaucoma, must be considered in the differential diagnosis.
UNASSIGNED: A comprehensive literature review concerning CNLDO was conducted. Different therapeutic steps are categorized and summarized in order to reflect the existing staged therapeutic concept.
UNASSIGNED: For CNLDO, a staged therapeutic concept is applicable, resulting in a cure rate of approximately 95% with only conservative or minimally invasive intervention. This concept includes five steps that encompass therapeutic interventions with increasing complexity. It includes conservative techniques, followed by probing and syringing, transcanalicular approaches without or with lacrimal intubation, and dacryocystorhinostomy which is the ultima ratio.
UNASSIGNED: To preserve the topographic anatomy as much as possible, therapeutic recommendations enable stepwise and individualized management of children with CNLDO.

A literature review was conducted to assess the role of minimally-invasive endoscopic treatments for lacrimal pathway neoplasms. The study involved the analysis of 316 patients with benign or malignant tumours affecting the lacrimal drainage system. Histologically, the analysis revealed a prevalence of squamous cell carcinoma, followed by lymphatic neoplasms and melanomas. In terms of treatment, minimally-invasive endoscopic approaches, such as endoscopic dacryocystorhinostomy, play a predominant role in managing early-stage tumours, rather than merely obtaining samples for histological analysis. For more extensive tumours, which constitute the majority of cases, more aggressive external approaches are required, along with the use of adjuvant radiotherapy and chemotherapy. The lack of universally shared staging systems poses a limitation in standardisation and comparison of results. Treatment of these tumours remains complex due to their rarity and histological heterogeneity. A multidisciplinary approach is mandatory to optimise outcomes.

BACKGROUND: The pigtail was used to create an opening at the lower punctal site in grade 0 stenosis with insertion of self-retaining tube and Mitomycin C (MMC).
METHODS: The patients with acquired lower punctal stenosis (grade 0) were divided randomly into equal groups, Group A: were treated with pigtail and MMC 0.02% and Group B: were treated with pigtail alone. The pigtail was inserted through the upper punctum until its tip reached the occluded punctum, this site was incised with a scalpel (No. 11). A self-retaining bicanalicular tube was then placed.
RESULTS: Results of 36 eyes from 26 patients were included. No differences were observed between both groups regarding epiphora score, FDD test and punctal size preoperatively. The postoperative epiphora score, there were significant differences at 1 month (P = 0.035), 3 months (P = 0.005), and 6 months after removal (P < 0.001). The FDD test, there were significant differences at 6 months (P = 0.045), 1 month (P = 0.021), 3 months (P = 0.012), and 6 months post tube removal (P = 0.005). The punctal size, both groups differed at 1 month (P = 0.045), 3 months (P = 0.03), and 6 months post tube removal (P = 0.005). Only one case (5.5%) at each group showed extrusion of the tube.
CONCLUSIONS: The pigtail probe, bicanalicular stent and MMC can be an effective method in treatment of severe punctal stenosis.

Chronic inflammatory process in the lacrimal drainage system is the main etiological factor leading to dacryostenosis and consequent obliteration - partial and total nasolacrimal duct obstruction. Prevention of this process is an urgent problem in dacryology. Currently, there is very little research on the development and use of conservative methods for treating dacryostenosis using anti-inflammatory, as well as anti-fibrotic drugs. In this regard, the main method of treating lacrimal drainage obstruction is dacryocystorhinostomy. However, the problem of recurrence after this operation has not been resolved. The causes of recurrence can be cicatricial healing of dacryocystorhinostomy ostium, canalicular obstruction, formation of granulations and synechiae in its area. Surgical methods of recurrence prevention are associated with possible complications, and there is conflicting data on the feasibility of their use. Based on this, the development of pharmacological methods for the prevention of fibrosis in dacryology is promising, among which the antitumor antibiotic Mitomycin C is the most studied. However, there are no specific scientifically substantiated recommendations for the use of this drug, and the data on its effectiveness vary. This has prompted researchers to look for and study alternative anti-fibrotic agents, such as antitumor drugs, glucocorticoids, hyaluronic acid, small molecule, biological, immunological and genetically engineered drugs, as well as nanoparticles. This review presents the current data on the efficacy and prospects of the use of these drugs in dacryology.
Основным этиологическим фактором, приводящим к дакриостенозу и последующей облитерации, является хронический воспалительный процесс в слезоотводяших путях. Профилактика этого процесса относится к насущным проблемам дакриологии. В настоящее время ведется крайне мало исследований, посвященных разработке и применению консервативных методов лечения дакриостеноза с использованием не только противовоспалительных, но и антифибротических препаратов. В связи с этим дакриоцисториностомия является основным методом лечения непроходимости слезоотводящих путей. Однако проблема рецидивирования после данной операции окончательно не решена. Причинами рецидивов могут быть рубцовое заращение дакриостомы, канальцевая обструкция, образование грануляций и синехий в области дакриостомы. Хирургические методы профилактики рецидива связаны с возможными осложнениями, и имеются противоречивые данные о целесообразности их применения. Исходя из этого, перспективным является развитие медикаментозных методов профилактики фибротизации в дакриологии, среди которых наиболее изучено использование противоопухолевого антибиотика Митомицина C. Однако конкретных научно обоснованных рекомендаций по применению этого препарата не существует, а данные о его эффективности разнятся. Этим продиктован интерес исследователей к поиску и изучению альтернативных антифибротических средств, таких как противоопухолевые препараты, глюкокортикостероиды, препараты гиалуроновой кислоты, низкомолекулярные, биологические, иммунологические и генно-инженерные препараты, а также наночастицы. В настоящем обзоре представлены имеющиеся на сегодняшний день данные об эффективности и перспективах применения таких препаратов в дакриологии.

Among secondary forms of nasolacrimal duct obstruction caused by radioactive iodine therapy, its distal forms localized in the area of the Hasner\'s valve are predominant. In this regard, during dacryocystorhinostomy (DCR) there is a high probability of developing the sump syndrome, for which the anatomical prerequisite is that the lower edge of the DCR ostium is above the level of obstruction. In such cases, we propose to supplement DCR with a counteropening in the area of the Hasner\'s valve.
OBJECTIVE: This study analyzes the clinical effectiveness of dacryocystorinostomy with a counteropening.
METHODS: The outcomes of 49 surgeries (49 patients) with secondary acquired nasolacrimal duct obstruction due to radioactive iodine therapy were analyzed, including 34 DCR and 15 DCR with a counteropening. The clinical outcomes were analyzed over the longest possible period after surgery. The analysis included the severity of tearing on the Munk scale, the characteristic of the formed ostium on the M. Ali scale and the height of the tear meniscus. Differences were considered significant at a confidence level of 95% (p≤0.05).
RESULTS: Analysis of the results of the performed surgeries showed that DCR was clinically effective in 30 (88%) cases, DCR with a counteropening - in 15 (100%) cases. The differences were not statistically significant in the total sample, but were statistically significant when comparing the results of surgeries in patients with distal obliteration.
CONCLUSIONS: The developed and clinically tested method of DCR with a counteropening in the area of the Hasner\'s valve was completely effective in 15 patients with secondary nasolacrimal duct obstruction caused by radioiodine therapy.
В структуре вторичных облитераций слезоотводящих путей вследствие терапии радиоактивным йодом преобладают дистальные формы, локализующиеся в области устья носослезного протока. В связи с этим при проведении дакриоцисториностомии (ДЦР) велика вероятность развития sump-синдрома, анатомической предпосылкой которого является формирование нижнего края дакриостомы выше уровня облитерации. В таких случаях авторы предлагают дополнять ДЦР наложением контрапертуры в области устья носослезного протока.
UNASSIGNED: Анализ клинической эффективности операции ДЦР с наложением контрапертуры.
UNASSIGNED: Проанализированы исходы 49 операций (49 пациентов) со вторичной облитерацией слезоотводящих путей вследствие терапии радиоактивным йодом, включая 34 ДЦР и 15 ДЦР с наложением контрапертуры. При анализе клинических исходов оценивали результаты на максимально отдаленном сроке после операции. Определяли выраженность слезотечения по шкале Munk, характеристику сформированной дакриостомы по шкале M. Ali и высоту слезного мениска. Различия считали достоверными при уровне достоверности 95% (p≤0,05).
UNASSIGNED: Анализ результатов проведенных операций показал, что ДЦР была клинически эффективна в 30 (88%) случаях, ДЦР с контрапертурой — в 15 (100%) случаях. Различия не были статистически достоверны в общей выборке, однако были статистически достоверны при сравнении результатов операций у пациентов с дистальной облитерацией.
UNASSIGNED: Разработанная и апробированная в клинике операция ДЦР с наложением контрапертуры в области устья носослезного протока показала абсолютную эффективность у 15 пациентов с вторичной облитерацией слезоотводящих путей вследствие терапии радиоактивным йодом.