Endonasal dacryocystorhinostomy location of lacrimal sac with forceps.
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Dacryocystorhinostomy↗
Biomedical subjects
S Cervenka
Publications and source records attributed to S Cervenka.
[Conjunctivocystorhinostomy--seven years of experience--part I (Description of the surgery, groups of patients)].
The principle of conjunctivocystorhinostomy according to Jones consists in creating new way (tunnel) between the conjunctival sac and the nasal cavity where the drainage of tears is possible through a hollow tube made from allogenic material implanted into the tunnel. The main indication for performing the conjunctivocystorhinostomy is the obliteration of the proximal part of both lacrimal canaliculi. The operation consists of two parts--dacryorhinostomy (DCR) and the insertion of the draining tube. DCR may be performed from an external access, or from an endonasal access, which is preferred by the authors. Authors present altogether 74 surgeries, which were performed during the period of 1996-2002 in 59 patients, (55 women, 19 men) mostly in the group of 51-60 years of age. During the surgery, they use the glass tubes only, because, in contrast to the silicone ones, they become not to be obstructed. In 11 cases the loss of the tubing occurred. To prevent the possibility of the loss and the migration of the tube, the authors fixate it always with a stitch to the lower eyelid.
Adolescent↗
[Conjunctivocystorhinostomy--seven years of experience--part II (Commentary)].
The authors answer the frequent questions concerning conjunctivo-cystorhinostomy (CDCR) according to Jones. The surgery is successful in 80-90%. The minimal age for the surgery is 10 years of age; patients 70 years old and older tolerate the operation less well. The basic prerequisite for its indication is good motivation of the patient. In the glass tube, the obstruction is not common, and there is the reason why the authors prefer them. The tube remains in situ during the whole life. In contrast to dacryocystorhinostomy, in CDCR the complication ratio is higher--up to 2/5 of patients. Fixation of the tube to the eyelid with a stitch lowers the number of commonest complications (loss and migration of the tube medially).
Conjunctiva↗
[Significance of the fluorescein dye disappearance test (FDDT) in the removal of the silicone cannula and prognosis in congenital lacrimal duct obstruction].
OBJECTIVE: Assessment of the prognostic value of the FDD test (fluorescein dye disappearance test) for treatment of congenital occlusion of the lacrimal pathways by means of silicone intubation and for assessment of the time of removal of the cannula. METHOD: The drainage function of the lacrimal pathways was evaluated perspectively in a group of 46 children with inborn occlusion of the lacrimal pathways, aged 1-3 years, treated by means of silicone intubation. The evaluation was made before insertion of the cannula, one week, one month after the operation, during removal of the cannula, one month and one year after its removal. The results of FDDT were compared with the clinical condition and the therapeutic results. RESULTS: In all instances (36 children) where shortly after surgery regression of the signs and symptoms of occlusion occurred and FDDT was 0-1 the long-term result (one year after removal of the cannula) of treatment was favourable. Nine of 11 cases where FDDT 2-3 and signs of occlusion persisted also when the cannula was removed after its removal marked improvement of the symptoms of occlusion occurred or they disappeared and the drainage of the lacrimal pathways was normal. If FDDT suggests during the period with the inserted cannula a satisfactory function of the lacrimal pathways, the prognosis of cure is good and the cannula can be removed already after 6-8 weeks. If during the time with the cannula the impaired drainage function of the lacrimal pathways persists, i.e. FDDT 2-3, it is better to remove the cannula not sooner than after 5-6 months. CONCLUSION: FDDT can serve as a prognostic factor in the treatment of congenital occlusion of the lacrimal pathways by means of a silicone cannula and for assessment of the time of its removal.
Child, Preschool↗
[Dacryolithiasis--analysis of 15 cases].
Dacryoliths are found in 15-20% patients subject to dacryocystorhinostomy. Dacryoliths are formed by proteins or calcium and phosphate salts. In the development or dacryolithiasis participates chronic inflammation of the sac, it is found more frequently in women where some part is played by the structure of the lacrimal duct, hormonal influence and the use of cosmetic preparations. A typical sign of the disease in the variability of complaints and results of clinical examinations. Assessment of the diagnosis before surgery can be facilitated by dacryocystography. The method of choice in dacryolithiasis is dacryocystorhinostomy. The authors present their own group of 16 dacryolithis which they observed 10x in women and 5x men. The concrements were examined by the method of infrared spectroscopy and gas chromatography. All were formed by proteins; calcium and phosphate salts were not found In all patients after dacryocystorhinostomy the complaints disappeared.
Adolescent↗
Intubation of the lacrimal pathways under endoscopic control.
Described herein is a new modification of the lacrimal pathway intubation in children with efferent lacrimal pathway obstruction. For removal of the intubation set probe without olive tips from the inferior nasal meatus, a special titanium loop is used. An endoscopic technique allows us a basically more considerate performance of this procedure and to speed it up. The risk of iatrogenic damage to the mucous membrane of the inferior meatus is, thus, reduced too. From April 1994 to June 1998, lacrimal pathway intubation was performed in 235 children 283 times. Infraction of the inferior concha was performed 27 times. Insertion of a probe submucously into the inferior nasal meatus was found 35 times and the probe was released by focused incision of the mucous membrane.
Adolescent↗
[Biodegradation of silicone drainage tubes in the efferent lacrimal system].
The authors present an account on their experience with biodegradation of silicone cannulas used for drainage of the efferent lacrimal system. They examined by means of a light microscope (enlargement up to 140 x) 38 cannulas, inserted into the lacrimal pathways for 1-7 months. They did not observe any biological damage of the surface of the cannula, not even when compared with non-exposed cannulas. Microbiological examination of six exposed cannulas did not reveal fungal infestation. The lacrimal pathways are not an aggressive environment for temporary cannulas.
Bacteria↗
[Initial experience with the Jones method of conjunctivo(dacryo)cystorhinostomy].
In obstruction of both lacrimal ducts at present the most frequently used method is conjunctivo(dacryo)cystorhinostomy using a Jones bypass cannula. The effectiveness of the procedure is 85-90%. The drainage cannulas can be straight or bent and are as a rule made from pyrex glass. The patients should be highly motivated and made familiar with possible complications, i.e. most frequently escape of the cannula. With regard to the necessary postoperative cooperation the operation is not recommended in young children. The authors performed in 1996-1997 a total of 8 conjunctivo(dacryo)cystorhinotomies. The lacrimal sac is opened into the nose under general anaesthesia by the endonasal route using endoscopes. In one instance the authors used a straight silicone cannula which fell out after three weeks. In the remaining patients they used a bent silicone cannula. Seven patients evaluate their condition after surgery as markedly improved and would be willing to have the operation again. One female patient (after escape of a straight cannula and later reinsertion of a bent cannula) would hesitate to have another operation. The authors evaluate their experience with this type of bypass operation as very satisfactory.
Dacryocystorhinostomy↗
[Scintigraphy of the lacrimal ducts].
Scintigraphy of the lacrimal pathways is an examination method which informs us on the function of the efferent lacrimal system. The authors made bilateral scintigraphic examinations in 32 patients with obstruction or stenosis of the lacrimal pathways, 22 times they made concurrent contrast examinations of the lacrimal pathways. In seven suprasaccal and 5 saccal obstructions and stenoses they did not find penetration of activity from the conjunctival sac into the lacrimal pathways. In 16 subsaccal obstructions, 12 times penetration of activity into the lacrimal sac was found. In five patients with a partly preserved patency of the lacrimal pathways three times activity was detected in the lacrimal sac and in one instance slow penetration of activity into the nasal cavity. In complete obstructions and severe stenoses scintigraphy does not provide, as compared with conclusions of other examinations (fluorescein tests, irrigation, probing, contrast dacryocystography) new information on the type of obstruction. The method is useful in particular in conditions with a preserved patency of the lacrimal pathways, in examinations of very mild stenoses, intermittent lacrimation and doubtful cases. Scintigraphy of the lacrimal pathways is a supplementary method which must be evaluated in the context with other methods, in particular methods which provide information on the anatomy of the lacrimal system (dacryography).
Adolescent↗
[Intubation of afferent lacrimal ducts--a review of techniques].
The authors present a review of various techniques of long-term intubation of efferent lacrimal pathways by a silicone fibre. They use an original way of intubation and intubate the insertion probes of the intubation set from the lower nasal outlet by means of a titanium loop under direct optic control by means of an endoscope. The use of the endoscope makes it possible to reduce the number of complications and iatrogenic damage of the mucosa and it enhances the effectiveness of the procedure. The authors prefer the use of special intubations sets; for young children intubation sets made from soft metal are preferable. At present all their demands are met by the intubation set they developed in collaboration with the Technical University, Prague. During the period between April 1994 and August 1996 the authors used the described technique for bicanalicular intubation of the efferent lacrimal pathways in 127 children and in adult patients 6x. In 86 instances they used an intubation set of Geuder Co., 44 times their own intubation set.
Adult↗
[Silicone intubation--treatment of complicated conditions of congenital lacrimal duct obstruction].
Between April 1994 and October 1996 on account of complicated obstruction of the lacrimal pathways temporarily into the lacrimal efferent system 144 silicone cannulas were inserted in 127 children aged 4 months to 9 years. A standard procedure was used, with the children under general inhalation anaesthesia, in collaboration of an ophthalmologist and otorhinolaryngologist using endonasal optics. By October 1996 100 cannulas were extubated, on average after 4.1 months. The effectiveness of the procedure evaluated on the basis of clinical manifestations and the Dye Disappearance test is 81%.
Child↗
[Digital subtraction dacrocystography].
The method of digital subtraction is based on the ability to eliminate interfering shadows from the X-ray picture, which makes it possible to make the parts of the picture containing contrast substance more visible. Digital subtraction dacryocystography makes better and more detailed imaging of the lacrimal pathways possible, in particular in the proximal part of the efferent lacrimal pathways, as compared with conventional dacryocystography. This is important for more detailed assessment of the necessary surgical intervention on the lacrimal pathways and its prognosis. The advantage is the possibility to deposit the image in the memory of the instrument as well as its digital processing and the smaller radiation load to which the lens is exposed. The authors examined by the method of digital subtraction dacryocystography 25 patients with disorders of the efferent lacrimal system and present some normal and pathological findings of the lacrimal pathways.
Humans↗
The triple classification of dry eye for practical clinical use.
PURPOSE: "Dry Eye is a condition produced by the inadequate interrelation between lacrimal film and ocular surface epithelium, and is caused by quantitative and qualitative deficits in one or both of them. It can be produced by one or combined etiologic causes, affecting one or several of the secretions of the glands serving the ocular surface, and producing secondary manifestations of different grades of severity". Clinicians need a practical classification to face diagnosis, prognosis and treatment. Dry eyes have many etiologies and pathogenesis, different affectation of the various dacryoglands and ocular surface epithelium, and diverse grades of severity. The specialists in xero-dacryology must know these three parameters to evaluate any case of dry eye, and to establish an adequate treatment. METHODS: To facilitate this, an open session in the 8th congress of the International Society of Dacryology and Dry Eye (Madrid, April, 2005) proposed modifying the Triple Classification of dry eye approved in the XIV congress of the European Society of Ophthalmology (Madrid, June, 2003). There was consensus of all conclusions. CONCLUSIONS: The following classification has been established: First, a classification of the etio-pathogenesis, distributed in ten groups: age-related, hormonal, pharmacologic, immunopathic, hyponutritional, dysgenic, infectious/inflammatory, traumatic, neurologic and tantalic. Second, a classification of the affected glands and tissues, which under the acronym of ALMEN includes the Aqueo-serousdeficient, Lipodeficient, Mucindeficient and Epitheliopatic dry eyes, and the Non dacryological affected exocrine glands (saliva, nasal secretion, tracheo-pharyngeal secretion, etc). And thirdly, a classification of severity, in three grades: Grade 1 or mild (symptoms without slitlamp signs), grade 2 or moderate (symptoms with reversible signs), and grade 3 or severe (symptoms with permanent signs).
Aging↗