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NCT05999630
The association of radioiodine therapy for the treatment of thyroid cancer with nasolacrimal duct obstruction has been well documented in the medical literature. Prior case reports have documented radioactive iodine detection in the tears of patients following radioiodine therapy. It is possible that radioactive uptake by the cells in the lacrimal sac and nasolacrimal duct lead to inflammation, fibrosis, and obstruction of the tear duct over time. A recent study has shown that the administration of artificial tears decreases the level of detectable radioiodine in the tears of patients undergoing radioiodine therapy for thyroid cancer. The purpose of this study will be to assess whether administering tears after radioactive iodine therapy for thyroid cancer decreases the incidence of nasolacrimal duct obstruction in the two years following radioactive iodine treatment.
NCT07154121
Primary acquired nasolacrimal duct obstruction (PANDO) is a lacrimal duct obstruction disease characterized by inflammatory fibrosis of the nasolacrimal duct, with primary symptoms including epiphora and increased secretions, commonly seen in middle-aged and elderly women over 40 years of age . The pathogenesis of PANDO remains unclear, and there are no effective pharmacological treatments. Dacryocystorhinostomy (DCR) is currently considered the primary treatment for PANDO, as it restores tear drainage by creating an alternative drainage pathway between the lacrimal sac and the nasal cavity. The surgical techniques for DCR primarily include external DCR (Ex-DCR) and endoscopic DCR (En-DCR), with En-DCR first proposed by McDonogh and Meiring in 1989. In recent years, with the advancement of endoscopic sinus surgery techniques, En-DCR has gained widespread recognition in the treatment of PANDO, as it not only minimizes surgical trauma and accelerates postoperative recovery but also leaves no external scars. In recent years, with the advancement of endoscopic surgical techniques, En-DCR has gained widespread recognition in the treatment of PANDO, as it not only causes minimal surgical trauma and facilitates rapid postoperative recovery; but also leaves no external scars, making it more aesthetically pleasing; and can simultaneously correct nasal cavity abnormalities such as deviated nasal septum and sinusitis. Recent studies indicate that the surgical success rate of En-DCR can reach 84%-94%, comparable to traditional external surgery Recent studies have shown that the surgical success rate of En-DCR can reach 84%-94%, comparable to traditional external approaches. Although the prognostic factors associated with En-DCR outcomes have not yet been fully elucidated, it has been demonstrated that lacrimal sac size is one of the key indicators for predicting the efficacy of En-DCR surgery, and a small lacrimal sac is a major risk factor for En-DCR surgical failure. In patients with normal-sized lacrimal sacs, creating a larger bone window can better expose the lacrimal sac, thereby forming a larger lacrimal sac flap, making the lacrimal sac opening wider, and reducing the risk of postoperative obstruction. However, in patients with small lacrimal sacs, even if the bone window is intentionally enlarged during surgery, the resulting lacrimal sac flap remains small due to the inherent small size of the lacrimal sac, making it difficult to achieve proper alignment with the nasal mucosal flap at the anterior margin of the hook process, resulting in poor anastomotic outcomes. In PANDO cases, the primary cause of surgical failure is often related to abnormal healing of the anastomotic site postoperatively, particularly scar formation at the surgical site and scar-induced closure of the bone window. Compared to patients with normal-sized lacrimal sacs, patients with small lacrimal sacs are more prone to osteotomy site closure due to granulation tissue proliferation postoperatively, thereby reducing surgical successrates. Therefore, preventing fibrous proliferation at the osteotomy site may be key to improving the success rate of En-DCR treatment for small lacrimal sac-type PANDO. Antimetabolite drugs are frequently used to treat various ocular lesions characterized by non-tumor cell proliferation. 5-Fluorouracil (5-FU) is one such drug, which inhibits DNA synthesis by blocking thymidine kinase, an enzyme involved in collagen gene expression. In vitro studies have shown that 5-FU interferes with the biosynthesis of F-actin and prevents fibroblast migration; 5-FU can inhibit scar formation by suppressing fibroblast proliferation; and 5-FU can prolong wound healing time. 5-FU is now widely used to inhibit fibroblast proliferation and scar formation within the filter after glaucoma filtration surgery, demonstrating good safety and efficacy. This study is the first to explore the efficacy of 5-fluorouracil as an adjunct to En-DCR therapy for small lacrimal sac PANDO, aiming to provide a new adjunctive treatment strategy for patients with small lacrimal sac PANDO.
NCT06530264
The aim of DCR is to form a new, mucosa-lined pathway between the lacrimal sac and the nasal cavity where tears can bypass a lacrimal obstruction and drain directly in the nose. The original external approach was described in 19046. In 1920s, mucosal flap anastomosis was added to the procedure as a modification7, and since then, many new modifications have been made to improve the original procedure.
NCT04837534
Follow-up of pediatric patients is important for their regular ocular morbidity monitoring, especially for amblyopia management. An observatory data of 1st week (1st to 7th) of January 2019 revealed that the follow-up compliance was very low (22%) among children aged 0-16 years in the pediatric department of Bharatpur Eye Hospital. A problem tree analysis showed a lack of awareness in children and their parents regarding the importance of follow-up and patients forgetting regarding the follow-up visit, usually when there is the long duration of follow up are the major contributing factors for poor adherence to follow-up. So, an intervention study was aimed at finding the effectiveness of counseling and reminders through SMS and phone calls to improve the follow-ups. All pediatric patients 0-16 years of age with ocular conditions requiring at least 3 follow-ups in the study period (January 2021 to April 2021) will be included. Two hundred and sixty-four participants will be equally distributed to three groups: routine standard care, counseling, and reminders with SMS and phone calls. In the routine care group, children will undergo routine care as per existing practice in the hospital and there will be no additional intervention. In counseling group, in addition to routine care parents/guardians along with the child will receive counseling from a trained counselor as per the set counseling protocol in every follow-up visits and will also be provided with the disease-specific information leaflets as additional information material before the child is discharged from the department. In the SMS and phone call reminder group, in addition to routine care, parents/guardians of children will receive reminders through short messaging text (SMS) 3 days and phone calls one day prior to the scheduled visit. Compliance to follow up Participants completing all the three follow-up visits as per the schedule within the window period of +/-2 days will be considered as a complaint to follow up. However, the follow-ups of all the participants will be recorded although that is beyond the window period. The primary outcome will be measured by the proportion of children completing all three scheduled follow-ups. The ethical approval has been obtained from the Institutional Review Committee of NHRC (ERB protocol registration number 761/2020 P). Informed consent will be taken from parent and child. Conclusion: If interventions improve the follow-up rate and are cost-effective, this can be applied in all the departments of the hospital.
NCT04122300
Congenital nasolacrimal duct obstruction (CNLDO) occurs in approximately 10 to 20% of all term newborns, and is the most common cause of persistent tearing and ocular discharge in children. CNLDO causes symptoms in up to 6% of children during the first year of life. The first clinical signs appear during the first month of life in 95% of cases and usually consist of tearing and debris on the eyelashes ("mattering"). Mucopurulent eye discharge occurs commonly in infants with CNLDO and, in the absence of other signs of infection, suggests bacterial overgrowth in the stagnant tear pool of the lacrimal sac. This study investigates whether early administration of Euphrasia eye drops (Weleda AG, Arlesheim) in preterm neonates presenting with first ocular discharge with or without tearing and reddened eye fosters the resolution of the ocular discharge and reduces the need for topical antibiotic therapy.
NCT03780868
While external DCR is the gold standard procedure for primary NLDO as well as complicated cases, SI with MMC could achieve comparable success rates in primary acquired NLDO, hence should be considered as an alternative as a safe and minimally invasive procedure.
NCT01431170
The goal of the study is to evaluate the application of Besivance™ (besifloxacin ophthalmic suspension, 0.6%) to treat congenital nasolacrimal duct obstruction in children. The hypothesis of the study is that Besivance™ is as safe and effective as the current standard of care for the treatment of nasolacrimal duct obstruction in children.