Silicone Intubation for Nasolacrimal Duct Stenosis in Adults

Purpose: To investigate long-term outcome and report reoperation rate of noninfected, complete acquired lacrimal drainage obstruction (ALDO) treated with canaliculodacryocystoplasty (CDCP) depending on site of stenosis. Method: Consecutive adult patients with non-infected, complete ALDO treated with CDCP were followed for 76 months. Location of stenosis at preoperative visit and intraoperative probing was recorded, and during follow-up, recurrence of stenosis prompting additional surgery and complications were noted. Survival analysis was applied to compare reoperation rate depending on site of stenosis. A follow-up questionnaire was sent to patients not requiring reoperation asking to grade current epiphora problems. Results: Among 85 included cases (71 patients), 57 were classified as canalicular stenosis and 28 as nasolacrimal duct obstruction (NLDO) preoperatively. At the end of follow-up, 39% (33/85) of cases had required additional surgery due to persistent/recurrent symptoms. No statistical difference was found between these groups.During CDCP, 25 of the 57 preoperatively classified canalicular stenosis were found to have an additional obstruction below the sac. The group with only canalicular stenosis had a statistically significant higher survival compared with cases with NLDO or multiple obstructions (p = 0.03). Of patients responding to the follow-up questionnaire, 11/37 cases experienced epiphora often or constant. Conclusion: Treating complete NLDO with CDCP results in a high reoperation rate and seems an insufficient alternative. Canaliculodacryocystoplasty (CDCP) may be discussed if preoperative examination indicates canalicular stenosis and dacryocystorhinostomy is not desirable. However, the patient needs to be aware of the higher risk for additional surgery, especially if a second stenosis is found during probing.

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“…For partial NLDO, reports state good short‐term results with success rates of 75–76% after 6–8 months (Andalib et al. ; Xu et al. ).…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions

Bohman

Kugelberg

Kopp

2019

Acta Ophthalmologica

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“…Complication rates for traditional bicanalicular intubation systems greatly vary, with rates from 0% to 41% described in the literature. [7][8][9][10][11][12][13] Complications can include stent prolapse or extrusion, punctal erosion (or "cheese wiring"), conjunctivitis, mucoid debris accumulation on the stent (or colonization), granuloma and fistula formation, and nasal bleeding. 8,9 Anderson and colleagues reported on complication rates of Guibor tubes in patients with all types of obstructions of the nasolacrimal system, and noted a 29% complication rate with this system.…”

Section: Discussionmentioning

confidence: 99%

“…As such, the duration of stent retention in this study (mean of 145 days with a range of 1 day to 580 days) is longer than stent retention times in many other studies. 6,[10][11][12] However, the preferred amount of time for stent retention varies based on the indication for tube placement as well as surgeon preference and training. 9 Though the 90-day complication rate in this study is similar to the prior Lacriflow study, the overall complication rate in our study of 13.9% is higher, possibly due to the longer follow-up time and longer time that the stents were retained.…”

Section: Discussionmentioning

confidence: 99%

<p>Bicanalicular Intubation with the Kaneka Lacriflow for Proximal Lacrimal Drainage System Stenosis</p>

DeParis¹,

Hougen²,

Rajaii³

et al. 2020

OPTH

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Purpose: The Kaneka Lacriflow CL (Lacriflow) bicanalicular lacrimal intubation system was evaluated as a self-retaining alternative to traditional modalities for stenting and dilation of the lacrimal drainage system in proximal lacrimal drainage system stenosis. Patients and Methods: A retrospective chart review was conducted to assess the use of the Lacriflow system for treatment of patients with punctal and canalicular stenosis. Anesthesia type, operative time, and complications were assessed. Results: In the time period evaluated, a total of 72 Lacriflow stents were placed in 45 patients, most commonly under intravenous sedation. Stents were left in place for a mean of 145 days, with 9 stents left in place for more than 1 year, and a mean follow-up time of 263 days. Early complications within 90 days included prolapse in 1 stent, symptomatic colonization for 2 stents, and corneal abrasion in 1 stent in a patient with anterior basement membrane dystrophy. Five additional stents developed colonization in the late postoperative period (four of which were more than 1 year after stent placement). The overall complication rate (per stent) at 3 months after surgery was 5.6% and at all follow-up time points was 13.9%. Operative times were significantly shorter for a cohort of patients undergoing bicanalicular intubation with the Ritleng system (P = 0.015). Conclusion: The Lacriflow bicanalicular stent can be easily placed without general anesthesia. Complication rates are comparable to other bicanalicular intubation systems, but increase with longer time that stents are left in place.

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“…[ 6 , 23 – 25 ] The disadvantages of these methods should not be neglected, such as false passage formation, punctum erosion, prolapsed tube, traumatic obstruction, and formation of pyogenic granuloma. [ 26 , 27 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hasner valvulotomy outcomes in pediatric and adult patients: does age matter?

Sun

Ding²,

et al. 2020

Chinese Medical Journal

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Background Hasner valve incision has been recently introduced as a new treatment for ophthalmic patients with epiphora symptoms. The aim of this study was to examine whether surgical outcomes of Hasner valve incision for inferior nasolacrimal duct obstruction were different between pediatric and adult patients. Methods A total of 53 eyes of 52 patients who underwent Hasner valve incision in the Beijing Tongren Hospital from October 2016 to November 2019 were retrospectively observed. Patients were divided into two groups, including pediatric group (23 eyes of 22 patients, <18 years old) and adult group (30 eyes of 30 patients, ≥18 years old). Success rate of surgery was determined by both subjective measure (complete resolution of epiphora) and objective measure (lacrimal passage irrigation and tear meniscus height). Fisher exact test was conducted. Results By conducting Fisher exact test and comparing complete resolution of epiphora ( P = 0.627), lacrimal passage irrigation ( P = 0.663), measurement of Tear Meniscus Height ( P = 0.561), and appearance of complication ( P = 0.339), there was no statistically significant difference of surgical outcomes between pediatric and adult patients ( P > 0.05). Conclusion Hasner valve incision was effective for both adult and children with inferior nasolacrimal duct obstruction, with no difference in surgical outcomes between the two groups.

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Silicone Intubation for Nasolacrimal Duct Stenosis in Adults

Abstract: Both MCI and BCI were successful in a similar percentage of patients with NLDS. The main advantages of the former technique were simple insertion and easy removal of the tube.

Cited by 20 publications

References 2 publications

Long‐term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions

Long‐term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions

<p>Bicanalicular Intubation with the Kaneka Lacriflow for Proximal Lacrimal Drainage System Stenosis</p>

Comparison of Hasner valvulotomy outcomes in pediatric and adult patients: does age matter?

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