Antegrade balloon dilatation of nasolacrimal duct obstruction in adults

Abstract

Aims-To determine the eYcacy of antegrade balloon dilatation of postsaccal lacrimal stenosis in adults. Methods-Balloon dilatation was performed in a series of 30 patients with complete nasolacrimal duct obstructions and epiphora. Obstruction was diagnosed by canalicular irrigation and transcanalicular endoscopic examination of the lacrimal pathway. Except for four cases in which general anaesthesia was applied, the procedure was performed under local anaesthesia. The Lacricath balloon catheter set was used. Silicone intubation was performed simultaneously. The time at which the tubes were removed depended on the findings at postoperative follow up but was, at the earliest, 3 months postoperatively. Results-Success was objectified by irrigation and was evaluated subjectively at each follow up examination according to Munk's scale. In all cases the procedure could be performed with subsequent silicone intubation. Three months postoperatively 89.9% of all cases were positive on simple irrigation, and subjective success was also registered (Munk's grade 0 or 1). At 6 months 70% of all cases were positive on irrigation, again with subjective success (Munk's grade 0 or 1). One year postoperatively 73.3% of all procedures showed subjective success (two successful redilatations would raise the success rate to 79.9%). Conclusion-Retrograde as well as antegrade dilatation has been reported to be more or less successful in partial nasolacrimal obstruction. Although the procedure is used as primary treatment in cases of complete obstruction, it can still be performed under local anaesthesia on an outpatient basis. Long term observation will be required to prove the sustained eVect of this procedure. (Br J Ophthalmol 2001;85:200-204)

Ergebnisse der Dacryozystorhinostomie nach Toti im Zeitraum von 2000 bis 2012

“…Die Dacryozystorhinostomie (DCR) wird trotz bestehender moderner Verfahren der endokanalikulären, mikroendoskopischen Tränenwegschirurgie als am längsten bewährte, unverzichtbare Methode zur operativen Behandlung bei Tränenwegsobstruktio-nen eingesetzt. Das Operationsverfahren bei einer Dacryozystorhinostomie kann extern durch einen Hautschnitt über der Crista lacrimalis erfolgen oder intern, transnasal durch mikroskopische, rein endoskopische oder endoskopisch lasergestützte Verfahren [1][2][3][4]. Die externe Dacryozystorhinostomie wurde erstmals 1904 vom italienischen Rhinologen Addeo Toti beschrieben [5].…”

Silicone Intubation with or without Balloon Dacryocystoplasty in Acquired Partial Nasolacrimal Duct Obstruction

“…6 -9 The reported munk at follow-up success of dacryocystoplasty alone ranges widely, from 25% to 50% 6,8 to 90%. 9,11 When (antegrade) dacryocystoplasty was combined with silicone intubation, two studies showed a six-month success rate of 56% to 60% in patients with incomplete NLD obstruction. 2,15 Kashkouli and associates recently compared endoscopically assisted balloon dacryocystoplasty and silicone intubation with silicone intubation alone in adults in a retrospective nonrandomized case series.…”

“…The catheter was withdrawn only after the balloon was deflated completely. 11 Next, bicanalicular silicone intubation was performed, using the Ritleng system (P. Ritleng, Issy-lesMoulineux, France). The two silicone tubes were tied together with a polypropylene 6-0 suture and was fixated to the lateral wall of the nose.…”

Recent Developments in the Evaluation and Management of Adult Lacrimal Obstruction

“…In a similar study, Kuchar and Steinkogler found that at one year the success rate was 73%. 49 Several studies have reviewed the short-and long-term outcomes of retrograde dacryocystoplasty in adults. [50][51][52] Fenton et al reported an overall re-obstruction rate of 29% at one year, but 69% of those with initially complete obstruction failed by one year.…”