Combination Surgery of Silicone Tube Intubation and Conjunctival Resection in Patients with Epiphora

PURPOSE: To compare the success rates of performing only silicone tube intubation versus carrying out both conjunctival resection and silicone tube intubation. METHODS: The subjects of this study involved 62 patients (96 eyes) between October 2015 and May 2017 who were diagnosed as having punctal stricture or nasolacrimal duct stenosis. Out of 96 eyes, 47 underwent only silicone tube intubation, and 49 underwent both silicone tube intubation and conjunctival resection. Three parameters were measured at 1, 3, and 6 months after the surgery: the area of the tear meniscus using RTVue-100 anterior segment optical coherence tomography, the height of the tear meniscus using a slit lamp microscope, and the subjective satisfaction of patients as a result of improved sympotms like epiphora. The surgery was considered successful when the patients' experienced the resolution of symptoms and reduction of the area and height of the tear meniscus. RESULTS: The area of the tear meniscus, height of the tear meniscus, and subjective satisfaction of patients was superior in the group that underwent both silicone tube intubation and conjunctival resection compared silicone tube intubation only. Based on these results, the success rate of the surgery was 68.9% in the group that underwent only silicone tube intubation and 78.7% in the group that underwent both silicone tube intubation and conjunctival resection. CONCLUSIONS: The resection of relaxed plica semilunares seems to increase the success rate of silicone tube intubation through the reduction of the area and height of the tear meniscus. Therefore, after determining the degree of conjunctivochalasis, if it was found to be severe, a combination with conjunctival resection was expected to increase the success rate of the surgery.

Clinical Efficacy of Lacrimal Endoscopy Assisted Silicone Tube Intubation in Patients with Nasolacrimal Duct Obstruction

PURPOSE: We evaluated the clinical efficacy of lacrimal endoscopy-assisted silicone tube intubation in patients with a nasolacrimal duct obstruction. METHODS: We conducted a retrospective chart review of 86 eyes of 67 patients who underwent lacrimal endoscopy (RUIDO fiberscope; Fibertechco, Tokyo, Japan)-assisted silicone tube intubation from December 2014 to March 2017. We compared clinical characteristics, irrigation test results, and dacryocystographic and lacrimal endoscopic findings, and analyzed factors related to surgical success. RESULTS: In total, 86 eyes of 67 patients underwent lacrimal endoscopy-assisted silicone tube intubation. The success rate was 87.2%. There was a significantly lower preoperative tear meniscus height (420.5 ± 198.1 µm vs. 639.0 ± 224.3 µm, p < 0.001). In the surgically successful group, narrowing was frequently observed (29.0% vs. 0%, p = 0.030). Dacryolith findings were associated with surgical failure (10% vs. 29%, p = 0.043). CONCLUSIONS: Lacrimal endoscopy-assisted silicone tube intubation is considered an effective and successful operative procedure and enables the observation of real-time findings inside the lacrimal drainage passage for the treatment of pathological lesions. Narrowing observed during lacrimal endoscopy indicated successful treatment as opposed to dacryolith findings, which were associated with a failed outcome.

A comparative study of endoscopic silicone tube intubation and conventional blind silicone tube intubation in the treatment of chronic dacryocystitis / 中国耳鼻咽喉头颈外科

OBJECTIVE To compare the costeffectiveness of two surgical approaches:endoscopic silicone tube intubation(ESTI) and conventional blind silicone tube intubation(CBSTI),in the management of chronic dacryocystitis(CDC).METHODS There were 46 cases of CDC from the Third Affiliated Hospital of Sun Yat-sen University from 2014 to 2015.Randomly,22 CDC patients were included in ESTI,24 patients were performed CBSTI.We analyzed both the final success rate,operating time,intraoperative visual analogue scale(VAS) and the rate of post-operative complications,as well as the final therapeutic effect.RESULTS In ESTI group,17 cases were cured,5 cases were improved and 3 cases were invalid.The success rate was 88.00％.Correspondingly for CBSTI group,14 cases were cured,6 eases were improved and 5 cases were invalid,and the success rate was 80.00％.ESTI was better,but there was no significant in success rate between the two groups (x2=0.881,P=0.644).Besides,the operating time and intraoperative VAS score in ESTI group was (10.32±2.30)min and 2.02±0.86,and they were(25.32 ± 4.87)min and 4.11 ± 1.44 in CBSTI group.So ESTI was better than CBSTI(t=-13.918,P=0.000;t=-6.012,P=0.000).ESTI had fewer complications(x2=4.878,P=0.027).CONCLUSION Compared to CBSTI,ESTI is a minimally invasive and highly effective technique for the treatment of CDC.The visualization of nasal endoscopy is the optimization of CBSTI,and this method need to be popularization and application.

Predictors of Silicone Tube Intubation Success in Patients with Lacrimal Drainage System Stenosis

PURPOSE: To evaluate prognostic factors affecting silicone tube intubation outcomes in Asian patients with lacrimal drainage system stenosis. METHODS: A retrospective review was conducted on the medical records of 822 patients (1,118 eyes) who had undergone silicone tube intubation to treat lacrimal drainage system stenosis between January 2011 and December 2012. Patients were divided into two groups: a success group and a failure group. Success was defined as the disappearance of epiphora symptoms, normalization of tear meniscus height, and the easy passage of fluid without resistance on the postoperative syringing test. Patient and ocular parameters were compared between the success and failure groups. RESULTS: A total of 994 eyes of 727 patients were included in analyses. Patients had a mean follow-up period of 34.11 ± 18.70 weeks. Silicone tube intubation was successful in 67.2% of participants. Significant differences between the success and failure groups were found for age (p < 0.001), history of ipsilateral facial palsy (p = 0.028), follow-up period (p < 0.001), and degree of passage on the preoperative syringing test (p = 0.001). Only age (p < 0.001) and degree of passage on the preoperative syringing test (p = 0.002) remained significantly associated with silicone tube intubation success in multivariate analysis. CONCLUSIONS: Age was negatively associated with silicone tube intubation success in patients with lacrimal drainage system stenosis. The success rate was higher in patients who showed easy passage of fluid without resistance on the preoperative syringing test. These factors should be considered by surgeons planning silicone tube intubation in patients with lacrimal drainage system stenosis.

Clinical Effects of Intranasal Steroid Application after Silicone Tube Intubation in Nasolacrimal Duct Obstruction

PURPOSE: To investigate the effects of intranasal steroid spray after silicone tube intubation in nasolacrimal duct obstruction. METHODS: We included 73 patients (73 eyes) who had undergone silicone tube intubation with partial nasolacrimal duct obstruction and who had been followed-up for more than 6 months. We divided them into two groups: Group 1 (37 patients, 37 eyes), who used intranasal steroid spray twice a day for 4 weeks after silicone tube intubation, and Group 2 (36 patients, 36 eyes), who did not use intranasal steroid spray. A retrospective medical record review was performed to analyze the clinical features of epiphora improvement and complications in the two groups. RESULTS: No significant difference was found in epiphora improvement after surgery between the two groups (33 eyes [89.2%] in Group 1, 31 eyes [86.1%] in Group 2) (p = 0.736). In addition, the difference in success rate between the two groups was also not statistically significant (33 eyes [89.2%] in Group 1, 28 eyes [77.8%] in Group 2) (p = 0.221). Group 1 (5/37 [13.5%] eyes) and Group 2 (12/36 [33.3%] eyes) complained of ocular discomfort during the period of silicone tube intubation (p = 0.045). The complication rate of Group 1 (5/37 [13.5%] eyes) was significantly lower than that of Group 2 (13/36 [36.1%] eyes) (p = 0.024). CONCLUSIONS: Silicone tube intubation is an effective treatment option for adults diagnosed with partial nasolacrimal duct obstruction, and postoperative intranasal steroid application may contribute to improvement of ocular symptoms after the surgery. There may be a merit of using intranasal steroid spray for adjuvant therapy to prevent postoperative complications, but it needs further study considering various factors.

The Clinical Outcome of Endoscopic Endonasal Silicone Tube Intubation According to Nasolacrimal Duct Resistance

PURPOSE: To evaluate the clinical result of silicone tube intubation through Hasner's valve according to nasolacrimal duct resistance under intranasal endoscopic guidance in partial acquired nasolacrimal duct obstruction patients. METHODS: The present study enrolled a total of 50 eyes from 31 patients diagnosed with partial acquired nasolacrimal duct obstruction in the Department of Ophthalmology, Chonbuk National University Hospital from 2012 January to 2012 December. Silicone tube intubation was done through the Hasner's valve and confirmed by intranasal endoscopy and the nasolacrimal duct resistance was measured. Success was defined as the disappearance of epiphora, and failure was defined as the maintenance of epiphora after silicone tube intubation. RESULTS: There were 8 male patients and 23 female patients, ages between 32 to 80 and the average age was 61.4 years old. 3 eyes of 3 patients (6%) had no resistance, 26 eyes of 17 patients (52%) had mild resistance, 17 eyes of 15 patients (34%) had moderate resistance and 4 eyes of 3 patients (8%) had severe resistance. The success was 44 eyes (88%) and the failure was 6 eyes (12%). In the no resistance and mild resistance groups the success rates were both 100%, while an 82% of success rate in the moderate resistance group and 25% success rate in the severe resistance group were observed. The success rates showed clear distinction between severe, moderate and mild resistance patients. CONCLUSIONS: Ensuring the passage of a silicone tube through Hasner's valve increases the success rate in the functional aspect; however, the resistance of the nasolacrimal duct can highly influence the success rate. Therefore, if a patient has severe nasolacrimal duct resistance, dacryocystorhinostomy should be considered earlier.

Clinical Outcomes of Probing in Children with Congenital Nasolacrimal Duct Obstruction

PURPOSE: To determine the success rate of probing for the treatment of congenital nasolacrimal duct obstruction and to identify the clinical factors affecting the success rates. METHODS: The records of probing procedures from January 2005 to January 2015 were reviewed. The present study included 200 eyes of 174 patients with congenital nasolacrimal duct obstruction. Successful probing was defined as complete resolution of epiphora 3 months after treatment. Success rates were compared between the 2 groups in terms of sex, age, laterality, and previous probing. RESULTS: A total of 200 eyes of 174 children (109 eyes of 94 males and 91 eyes of 80 females; mean age, 7.51 ± 3.39 months) had undergone the probing procedure. The overall success rates of primary probing were 81.5%, with an 80.7% success rate in males (88 eyes of 109 eyes) and 82.5% in females (75 eyes of 91 eyes). Success rates were 83.5% for the 91 eyes in children aged 0 to 6 months, 80.0% for the 90 eyes in children 6 to 12 months, and 78.9% for the 19 eyes in children over 12 months. No statistical significances were found among age groups. The probability of treatment success was lower in bilateral disease (p < 0.05; 86.4-67.3%). Twenty-four of 37 eyes with unsuccessful primary probing underwent secondary probing, resulting in a 70.8% success rate. Silicone tube insertion was performed in 4 eyes repeatedly, however, the procedures were unsuccessful. The overall success rate was 90%. CONCLUSIONS: The success rates among various age groups were not statistically significant. The probability of treatment success was lower in bilateral cases. Probing is an effective first-line treatment in children diagnosed with nasolacrimal duct obstruction. Close observation and appropriate treatment should be considered in patients with bilateral disease.

Clinical Outcomes of Probing in Children with Congenital Nasolacrimal Duct Obstruction

PURPOSE: To determine the success rate of probing for the treatment of congenital nasolacrimal duct obstruction and to identify the clinical factors affecting the success rates. METHODS: The records of probing procedures from January 2005 to January 2015 were reviewed. The present study included 200 eyes of 174 patients with congenital nasolacrimal duct obstruction. Successful probing was defined as complete resolution of epiphora 3 months after treatment. Success rates were compared between the 2 groups in terms of sex, age, laterality, and previous probing. RESULTS: A total of 200 eyes of 174 children (109 eyes of 94 males and 91 eyes of 80 females; mean age, 7.51 ± 3.39 months) had undergone the probing procedure. The overall success rates of primary probing were 81.5%, with an 80.7% success rate in males (88 eyes of 109 eyes) and 82.5% in females (75 eyes of 91 eyes). Success rates were 83.5% for the 91 eyes in children aged 0 to 6 months, 80.0% for the 90 eyes in children 6 to 12 months, and 78.9% for the 19 eyes in children over 12 months. No statistical significances were found among age groups. The probability of treatment success was lower in bilateral disease (p < 0.05; 86.4-67.3%). Twenty-four of 37 eyes with unsuccessful primary probing underwent secondary probing, resulting in a 70.8% success rate. Silicone tube insertion was performed in 4 eyes repeatedly, however, the procedures were unsuccessful. The overall success rate was 90%. CONCLUSIONS: The success rates among various age groups were not statistically significant. The probability of treatment success was lower in bilateral cases. Probing is an effective first-line treatment in children diagnosed with nasolacrimal duct obstruction. Close observation and appropriate treatment should be considered in patients with bilateral disease.

Surgical Outcomes of Endonasal Revision Surgery for Failed DCR According to Number of Silicone Tubes

PURPOSE: To evaluate the causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted endonasal revision surgery according to the number of silicone tubes. METHODS: Sixty-seven patients (70 eyes) who underwent revision surgery using transcanalicular diode laser for failed primary endonasal DCR at Sungmo Eye Hospital between March 2007 and December 2012 were studied retrospectively. The causes of failed DCR and the time of recurrence were evaluated. The revision surgeries were endoscopic removal of granuloma and membrane and synechiolysis with intubation of 1 or 2 silicone tubes. We compared the results of revision surgery with 1 silicone tube and 2 silicone tube intubations. RESULTS: Recurrence occurred after a mean duration of 4.6 months following the first DCR. The causes of surgical failure were granuloma (35 eyes), membranous obstruction (23 eyes), synechia (7 eyes), and functional obstruction (5 eyes). We performed revision surgery with 1 silicone tube intubation in 45 eyes (group A) and 2 silicone tube intubations in 25 eyes (group B). The final success rates in groups A and B were 75.6% (34/45) and 84% (21/25), respectively (chi-square test, p = 0.828). CONCLUSIONS: Transcanalicular diode laser-assisted endonasal revision surgery with 2 silicone tubes is not recommended.

Results of Silicone Tube Intubation in Patients with Common Canalicular Obstruction in Dacryocystography

PURPOSE: To evaluate the effects of silicone tube intubation in patients showing common canalicular obstruction in dacryocystography. METHODS: We conducted a retrospective chart review of 136 eyes of 93 patients who underwent silicone tube intubation and who were followed for more than 6 months. The patients were divided into 2 groups: the normal canaliculus group (112 eyes of 72 patients) and the common canalicular obstruction group (24 eyes of 21 patients). The demographic characteristics, degree of nasolacrimal duct obstruction on probing, and functional and anatomical success rates of silicone tube intubation were compared between the two groups. Surgery success was noted when the patient was satisfied with the 'improved' tearing symptom and the tear meniscus height decreased. RESULTS: On probing, 17 (70.8%) of 27 eyes revealed definite obstructive feeling at nasolacrimal duct in the common canalicular obstruction group, and there was no significant difference compared to the normal canaliculus group (p = 0.639). The anatomical success rate of silicone tube intubation was 91.1% in the normal canaliculus group and 83.3% in the common canalicular obstruction group, and the functional success rate was 85.7% in the normal canaliculus group and 75.0% in the common canalicular obstruction group. There were no significant differences in success rates between the two groups (p = 0.271, p = 0.161, respectively). CONCLUSIONS: Silicone tube intubation can be considered as a primary treatment option for management of common canalicular obstruction.

Comparison Results of Silicone Tube Intubation According to Syringing and Dacryocystography

PURPOSE: To compare the surgical success rate of silicone tube intubation according to the preoperative lacrimal syringing test and dacryocystography (DCG) in adult patients with epiphora. METHODS: Medical records of 142 patients who underwent silicone tube intubation were retrospectively reviewed. The surgical results were divided into 3 groups based on postoperative symptoms and the syringing test results: Good, Fair, and Fail. Good and Fair were classified into the surgical success groups. We compared the surgical success rate according to the preoperative syringing test and stenosis site observed on dacryocystography. RESULTS: The success rates of silicone tube intubation were 88.4% and 87.4% in eyes with preoperative syringing results of totally-passed and partially-passed syringing tests, respectively, revealing no statistically significant differences (p = 0.838, chi-square test). However, in eyes with the preoperative syringing results of partially-passed syringing tests, the success rates were 66.7% in patients with canalicular stenosis, 83.3% in patients with nasolacrimal duct stenosis, and 94.5% in those with diffuse stenosis (p = 0.018, chi-square test). CONCLUSIONS: No significant differences were found in the success rates of silicone tube intubation according to preoperative syringing test results. However, when considered together with DCG findings, the lowest success rate was found in eyes with the partially-passed syringing test and simultaneously showed canalicular stenosis on DCG. The syringing test results considered with DCG findings may help predict the success rates of silicone tube intubation.

Results of Cultured Silicone Tubes Inserted in Congenital Nasolacrimal Duct Obstruction

PURPOSE: We evaluated cultured specimens from silicone tubes removed from patients with congenital nasolacrimal duct obstruction and determined the antibiotic sensitivities of the specimens. METHODS: This study included 26 eyes of 22 patients who had received endonasal silicone tube intubation for congenital nasolacrimal duct obstruction. The removed silicone tubes were divided into canaliculus, lacrimal sac, nasolacrimal duct and nasal cavity parts according to insertion state. Then, bacteria and fungus cultures were performed and their antibiotic sensitivity was tested. RESULTS: Bacteria culture rate was 80.8% in the canaliculus and the lacrimal sac, and 88.5% in the lacrimal duct, and the nasal cavity, which was not significantly different according to insertion site. Fungus culture rate was significantly higher in the nasal cavity than in the nasolacrimal duct and in the nasolacrimal duct than in the lacrimal sac and the canaliculus (p-value < 0.05). The species of cultured Gram-positive bacteria were in the following order: Staphylococcus aureus, Streptococcus pneumonia and coagulase negative Staphylococcus. Common species of cultured Gram-negative bacteria were Pseudomonas and Serratia marcescens. All six species of cultured fungi were Candida. Among 12 Staphylococcus aureus cultured, eight species showed resistance to methicillin (MRSA). In all patients, the symptoms and the signs of nasolacrimal duct obstruction improved after the tube removal. CONCLUSIONS: Bacterial and fungal infection of the silicone tube in patients with congenital nasolacrimal duct obstruction does not appear to affect directly the outcome of silicone tube intubation. Further studies of bacterium and fungi in the nasolacrimal duct before silicone tube intubation are needed for determining the infection causing nasolacrimal duct obstruction.

Success Rate of Silicone Intubation Between Nasolacrimal Duct Obstruction and Stenosis According to Dacryocystography

PURPOSE: This study compares the success rate of silicone tube intubation between nasolacrimal duct obstruction and stenosis according to dacryocystographic findings. METHODS: A total of 115 patients who suffered from epiphora were divided into nasolacrimal duct obstruction and nasolacrimal duct stenosis according to dacryocystographic findings. Silicone tube intubation was performed on every patient. The success rate was estimated based on functional and anatomical success. Functional success was estimated by patient's satisfaction with 'good' or 'fair' at the last visit, and anatomical success was estimated by decrease or normalization of tear meniscus height. Surgery success was defined when anatomical and functional successes were fulfilled. RESULTS: Success rate of silicone tube intubation was 75.76% for patients with nasolacrimal duct obstruction based on dacryocystography, and 86.59% for patients with nasolacrimal duct stenosis based on dacryocystography; the difference was not statistically significant (Pearson chi-square test, p = 0.693). CONCLUSIONS: Silicone tube intubation can be considered as a primary treatment option for management of epiphora in nasolacrimal duct stenosis and obstruction.

Long-Term Results of Silicone Tube Intubation in Patients with Common Canalicular Stenosis

PURPOSE: To evaluate the clinical effects of silicone tube intubation in patients with epiphora and a narrow common canaliculus. METHODS: We conducted a retrospective chart review of 107 patients (169 eyes) who underwent silicone tube intubation for treatment of canaliculus between August 2008 and August 2010 and who were followed for more than 12 months. The patients were divided into 3 groups: patients with canalicular stenosis (A), patients with common canalicular stenosis (B), and patients with nasolacrimal duct stenosis (C). Successful treatment was defined as attainment of the predefined requisites, which included improvements in the clinical symptoms following surgery, an adequate passage of tears resulting from post-operative probing and syringing, and continued improvement to the time of the patients' final follow-up visit. In contrast, surgical failure was defined as the lack of post-operative symptom improvement, and recurrence was defined as the appearance of epiphora following the silicone tube extubation. RESULTS: The average follow-up duration for the entire group of patients was 30.5 months. The success rates of Group A, Group B, and Group C were 66%, 75.4%, and 56.3%, respectively, demonstrating that Group B attained the highest success rate. These success rates are similar to rates resulting from other types of surgery such as canaliculodacryocystorhinostomy. CONCLUSIONS: Silicone tube intubation can be considered a relatively simple and effective surgical technology for the long-term treatment of patients with a narrow common canaliculus.

The Clinical Outcome of Endoscopic Silicone Tube Intubation for Congenital Nasolacrimal Duct Obstruction

PURPOSE: To evaluate the surgical results and clinical effectiveness of silicone tube intubation through Hasner's valve under intranasal endoscopic guidance in children with congenital nasolacrimal duct obstruction (CNDO). METHODS: The present study enrolled a total of 58 eyes of 46 children over 12 months of age diagnosed with CNDO in the Department of Ophthalmology, Inje University College of Medicine from 2003 to 2010. Patients who had previously undergone ineffective probing or had a combination of an anatomical abnormality such as secondary nasolacrimal duct obstruction were also included. The silicone tube was intubated through the Hasner's valve and observed with intranasal endoscopy; tube retention time was planned for at least 12 weeks. RESULTS: A total of 20 eyes were previously probed preoperatively (mean 1.7 times). After the average follow-up period of 13.5 months, the overall success of silicone intubation was 57 of 58 eyes (98%). In one failed eye, nasolacrimal obstruction was already combined preoperatively, and unintentional tube removal by the patient occurred within one week. Silicone tube reintubation was performed after four months, and CNDO symptoms improved. CONCLUSIONS: Intranasal endoscopic observation to ensure the passage of a silicone tube through Hasner's valve decreases anatomical injury. When considering patient age and former treatment, silicone tube intubation with intranasal endoscopic observation could produce desirable results with a higher success rate.

The Effectiveness of Lacrimal Trephination for the Treatment of Canalicular Obstruction

PURPOSE: To determine the effectiveness of lacrimal trephination to treat canalicular obstruction. METHODS: Silicone intubation following lacrimal trephination was performed in 38 eyes of 29 patients with epiphora due to canalicular obstruction between December 2005 and October 2009. Medical records were retrospectively reviewed and telephone interviews were performed. The severity of epiphora was graded by Munk's scale, and anatomical improvement was evaluated by postoperative probing and syringing. RESULTS: The procedure was successful in 73.7% of the cases (grade 0 or 1), and 68.4% of the eyes had complete resolution of epiphora (grade 0). The anatomical success rate was 81.6%. CONCLUSIONS: Lacrimal trephination is a simple and effective treatment for canalicular obstructions. Therefore, lacrimal trephination could be performed prior to attempting an invasive conjunctivodacryocystorhinostomy.

Comparison of Dacryocystographic Results Before and After Silicone Intubation in Incomplete Nasolacrimal Duct Obstruction

PURPOSE: To compare the dacryocystographic results before and after silicone tube intubation in partial nasolacrimal duct obstruction. METHODS: Dacryocystography was performed on 33 eyes of 17 patients diagnosed with partial nasolacrimal duct obstruction. The anteroposterior (AP) diameters and the mediolateral diameters of the nasolacrimal ducts intubated at the operation were measured by dacryocystography, before the operation and after silicone tube removal. RESULTS: The mean AP, mediolateral diameter and length of nasolacrimal duct in the group who demonstrated improvement after the operation was 2.32 mm, 1.39 mm, and 17.14 mm before the operation, and 2.40 mm, 1.77 mm, and 17.38 mm after the operation, respectively. The mean AP, mediolateral diameter and length of nasolacrimal duct in the group who demonstrated no symptomatic improvement was 2.06 mm, 1.28 mm, and 17.42 mm before the operation, and 2.75 mm, 1.99 mm, and 18.03 mm after the operation, respectively. The alteration of the nasolacrimal duct size in the group with successful postoperative results compared with unsuccessful postoperative results showed no significant difference. CONCLUSIONS: The nasolacrimal duct showed expansion in size based on dacryocystographic results after silicone tube intubation in partial nasolacrimal duct obstruction. However, the operation results and the alteration of the nasolacrimal duct size based on dacryocystographic results demonstrated no accordance.

Factors Affecting the Long-term Outcome of Silicone Tube Intubation in Patients With Nasolacrimal Duct Obstruction

PURPOSE: To evaluate factors affecting the outcome of silicone tube intubation in patients with nasolacrimal duct obstruction. METHODS: A retrospective study of the outcome of silicone tube intubation performed from August 2001 to August 2009 in 98 patients (132 eyes) with nasolacrimal duct obstruction was conducted. Improvement was defined as the disappearance of epiphora after silicone tube intubation and success was defined as maintenance of improvement by the time of the final patient follow-up. Recurrence was also defined as appearance of epiphora after silicone tube extubation. RESULTS: The success rate was 76.5% (101 eyes), failure rate was 8.3% (11 eyes), and recurrence rate was 15.2% (20 eyes). Preoperative canaliculus irrigation test was significantly correlated with symptomatic improvement and recurrence after silicone tube intubation (p = 0.003 and 0.045, respectively). The mean time that patients experienced recurrence was 43.7 months after silicone tube intubation, according to Kaplan-Meier survival analysis. CONCLUSIONS: Preoperative canaliculus irrigation test is a simple and effective tool to estimate the outcome of silicone tube intubation. This outcome should be considered in the stage of planning treatment in nasolacrimal duct obstruction patients.

Lateral Tarsal Strip Procedure and Silicone Tube Intubation on the Functional Nasolacrimal Duct Obstruction

PURPOSE: To compare the effects of the lateral tarsal strip procedure alone and the lateral tarsal strip procedure combined with silicone tube intubation in the treatment of functional lacrimal duct obstruction. METHODS: The present study investigated 27 eyes of 20 patients underwent lateral tarsal strip procedure (LTS) alone and 29 eyes of 18 patients underwent combined lateral tarsal strip procedure and silicone tube intubation and who were diagnosed with functional lacrimal duct obstruction. The authors retrospectively reviewed patients' medical records for information including age, gender, history, follow-up period, tear meniscus height (TMH), and symptoms. RESULTS: The average age of the LTS alone group was 60.3 years, and that of the combined groups was 65.9 years. The TMHs in the LTS only and combined operation groups were 0.62 +/- 0.23 mm and 0.62 +/- 0.19 mm before the operation and 0.43 +/- 0.20 mm and 0.26 +/- 0.09 mm after the operation, respectively. The postoperative improvement in epiphora was 74.1% after the LTS alone and 86.2% after combined LTS with silicone tube intubation. The postoperative improvement in epiphora and the operative technique of the lateral tarsal strip-canthus sparing or cantholysis were not relevant. CONCLUSIONS: Lateral tarsal strip combined with silicone tube intubation appeared useful in the treatment of epiphora patients without anatomic lacrimal duct obstruction. Determining which operative technique of lateral tarsal strip procedure should be chosen is difficult, and the preoperative syringing and snap back test may be helpful.

Clinical Characteristics and Treatment of Congenital Nasolacrimal Duct Obstruction

PURPOSE: A comparison analysis of the clinical characteristics and treatment results of congenital NLD obstruction. METHODS: The present study involved 216 pediatric patients (258 eyes) diagnosed with and treated for congenital NLD obstruction. Treatment was applied step by step starting with conservative massaging, lacrimal probing, and silicone tube intubation. RESULTS: The treatment results of congenital NLD obstruction in pediatric patients under 12 months of age showed an 87.3% success rate after an average of 4.3 months of treatment in the group using lacrimal sac massage and antibiotic eye drops (conservative treatment). The group treated by correct massaging techniques showed a 93.6% success rate after an average of 3.8 months of treatment. The success rate of lacrimal probing, applied to patients not showing improvement after massage therapy was 77.8%. Pediatric patients not showing improvement after lacrimal probing underwent silicone tube intubation. All patients showed improvement except in 1 case that had an early silicone tube dislocation. DISCUSSION: A step-by-step approach is effective in treating congenital NLD obstruction patients, and correct lacrimal massage techniques improve the success rate during conservative therapy. The period of conservative treatment and number of probing times did not have a statistically significant correlation with the success rate of lacrimal silicone tube intubation. Silicone tube intubation showed a high success rate in patients sustaining the silicone tube for a minimum of 2.1 months.