SİLİKON TÜP ENTÜBASYONLU EKSTERNAL DAKRİYOSİSTORİNOSTOMİ; UZUN DÖNEM SONUÇLARI

Öz

Amaç: Nazolakrimal kanal obstrüksiyonu (NLDO) olgularda eksternal dakriosistorinostomi (EDRS) ile kombine bikanaliküler silicon tüp enbübasyonunun uzun dönem sonuçlarını sunmak. Yöntem: Kliniğimizde Ocak 2010-Aralık 2020 tarihleri arasında eksternal dakriosistorinostomi uygulanan 169 hastanın 169 gözünün uzun dönem sonuçları retrospektif olarak değerlendirildi. Postoperatif 1. gün, 10. gün, 1. ay, 3. ay, 6. ay, 9. ay, 12. ay ve son kontrollerde hastalar değerlendirildi. Özellikle ameliyat sonrası 1. gün enfeksiyon belirtileri, silikon tüpün pozisyonu, gerginliği, yerleşimi ve epifora varlığı açısından. Ameliyattan 6 ay sonra hastaların silikon tüpleri çıkarıldı. cerrahi başarı; Hastaların semptomlarının kaybolması lakrimal drenaj açık olarak değerlendirildi. Bulgular: Olgularımızın 102'si kadın, 67'si erkekti. Ortalama yaş standart hatası 55,48±1,36 idi. Ortalama takip standart hatamız 47,83±2,27 aydı. İki hastamızda cerrahi başarısızlık meydana geldi. Bu olgular ameliyat sırasında şiddetli kanama olan ve fleplerin zorlukla oluşturulduğu olgulardı. Bu olgularda içten yaklaşımla revizyon ameliyatları yapılmış ve her ikisinde de cerrahi başarı sağlanmıştır. Eksternal dakriyosistorinostomi ile kombine bikanaliküler silikon tüp entübasyon cerrahisi uygulanan hastalarımızda cerrahi başarı oranı ilk operasyonda %98,76, ikinci operasyonda %100 idi. Sonuç: Bikanaliküler silikon tüp entübasyonu ile dakriyosistorinostomi ameliyatlarının uzun dönem sonuçları göz önüne alındığında nazolakrimal kanal tıkanıklığında en etkili ve başarı oranı en yüksek cerrahi yöntemdir.

Anahtar Kelimeler

• external dacryoystorhinostomy
• epiphora
• nasolacrimal
• obstruction
• silicone tube intubation.

EXTERNAL DACRIOCYSTORINOSTOMY WITH SILICONE TUBE INTUBATION; LONG TERM RESULTS

Öz

Aim: To present the long-term results of bicanalicular silicone tube intubation combined with external dacryocystorhinostomy (EDRS) in-patient with nasolacrimal duct obstruction (NLDO) Methods: Long-term results of 169 eyes of 169 patients who underwent external dacryocystorhinostomy between January 2010 and December 2020 in our clinic were evaluated, retrospectively. On the postoperative 1st day, 10th day, 1st month, 3rd month, 6th month, 9th month, 12th month, and last visits, the patients were evaluated. Especially on the postoperative 1st day for signs of infection, the position, tension, and placement of the silicone tube, and the presence of epiphora. Silicone tubes of the patients were removed 6 months after surgery. Surgical success; The disappearance of the patient's symptoms was evaluated as the lacrimal drainage open. Results: 102 of our cases were female and 67 were male. The mean age-standard error was 55,48±1,36. Our average follow-up-standard error was 47,83±2,27 months. Surgical failure occurred in two of our patients. These cases were who were severe bleeding occurred during surgery and flaps were formed with difficulty. In these cases, revision surgeries were performed with an internal approach and surgical success were achieved in both of them. In our patients, who underwent bicanalicular silicone tube intubation surgery combined with external dacryocystorhinostomy, the surgical success rate was 98,76% in the first operation and 100% in the second operation. Conclusions: Considering the long-term results of bicanalicular silicon tube intubation combined with dacryocystorhinostomy operations, it is the most effective surgical method with the highest success rate in nasolacrimal canal obstruction.

Anahtar Kelimeler

• external dacryoystorhinostomy
• epiphora
• nasolacrimal
• obstruction
• silicone tube intubation.

Kaynakça

1. 1. Blicker JA, Buffam FV. Lacrimal sac, conjunctival, and nasal culture results in dacryocystorhinostomy patients. Ophthalmic Plastic Reconstr Surg. 1993;9(1):43–46.
2. 2. Orhan M, Şener C, Çalışkan S, Dayanır V, Bilgiç S. Lakrimal drenaj sistemi tıkanıklıklarında silikon tüp ile entübasyon dakriyosistorinostomi yöntemi. Türk Klin Oftal. 1994;3:172-174.
3. 3. Javed Ali M, Honavar SG. Assessment of patient satisfaction following external versus transcanalicular dacryocystorhinostomy. Curr Eye Res. 2012;37(9):853–854.
4. 4. Baldeschi L, Nardi M, Hintschich CR, Koornneef L. Anterior suspended flaps: a modified approach for external dacryocystorhinostomy. Br J Ophthalmol. 1998;82(7):790-792.
5. 5. Lee MJ, Park J, Yang MK, et al. Long-term results of maintenance of lacrimal silicone stent in patients with functional epiphora after external dacryocystorhinostomy. Eye (Lond). 2020;34(4):669-674.
6. 6. Rosen N, Sharir M, Moverman DC, Rosner M. Dacryocystorhinostomy with silicone tubes; evaluation of 253 cases. Ophthalmic Surg. 1989;20(2):115-119.
7. 7. Dressner SC, Codere F, Brownsteins S, Jouve P. Lacrimal drainage system enflamatory masses from retained silicone tubing. Am J Ophthal. 1984;98(5):609-613.
8. 8. Welham RAN, Wulc AE. Management of unsuccesfull lacrimal surgery. Br J Ophthalmol 1987;71(2):152-157.

9. 9. Elwan S. A randomized study comparing DCR with and without excision of the posterior mucosal flap. Orbit. 2003;22(1):7-13.
10. 10. Cokkeser Y, Evereklioglu C, Er H. Comparative external versus endoscopic dacryocystorhinostomy: results in 115 patients (130 eyes). Otolaryngol Head Neck Surg. 2000;123(4):488-491.
11. 11. Feng YF, Cai JQ, Zhang JY, Han XH. A meta-analysis of primary dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol. 2011;46:521-7.
12. 12. Ornek F, Acar DE, Acar U. The outcomes of 326 external dacryocystorhinostomy operations in children with dacryostenosis - 30-year experience of an oculoplastic surgeon. Arq Bras Oftalmol. 2018;81(6):500-504.
13. 13. Pandya VB, Lee S, Benger R, et al. The role of mucosal flaps in external dacryocystorhinostomy. 2010;29(6):324–327.
14. 14. Deka A, Bhattacharjee K, Bhuyan SK, Barua CK, Bhattacharjee H, Khaund G. Effect of mitomycin C on ostium in dacryocystorhinostomy. Clin Exp Ophthalmol. 2006;34(6):557-561.
15. 15. Walland MJ, Rose GE. The effect of silicone intubation on failure and infection rates after dacryocystorhinostomy. Ophthalmic Surgery 1994;25(9):597-600.
16. 16. Malhotra R, Norris JH, Sagili S, Al-Abbadi Z, Avisar I. The Learning Curve in Endoscopic Dacryocystorhinostomy: Outcomes in Surgery Performed by Trainee Oculoplastic Surgeons. Orbit. 2015;34(6):314-319.
17. 17. Liao SL, Kao SC, Tseng JH, Chen MS, Hou PK. Results of intraoperative mitomycin C application in dacryocystorhinostomy. Br J Ophthalmol 2000;84(8):903-906.
18. 18. Deka A, Saikia SP, Bhuyan SK. Combined posterior flap and anterior suspended flap dacryocystorhinostomy: A modification of external dacryocystorhinostomy. Oman J Ophthalmol. 2010;3(1):18-20.
19. 19. Serin D, Alagöz G, Karsloğlu S, Celebi C, Kukner S. External dacryocystorhinostomy: Double-flap anastomosisor excision of the posterior flaps. Ophthal Plast Reconstr Surg. 2007;23(1):28-31.
20. 20. Trimarchi M, Giordano Resti A, Vinciguerra A, Danè G, Bussi M. Dacryocystorhinostomy: Evolution of endoscopic techniques after 498 cases. Eur J Ophthalmol. 2020;30(5):998-1003.
21. 21. Derya K, Demirel S, Doganay S, Orman G, Cumurcu T, Gunduz A. Endoscopic transcanalicular dacryocystorhinostomy: is it an alternative method to conventional external dacryocystorhinostomy?. Plast Reconstr Surg. 2013;29(1):15-17.
22. 22. Akcam HT, Konuk O. Mechanical transnasal endoscopic dacryocystorhinostomy versus transcanalicular multidiode laser dacryocystorhinostomy: Long-term results of a prospective study. Lasers Med Sci. 2021;36(2):349-356.
23. 23. Ghasemi H, Asghari Asl S, Yarmohammadi ME, Jafari F, Izadi P. External. Dacryocystorhinostomy; Success Rate and Causes of Failure in Endoscopic and Pathologic Evaluations. P.Iran J Pathol. 2017;12(3):189-194.