RESUMEN
BACKGROUND: To determine the clinical outcomes and morbidity of endoscopic medial wall combined with transcutaneous lateral orbital wall decompression in Graves' orbitopathy. METHODOLOGY: A retrospective noncomparative case series of patients who underwent surgical decompression for Graves' orbitopathy at Hospital Universitario de Fuenlabrada between 2004 and 2014 was performed. We reviewed the patients' charts and analyzed before and after the decompression, the visual acuity (Snellen chart), optic nerve compression (fundoscopy and optic coherence tomography), exophthalmometry (Hertel measurement), ocular motility, diplopia, eyelid surgery needed after decompression and its possible complications. RESULTS: A total of 20 patients (36 orbits) were operated. The mean follow-up was 44 months (range 18-84). Vision improved dramatically in all compressive optic neuropathy cases (5 cases). Hertel measurements improved on average 3.5 mm (range 1.5-4.5). Diplopia was cured in eight patients (40%) and nine patients with severe preoperative diplopia required strabismus surgery after decompression. Eyelid surgery was further needed in 13 patients. Hyaluronic acid injection was the most used technique for the treatment of eyelid retraction (6 out of 13 patients). Only two major complications were observed: one case had a major post-operative epistaxis and another a cerebrospinal fluid leak. Both were resolved without further sequelae. CONCLUSIONS: These results suggest that endoscopic medial wall combined with transcutaneous lateral wall orbital decompression is an effective and safe treatment for the symptomatic dysthyroid eye disease with important proptosis or compressive optic neuropathy.
Asunto(s)
Oftalmopatía de Graves/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Adulto , Anciano , Endoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Bilateral agenesis of the lacrimal puncta and enlargement of the nasolacrimal canal are rare anatomic variants. The authors present 2 familial cases: a 39-year-old woman with bilateral dacryocystocele and lacrimal puncta agenesis and her 46-year-old brother, who had a long history of epiphora and recurrent dacryocystitis, and also had bilateral lacrimal puncta agenesis and a left dacryocystocoele. The authors report the endoscopic, CT, and MRI findings, and describe the surgical treatments, by endoscopic dacryocystorhinostomy in the first case, and conjunctivodacryocystorhinostomy with Jones tube in the second case. At 24 months after surgery, both patients' symptoms were improved.
Asunto(s)
Dacriocistorrinostomía , Enfermedades del Aparato Lagrimal/genética , Enfermedades del Aparato Lagrimal/cirugía , Conducto Nasolagrimal/anomalías , Conducto Nasolagrimal/cirugía , Adulto , Endoscopía , Femenino , Humanos , Intubación/métodos , Enfermedades del Aparato Lagrimal/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Conducto Nasolagrimal/patología , Recurrencia , Sinusitis/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To evaluate the effectiveness of transcanalicular dacryocystorhinostomy with diode laser in treatment of epiphora in adults. METHODS: A prospective, noncomparative, interventional case series of transcanalicular dacryocystorhinostomy in 25 patients presenting with epiphora due to nasolacrimal obstruction. Patient age ranged from 32 to 72 years. Patients were evaluated postoperatively at 12, 24, and 36 months. Patients were evaluated for symptom improvement through a visual analog scale, and patency of osteotomy by lacrimal system irrigation with fluorescein and direct visualization by nasal endoscopy. Success was defined as resolution of epiphora. RESULTS: Transcanalicular dacryocystorhinostomy was able to re-establish patency of the lacrimal system in 88% of cases after 36 months of surgery. No differences were found between patients older than 65 years and younger patients (chi-square, p > 0.05). Early (12 months) and late (36 months) results were similar (chi-square, p > 0.05). CONCLUSIONS: In this prospective series, transcanalicular dacryocystorhinostomy was effective in treatment of epiphora in adults with little morbidity.