Regurgitation on pressure over the lacrimal sac versus lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries

Abstract

Purpose: To determine the diagnostic accuracy of manual regurgitation on pressure over the lacrimal sac (ROPLAS) versus lacrimal irrigation for screening nasolacrimal duct obstruction (NLDO) in adults prior to intraocular surgeries. Methods: This cross-sectional study took place in a tertiary eye care hospital in South Tamil Nadu, India. From January to December 2017 and included consecutive patients who presented for routine cataract surgery. Prospective data collection occurred in 8369 eyes of patients who underwent cataract surgery. All patients underwent ROPLAS testing by an ophthalmologist followed by lacrimal irrigation by trained ophthalmic assistants, rechecked or confirmed in equivocal cases by ophthalmologists who were masked to the ROPLAS status. The primary outcome, the sensitivity, specificity, positive, and negative predictive values to detect lacrimal occlusion by ROPLAS compared with lacrimal irrigation with 95% confidence intervals was estimated. Results: A total of 8369 eyes underwent cataract surgery during the time periods of the study. ROPLAS and lacrimal irrigation were performed in all eyes. The sensitivity of ROPLAS to diagnose NLDO correctly was 54.5% (95% CI, 44.8%–63.9%) and its specificity was 100% (95% CI, 100%–100%). The positive and negative predictive values were 75.3% (95% CI, 65.6%-83.0%) and 99.4% (95% CI, 99.2%–99.5%), respectively. Conclusion: We found that ROPLAS when used alone had very low sensitivity and low positive predictive value in detecting NLDO prior to cataract surgery as compared with lacrimal irrigation. Hence, we recommend performing ROPLAS and lacrimal irrigation in every patient as part of the routine preoperative workup prior to cataract surgery.

Advancing Proficiency in Lacrimal Syringing: Comparative study of Two Different Syringing Techniques and Designing of a Self-serve Training Model

“…However, relying solely on the ROPLAS test has limited sensitivity and a low positive predictive value due to incorrect technique or sac emptying prior to examination [17]. In contrast, lacrimal syringing can provide more comprehensive details and is therefore recommended as a complementary method for preoperative assessment of NLDO before cataract surgery, ensuring a more comprehensive evaluation [2].…”

“…Lacrimal syringing is a commonly used and minimally invasive test in clinical practice for investigating obstructed or in amed conditions of the lacrimal system [1,2]. It plays a crucial role in diagnosing lacrimal diseases by providing valuable insights into the location and nature of obstructions within the lacrimal duct.…”

Commentary

“…However, when the safety of a vision-restoring surgical procedure (elective cataract surgery) is in question, more details in the ophthalmic examination will add to the safety value. As per the current study by Kim et al ,[ 5 ] the ROPLaS and lacrimal irrigation are both recommended to be performed in the preoperative workup of a cataract patient. [ 5 ] In their study, the ROPLaS was performed by an ophthalmologist, while a trained ophthalmic technician performed the lacrimal irrigation.…”

“…As per the current study by Kim et al ,[ 5 ] the ROPLaS and lacrimal irrigation are both recommended to be performed in the preoperative workup of a cataract patient. [ 5 ] In their study, the ROPLaS was performed by an ophthalmologist, while a trained ophthalmic technician performed the lacrimal irrigation. We want to emphasize that ophthalmologists should first train the technician adequately before performing an invasive procedure (lacrimal irrigation) on a patient.…”

Commentary

“…Kim et al . [ 3 ] in their paper entitled “Regurgitation on pressure over the lacrimal sac (ROPLAS) vs. lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries” concluded that ROPLAS has a very low sensitivity as far as the diagnosis of NLDO is concerned and each and every patient undergoing cataract surgery should be subjected to both ROPLAS and lacrimal irrigation. Although the paper is impressive with a sample size of 8000 patients, I think that the message is still not very loud and clear.…”