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Abstrak :

Penelitian ini bertujuan untuk menilai kesesuaian antara dacryoscintigraphy dibandingkan dacryocystography sebagai pemeriksaan penunjang pada pasien obstruksi duktus nasolakrimal primer didapat (PANDO). Penelitian ini merupakan suatu studi diagnostik pada pasien tersangka PANDO dengan epiphora yang datang ke poliklinik Plastik dan Rekonstruksi RSCM Kirana. Pasien tersebut selanjutnya dikirim ke Departemen Radiologi untuk pemeriksaan dacryoscintigraphy dan dacryocystography. Selanjutnya dengan observasi dan kuesioner dinilai efek samping dan kenyamanan terhadap kedua pemeriksaan.

 

Penelitian ini merekrut 31 subjek (62 mata). Melalui tes irigasi dan sondase didapatkan 47 mata tersangka PANDO. Sebanyak 87.1% subjek berjenis kelamin perempuan, dengan kelompok umur terbanyak (74.2%) yaitu >40 tahun. Pada pemeriksaan dacryoscintigraphy, waktu yang dibutuhkan untuk mencapai sakus yaitu 0 menit, duktus (5 menit), dan kavum nasi (12.5 menit). Nilai kesesuaian antara kedua pemeriksaan dalam menentukan ada atau tidaknya obstruksi sebesar 83.8% (strong agreement), sedangkan dalam menentukan letak obstruksi sebesar 70.9% (agreement).

 

Pada pemeriksaan dacryoscintigraphy tidak ditemukan adanya efek samping, sedangkan pada dacryocystography, terdapat 2 pasien yang menunjukan hiperemis konjungtiva. Terdapat 22 subjek mengeluhkan nyeri saat pemeriksaan dacryocystography, sedangkan tidak ada subjek yang mengeluhkan nyeri saat pemeriksaan dacryoscintigraphy (p<0.005). Sebanyak 16 subjek menyatakan dacryoscintigraphy lebih nyaman, 11 subjek menyatakan dacryocystography lebih nyaman, sedangkan 4 subjek menyatakan kedua pemeriksaan sama nyamannya. Dacryoscintigraphy memiliki nilai kesesuaian yang baik dengan dacryocystography dalam menentukan ada atau tidak obstruksi dan menentukan letak obstruksi pada pasien PANDO. Kedua pemeriksaan tersebut mempunyai tingkat kenyamanan yang sama, namun pemeriksaan dacryocystography dirasakan lebih nyeri sewaktu atau durante tindakan dibandingkan dengan dacryoscintigraphy.

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This study aims to assess conformity of dacryoscintigraphy compared to dacryocystography as supporting assessment in patient with primary acquired nasolacrimal duct obstruction (PANDO). This diagnostic study performed in PANDO with epiphora complaint whose visiting RSCM Kirana Plastic and Reconstruction Division. Subsequently, subjects were sent to Radiology Department for dacryoscintigraphy and dacryocystography examinations. After the examination, observation and questionnaire assessed the side effects and comfort of both examinations.

This study recruited 31 subjects (62 eyes). Through irrigation and probing, there were 47 eyes found with PANDO. As much as 87.1% subjects were female, with mostly (74.2%) aged >40 years old. With dacryoscintigraph, time needed to reach sac was 0 minutes, duct was 5 minutes, and nasal cavum was 12.5 minutes. Conformity value between the two examinations in detecting obstruction was 83.8%, meanwhile in detecting the location of obstruction was 70.9%.

With dacryoscintigraph, there were no side effects found. Meanwhile with dacryocystograph, there were 2 patients found with conjunctival hyperemia. There were 22 subjects complaining with pain at dacryocystograph examination, while there were none at dacryoscintigraph examination (p<0.005). Sixteen subjects feel dacryoscintigraph examination was more convenient, eleven subjects feel dacryocystohraph examination was more convenient, while 4 subjects feel the two examinations just as convenient.

Dacryoscintigraph has good conformity value with dacryocystograph examination in detecting obstruction and defining the location in PANDO patients. Both examinations have high convenience level, even though dacryocystograph was more painful at the examination than dacryoscintigraph.

Abstrak :
Purpose: We evaluated cultured specimens from silicone tubes removed from patients with congenital nasolacrimal duct obstruction and determined the antibiotic sensitives of the specimens. Methods: This study included 26 eyes of 22 patients who had received endonasal silicone tube intubation for congenital nasolacrimal duct obstruction. The removed silicone tubes were divided into canalicus, lacrimal sac, nasolacrimal duct and nasal cavity parts according to insertion state. Then, bacteria and fungus cultures were performed and rheir antibiotic sensitivity was tested. Results: Bacteria culture rate was 80.8% in the canaliculus and the lacrimal sac, and 88.5% in the lacrimal duct, and the nasal cavity, which was not significantly higher in the nasal cavity than in the nasolacrimal duct and in the nasolacrimal duct than in the lacrimal sac and the canaliculus (p-value < 0.05). The species of cultured Gram-positive bacteria were in the following order: Staphylococcus aureus, streptococcus pneumonia and coagulase negative staphylococcus. Common species of cultured Gram-negative bacteria were Pseudomonas and Serratia marcescenes. All six species of cultured fungi were candida. Among 12 Staphylococcus aureus cultured, eight species showd resistance to methicillin (MRSA). In all patients, the symptomps and the signs of nasolacrimal duct obstruction improved after the tube removal. Conclusions: Bacterial and fungal infection of the silicone tube in patients with congenital nasolacrimal duct obstruction does not appear to affect directly the outcome of silicone tube intubation. Further studies of bacterium and fungi in the nasolacrimal duct before silicone tube intubation are needed for determining the infection causing nasolacarimal duct obstruction J Korean Ophthalmol Soc 2014;55(8): 1121-1125

Abstrak :
Latar Belakang: Akses yang baik ke sakus lakrimal sangat penting dalam prosedur DCR endoskopik pada kasus obstruksi duktus nasolakrimal. Struktur ini dapat terhalangi oleh keberadaan agger nasi, yang juga dapat mempersulit prosedur operasi dan meningkatkan angka kegagalan. Tujuan: Untuk menentukan variasi anatomi agger nasi dalam hubungannya dengan sakus lakrimal menggunakan CT scan dan membandingkannya dengan pembukaannya. Metode: Studi ini merupakan studi potong lintang yang dilakukan pada 11 subjek yang didiagnosis dengan sumbatan saluran air mata hidung terperoleh primer. Subjek menjalani CT scan untuk menilai keberadaan agger nasi dan penempatannya terhadap sakus lakrimal. Subjek kemudian menjalani dakriosistorinostomi endoskopik, dan operator menilai apakah agger nasi perlu dibuka atau tidak untuk mengakses sakus lakrimal. Analisis statistik menggunakan Cohen's Kappa dilakukan untuk mengevaluasi kesepakatan antara kedua temuan tersebut. Hasil: Dari 13 subjek, 12 adalah perempuan. Agger nasi ditemukan pada 12 dari 13 subjek. Pada pemeriksaan radiologi, 8 dari 12 subjek menunjukkan penempatan sakus lakrimal dengan agger nasi. Pada intraoperatif, agger nasi dibuka pada 9 subjek. Terdapat kesepakatan yang substansial dengan κ = 0,800; p = 0,005. Satu pasien tidak menunjukkan penempatan, namun agger nasi dibuka karena kesulitan mengakses sakus lakrimal yang disebabkan oleh sudut proses frontal maksila. Kesimpulan: Evaluasi aposisi agger nasi terhadap sakus lakrimal dapat dilakukan secara rutin. Terdapat kesepakatan yang substansial antara pemeriksaan radiologi dan temuan intraoperatif mengenai pembukaan agger nasi. ......Background: Proper access to the lacrimal sac is crucial in endoscopic DCR procedures in nasolacrimal duct obstruction. This structure can be obstructed by the presence of the agger nasi, which may complicate the surgery and increasing failure rate. Objectives: To determine the anatomical variations of the agger nasi in relation to the lacrimal sac using CT scan and comparing it with its opening. Methods: This study is a cross-sectional study conducted on 11 subjects diagnosed with primary acquired nasolacrimal duct obstruction. The subjects underwent CT to assess the presence of the agger nasi and its apposition to the lacrimal sac. Endoscopic dacryocystorhinostomy was performed, and the operator assessed whether the agger nasi needed to be opened or not to access the lacrimal sac. Statistical analysis using Cohen's Kappa was conducted to evaluate the agreement between the two findings. Results: Out of the 13 subjects, 12 out of 13 were female. Agger nasi was found in 12 out of 13 subjects. In radiological examination, 8 out of 12 subjects showed apposition of the lacrimal sac with the agger nasi. Intraoperatively, the agger nasi was opened in 9 subjects. There was substantial agreement with a κ = .800; p = .005. One patient did not show apposition, however agger nasi was opened due to difficulty in accessing the lacrimal sac caused by the angulation of the frontal process of the maxilla. Conclusion: Evaluation of the apposition of the agger nasi to the lacrimal sac can be routinely performed. There is substantial agreement between radiological examination and intraoperative findings regarding the opening of the agger nasi.