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

Abstract

• PURPOSE: To examine if the addition of (antegrade) balloon dacryocystoplasty to bicanalicular silicone intubation affects the success rate in adults with incomplete nasolacrimal duct (NLD) obstruction.• DESIGN: Prospective, randomized trial.• METHODS: Seventy eyes of 70 patients with incomplete NLD obstruction and severe epiphora (Munk score grade 3 or 4) were treated randomly with dacryocystoplasty (Lacricath) and silicone intubation (Ritleng; n ‫؍‬ 35, group 1; mean age, 54.4 years; standard deviation [SD], 11.8 years) or silicone intubation alone (n ‫؍‬ 35, group 2; mean age, 53.5 years; SD, 13.1 years; P > .05). The silicone tubes were removed after, on average, three months. At the visit, we assessed the grade of epiphora using the Munk score. Complete success was defined as Munk score of 0 or 1, partial success was defined as Munk score of 2, and failure was defined as Munk score of 3 or 4. Long-term Munk scores were obtained through a telephone survey nine to 76 months after surgery (mean, 43.4 in group 1 and 34.9 in group 2; P > .05).• RESULTS: Complete success was reported by 18 patients (52%) in group 1 and by 20 patients (57%) in group 2. Partial success was reported by one patient in group 1 and by one patient in group 2. No improvement was reported by 15 patients (44%) in group 1 and by 14 patients (40%) in group 2. Differences between the two groups proved to be not significant (P ‫؍‬ .8, exact Chi-square trend test).• CONCLUSIONS: In our patients with acquired partial NLD obstruction, treatment with a combination of antegrade dacryocystoplasty and silicone intubation was not associated with a higher success rate compared with treatment with silicone intubation alone. (Am J Ophthalmol 2007;144:776 -780.

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

“…However, with a longer follow‐up (18–29 months) only 47–61% of patients are symptom free (Kashkouli et al. ; Bleyen & Paridaens ). If the stenosis is confined to the canaliculi, studies report success rates of 65%‐76%, but in some articles, both partial and complete stenosis were included and follow‐up varied between eight and 70 months (Fulcher et al.…”

Perspective: what does the term functional mean in the context of epiphora?

“…The studies by Peter and Pearson and Wormald and Tsirbas demonstrate success rates of 54% and 84%, respectively, for DCR in these patients 10,28 . Other studies that do not differentiate between partial stenosis and functional block report success rates of 50–94% for DCR in this combined group of patients 9,22–24,30–34 . There is some evidence from Peter and Pearson's study that Lester Jones Tube insertion may result in up to 100% functional success for patients that have persistent epiphora after DCR 10 .…”

A clinical trial of endoscopic vs external dacryocystorhinostomy for partial nasolacrimal duct obstruction

“…These include bicanalicular nasolacrimal duct intubation, and balloon dacryoplasty with or without intubation. 2 The most recent work shows that the results for silicone tube intubation in partial NDO are disappointing, with about a 50% failure and overall about 20-25% of patients opting for subsequent ext-DCR. The current study shows outcomes for both EES-DCR and ext-DCR have higher success rates than these alternative procedures.…”

“…[1][2][3][4][5] In the scientific literature, there are large gaps in our understanding of what benefit endoscopic DCR (EES-DCR) offers in partial NDO from clinical studies as opposed to anecdotal evidence, as summarised in Table 1. 3-5 The current study addresses two significant deficiencies in the evidence base. First, no prospective study had hitherto looked at the outcome of EES-DCR in the treatment of partial obstruction of the nasolacrimal system.…”