Efficacy and economic benefit of endoscopic modified SHSI and En-DCR in the treatment of NLDO / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the medical effects and economic benefits between spherical headed silicone intubation(SHSI)and endoscopic dacryocystorhinostomy(En-DCR), to further verify the therapeutic effect of modified SHSI under endoscope on NLDO.<p>METHODS: The 43 patients with 50 eyes of NLDO were randomly divided into SHSI group(21 cases and 25 eyes)and En-DCR group(22 cases and 25 eyes). Then to compared the intraoperative bleeding volume, monocularoperation time, surgical discomforta, nd hospitalization time between the two groups of patients. Followed-up to 12mo after surgery, the clinical efficacy was evaluated according to the situation of tear overflow and lacrimal lavage at the last follow-up, and the cost-effectiveness ratio(C/E)was used to evaluate the economic benefits.<p>RESULTS: The intraoperative blood loss and surgical discomfort visual analogue scores of patients in the SHSI group were significantly lower than those in the En-DCR group(4.96±1.989mL <i>vs</i> 27.60±14.950mL, 2.84±0.64 <i>vs</i> 4.88±0.84). Monocular surgery time and hospital stay were significantly shorter than those in the En-DCR group(13.40±6.007min <i>vs</i> 59.64±12.786min, 0.50±0.010h <i>vs</i> 137.280±23.085h)(All <i>P</i><0.001). At the last follow-up, the clinical effectiveness rate of the two groups was no difference(88% <i>vs</i> 96%, <i>P</i>>0.05), but the C/E(13.57)of patients in SHSI group was far smaller than that of En-DCR(121.50).<p>CONCLUSION: Endoscopic SHSI and En-DCR are both effective surgical methods for nldo. But SHSI surgery is relatively lower difficult and has significant cost-effective advantages.

Middle Meatus Osteotomy with Lacrimal Intubation for Post-traumatic Epiphora.

Nasolacrimal duct obstruction is common sequel following naso-orbito ethmoidal fractures. After 2 months of receiving conservative treatment, a 24-year-old male patient reported epiphora from the right eye following self-fall from a tree. Lacrimal sac mucocele was diagnosed and mucopurulent regurgitation noted on finger pressure and lacrimal sac syringing. Computed tomography revealed healed old fractures involving right nasal bone, maxillary nasal process adjacent to the medial orbital wall with lytic areas. Possibility of the subperiosteal abscess with osteomyelitis changes was suspected. A thick fibro-osseous (sequestrum) wall formation was noted separating nasal cavity and orbit. Lateral nasal wall adhesions were released by transnasal endoscopy. Two weeks later, the thick wall was fenestrated through external dacryocystorhinostomy approach. Lacrimal sac mucocele opened and bicanalicular silicone intubation performed. Epiphora relieved and lacrimal passage patency maintained and confirmed by lacrimal sac syringing on 3 months follow-up. To evaluate etiopathogenesis and patency, integrity of silicone intubation is the purpose of presenting this case.

Efficacy analysis of lacrimal fistula excision combined double silicone intubation in the treatment of chronic dacryocystitis with lacrimal fistula / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM:To observe the clinical effects of thelacrimal fistula excision combined with double silicone intubation in the treatment of chronic dacryocystitis with lacrimal fistula.? METHODS: Totally 25 cases ( 25 eyes ) of chronic dacryocystitis with lacrimal fistula were allocated into two groups:the double silicone intubation group of 13 cases (13 eyes) received lacrimal fistula excision combined with double silicone intubation, and the routine group of 12 cases (12 eyes) received routine dacryocystorhinotomy, we analyzed the curative effect.?RESULTS: The double silicone intubation group had a cure rate of 92. 3% (12 eyes), a effective rate of 100%, compared with the routine group had a cure rate of 91. 7%( 11 eyes ) , a effective rate of 100%, there were no statistically significant difference between the two groups (P>0. 05).?CONCLUSlON:Lacrimal fistula excision combined with double silicone intubation has a same effect with routine dacryocystorhinotomy in the treatment of chronic dacryocystitis with lacrimal fistula, but less invasive, no scar, less pain, and meet the patients' esthetic needs.

Surgical technique and preliminary results of transcanalicular endoscopic lacrimal duct recanalization and balloon dacryoplasty with silicone intubation in Filipino patients with complete nasolacrimal duct obstruction

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the surgical technique of transcanalicular endoscopic lacrimal duct recanalization (TELDR) with balloon dacryoplasty and silicone intubation in patients with complete nasolacrimal duct obstruction and assess their effectivity.</p> <p style="text-align: justify;"><strong>METHODS:</strong> Ten lacrimal systems from eight patients diagnosed with complete nasolacrimal duct obstruction (NLDO) underwent TELDR and balloon dacryoplasty with silicone intubation.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> All 10 lacrimal systems from eight patients who underwent TELDR and balloon dacryoplasty with silicone intubation had 100% anatomical and functional patency.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> TELDR and balloon dacryoplasty with silicone intubation represents an alternative, minimally invasive technique in the management of complete nasolacrimal duct obstruction.</p>

The Effect of Mitomycin C Instillation after Silicone Intubation in Adult Partial Nasolacrimal Duct Obstruction

PURPOSE: To compare the result of mitomycin C (MMC) instillation after silicone intubation in partial nasolacrimal duct obstruction in adults according to duration of instillation. METHODS: An instillation of 0.04% MMC eyedrops was performed on 61 eyes of 38 patients diagnosed with partial nasolacrimal duct obstruction. The clinical result of patient groups, classified according to duration of MMC eyedrops instillation, was analyzed prospectively. The patients groups was as follows: no MMC eyedrop instillation (group A), 1 week of MMC instillation (group B), 2 weeks of MMC instillation (group C), and 3 weeks of MMC instillation (group D). RESULTS: Among all patients, 50 eyes (81.9%) showed improved symptoms. Fifteen eyes (71.4%) in group A, 8 eyes (72.7%) in group B, 13 eyes (86.7%) in group C and 14 eyes (100.0%) in group D had a successful outcome. The success rate was observed in groups D, C, B, and A, in descending order, which was statistically significant (p = 0.025). CONCLUSIONS: Silicone intubation is an effective treatment option for partial nasolacrimal duct obstruction in adults and MMC eyedrop instillation may improve silicone intubation results.

A Case of Acquired Dacryocystocele Treated by Lacrimal Silicone Intubation

PURPOSE: To report a case of an acquired dacryocystocele successfully treated with bicanalicular silicone intubation and to review relating literature. CASE SUMMARY: A 17-year-old girl visited our clinic with tearing of both eyes since birth and a mass on the right medial canthal area for 2 years. A firm, non-tender mass with a well-demarcated border was palpated in the subcutaneous level just inferior to the right medial canthal ligament. Lacrimal irrigation via the lower punctums showed reflux through the opposite punctums without nasal passage in both of her eyes. Computed tomographic scan showed a widening of the right lacrimal sac fossa and bony nasolacrimal canal and a 16 x 18 mm sized cyst-like mass in the right lacrimal sac. The patient was diagnosed with right acquired dacryocystocele associated with bilateral congenital nasolacrimal duct obstructions. After opening of the obstructed common canaliculus using a fine lacrimal probe, silicone intubation was performed. The tearing symptom improved and the mass disappeared during the subsequent follow-up period of 1 year. CONCLUSIONS: When only accompanied by distal nasolacrimal duct obstruction, acquired dacryocystocele can be inferred to be associated with congenital nasolacrimal duct obstruction. Subsequently, bicanalicular silicone intubation can be considered as a treatment of choice.

Lacrimal Silicone Intubation for Anatomically Successful but Functionally Failed External Dacryocystorhinostomy

PURPOSE: To investigate the efficacy of lacrimal silicone intubation for the management of epiphora in patients who have previously undergone anatomically successful dacryocystorhinostomy (DCR). METHODS: The authors recruited 13 patients (4 male, 9 female) who had persistent epiphora after an anatomically successful primary external DCR and conducted lacrimal silicone intubation through the dacryocystorhinostomy site. RESULTS: Mean patient age was 54.2 years (range 42-80) and mean follow-up was 13.8 months (range 6-30). Epiphora was resolved in all 13 patients following silicone intubation. Spontaneous tube extrusion occurred in three patients, but a new one was easily reintubated. CONCLUSIONS: Lacrimal silicone intubation is a simple safe and effective procedure for patients with epiphora even after anatomically successful DCR.

Lacrimal Silicone Intubation for Anatomically Successful but Functionally Failed External Dacryocystorhinostomy

PURPOSE: To investigate the efficacy of lacrimal silicone intubation for the management of epiphora in patients who have previously undergone anatomically successful dacryocystorhinostomy (DCR). METHODS: The authors recruited 13 patients (4 male, 9 female) who had persistent epiphora after an anatomically successful primary external DCR and conducted lacrimal silicone intubation through the dacryocystorhinostomy site. RESULTS: Mean patient age was 54.2 years (range 42-80) and mean follow-up was 13.8 months (range 6-30). Epiphora was resolved in all 13 patients following silicone intubation. Spontaneous tube extrusion occurred in three patients, but a new one was easily reintubated. CONCLUSIONS: Lacrimal silicone intubation is a simple safe and effective procedure for patients with epiphora even after anatomically successful DCR.

Efficacy of Silicone Nasolacrimal Intubation with Mitomycin C Treatmentfor Treatment of Incomplete Nasolacrimal Duct Obstruction

PURPOSE: To investigate the efficacy and safety of adjunctive Mitomycin C (MMC) during silicone intubation (SI) for treatment of acquired incomplete nasolacrimal duct obstruction (NLDO). METHODS: Nineteen eyes with incomplete NLDO underwent SI only (group I). 20 different eyes were administered adjunctive 0.4 mg/ml MMC for 4 minutes (group II). Diagnosis of incomplete NLDO was based upon subjective complaints of tearing, dye disappearance testing, clinical evidence of epiphora, and nasolacrimal duct irrigation. Follow-up examination was conducted at 1, 3, and 6 months. RESULTS: Follow-up ranged from 3 to 15 months (mean, 6.1 months). Twelve (63.1%) eyes in group I and 14 (70.0%) eyes in group II had a successful outcome and remained symptom-free. Four (21.1%) eyes in group I and three (15.0%) eyes in group II showed improvement but still experienced periodic epiphora. The difference was not statistically significant (p=0.873). CONCLUSIONS: SI as a treatment for incomplete NLDO provides complete relief or substantial improvement in a significant percentage of patients but MMC application during SI did not benefit outcome.

Silicone Intubation for Treatment of Punctal Stenosis

PURPOSE: To evaluate the surgical results and complications of silicone intubation in patients with epiphora by punctal stenosis. METHODS: We reviewed the records of 35 eyes of 23 patients who had undergone silicone intubation from 1998 to 2002 and followed more than 1 year postoperatively. RESULTS: Following 1 year postoperatively, 33 eyes (94.3%) showed no epiphora, 2 eyes (5.7%) showed intermittent epiphora. Complications after silicone intubation included prolapse of tube in 3 eyes, punctal slitting in 1 eye, itching in 6 eyes, foreign body sensation in 2 eyes, discharge from punctum in 3 eyes and intranasal discomfort in 1 eye. CONCLUSIONS: Silicone intubation seemed to be an alternative method in patient with epiphora due to punctal stenosis and also a useful method to treat upper and lower punctum.

Systematic, Combined Treatment Approach to Nasolacrimal Duct Obstruction in Different Age Groups

PURPOSE: we studied the clinical outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction (CNDO). METHODS: we analyzed 186 patients (222 eyes) who had been treated for CNDO between January 1996 and December 2000. According to age, conservative treatment, nasolacrimal duct probing and silicone intubation were applied systematically until a successful outcome was achieved. Patients were grouped according to their age at the time of first visit.: Group 1 (0~6 months), Group 2 (7~12 months), Gruop 3 (13~24 months), Group 4 (25~72 months). Treatment efficacy was determined according to age and success rate was compared. RESULTS: Conservative treatment was applied only in children less than 1 year of age and was successful in 75.9% of Group 1 and 47.3% of Group 2. The difference between these two success rates was significant (p=0.0001). The overall success rate for first probing in all groups was 65.2% with a range 75.8% in Group 1, 62.1% in Group 2, 65.0% in Group 3, and 40.0% in Group 4. After second probing, the overall cure rates for the entire cohort were 82.6% with a range 87.9% in Group 1, 89.7% in Group 2, 80.0% in Group 3, and 50.0% in Group 4. There was no real difference in first probing cure rate relative to age (p=0.208). But after second probing, overall cure rate was significantly decreased when the age of the patients was over 12 months (p=0.027). Silicone intubation was performed in 4 of Group 1, 3 of Group 2, 4 of Group 3, and 5 of Group 4 and was successful in all cases. CONCLUSIONS: Systematic treatment approach to CNDO including conservative treatment, nasolacrimal duct probing, and silicone intubation, was highly successful. In this study, the cure rate for this combined approach was 100% in 186 patients (222 eyes).

Monocanalicular Lacrimal Silicone Intubation for the Treatment of Pediatric Lacrimal Duct Obstruction

PURPOSE: To assess the clinical efficacy of monocanalicular lacrimal silicone intubation in the pediatric patients with lacrimal duct obstruction. METHODS: The medical records of 14 children with 14 eyes who underwent this procedure were reviewed retrospectively. RESULTS: Monoka(r) silicone tube was used in 3 eyes and Ritleng Self-threading Monoka(r) tube, in 11 eyes. Postoperatively, epiphora was resolved in all cases between one week and 7 months. Early postoperative extrusion of silicone tube occurred in 3 eyes(21.4%). Corneal erosion in 1 eye(7.1%), and granuloma formation in another eye(7.1%) were noticed but disappeared after removal of tubes. Removal of silicone tube was easily performed postoperatively between 3 and 7 months(mean, 4.6 months) in the clinic without sedation in all cases. CONCLUSIONS: Monocanalicular lacrimal intubation using especially Ritleng Self-threading Monoka(r) silicone tube is an easy technique for intubation and removal, and an effective method for the treatment of pediatric lacrimal duct obstruction.

Silicone Intubation for Functional Nasolacrimal Duct Obstruction

Functional nasolacrimal duct obstruction refers to a situation in which the lacrimal system is patent to syringing in a patient complaining of tearing. From July 1995 to July 1998 we performed silicone tube intubation in 29 eyes of 22 patients with functional obstruction of the lacrimal drainage passages. Seventy-two percent of patients had resistance in the lacrimal passage atprobing and proximal nasolacrimal duct was the most frequent obstruction site.Epiphora has improved in 58.6% (17 eyes)after silicone intubation without any improvement in the remaining.Some even became aggravated. Most patients with functional obstruction had partial obstruction in the lacrimal passage and more than half of them became improved with the sil-So silicone intubation can be considered as an initial procedure prior to dacryocystorhinostomy

Clinical Results of Silicone Intubation for Epiphora Patients

In this study, silicone intubation was performed for punctal stenosis in 26 eyes (group 1), incomplete nasolacrimal duct obstruction in 65 eyes (group 2), and complete nasolacrimal duct obstruction in 62 eyes (group 3).Follow up period was 3~14 months (mean 6 months).After intubation, 22 eyes (84.6%) in group 1, 50 eyes (76.9%)in group 2, and 25 eyes (40.3%)in group 3 showed no epiphora.The success rates based on age were 100%under 10 years, 67.2%between 10 years and 50 years, and 65.4%above 50 years.81.8%in male patients and 58.3%in female patients showed improvement.The most common complication was itching sensation.In summary, silicone intubation can be an alternative to dacryocystorhinostomy in patients who have punctal stenosis and incomplete obstruction of nasolacrimal duct system.

Silicone Tube Intubation in Acquired Nasolacrimal Duct Obstruction

45 eyes of 37 adult patients with nasolacrimal duct[NLD]obstruction were treated with silicone tube intubation. Silicone tube was removed between 1 and 12 months[mean 3.96 months]after surgery. After variable follow-up periods of 3 to 23 months[mean 6.82 months], 57.8%showed no epiphora, 28.9% showed intermittent epiphora and 13.3%showed ersistent epiphora. Complications were minimal and did not affect the outcome. We recommend that silicone intubation can be an alternative to dacryocystorhinostomy in selected adult patients. It is safe and less traumatic procedure with relatively high success rate in partial NLD obstruction and total obstruction with recent onset.

Success Rate of Silicone Tube Intubation

It has been Known that silicone intubation may be an effective procedure for total or partial obstruction in infants of age one year or less, and the older the patient, the lower the success rate. We had performed silicone intubation on 40 eyes of 39 patients from january 1995 to May 1996, and they were divided into 3 groups according to age: group 1, 6 months to 6 years: group 2,6 to 16.: group 3, one 16 years. The success rate was 92.4% in groups 1 and 2, respectively: 83.3% ingroup 3. The success rate in patients with partial obstruction in group 3 was 100% In view of the results of the present study, silicone intubation may be in primary procedure for partial obstruction of lacrimal drainage system.

Clinical Results of silicone Intubation for Nasolacrimal Duct Obstruction in Adult

On this study, silicone intubation was performed for punctal stenois in 10 patients(group 1), incomplete nasolacrimal duct obstruction in 47 patients (group 2), and complete nasolacrimal duct obstruction in 18 patients(group 3) in adults. Silicone tube was removed between 3-6 months(mean 5.7 months) after intubation. Mean follow-up period of 9.5 months, 9 patients(90%)in group 1,39 patients(83%)in group 2,and 8 patients(44%) in group 3 showed no epiphora, and 1 patient(10%)in group 1, 8 patients (17%) in group 2, and 4 patients(22%) in group 3 showed intermittent epiphora. 6 patients(33%) in group 3 showed persistent epiphora. In summary, silicone intubation can be an alternative to dacryocystorhinostomy in selected adult patients who have punctal stenosis and incomplete obstruction of nasolacrimal duct system. It is safe, and less traumatic with high success rate in these patients.

Silicone Intubation in Children with Nasolacrimal Duct Obstruction

When nasolacrimal duct obstruction in children cannot be treated with probing, the fracture of inferior turbinate and/or silicone intubation can be performed, prior to dacryocystorhinostomy So far, there have been many reports and controversies regarding the methods and duration of intubation. The authors report the clinical results of treatment with silicone intubation on the nasolacrimal duct obstruction in children. In seven eyes of seven cases with nasolacrimal duct obstruction, the silcone intubation was performed. In four eyes of four cases, the fracture of infeior turbinate was accompanied by silicone intubation. The ages of the patients ranged from 1 to 9 years, and the duration of intubation ranged from 2 weeks to 5.5 months, averaging 3 months. The follow-up period ranged from 1 to 26 months after the tube removal. In 6 eyes of 6 cases(86%), the symptoms were resolved. The authous recommend that the tube be removed within 3 months after insertion.

Bicanalicular Silicone Intubation of Canalicular Laceration

Thirty cases of lacerated canaliculi were repaired by bicanalicular silicone intubation(Pilling(R) Intubation Set)with use of a silicone sponge for nasal fixation. The results were as follows: Canalicular laceration occurred mainly in males(25 cases), and in young age group(10-39yrs). An isolated inferior canalicular laceration was the most common and occurred in 23 cases. There was no significant difference in laterality between right and left. The average follow up period was 13.8 months and final results were better in patients who were repaired earlier and had a longer intubation time. Postoperative complications occurred in 7 cases and all of them were canalicular slits. Canalicular slits were not related to the duration of intubation and did not affect the final results significantly. The advantages of this operation were good cosmetic results, minimal irritation by tube, and easy removal of tube.