Clinicopathologic findings after nasolacrimal polyurethane stent implantations

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantations for the treatment of primary acquired nasolacrimal duct obstruction, and to determine the effects of various surgical procedures, including stent removal, in subsequent nasolacrimal duct obstruction. METHODS: This study included 15 patients who had nasolacrimal polyurethane implantations for the treatment of primary acquired nasolacrimal duct obstruction. Occluded stents were removed either by nasal endoscopy or during dacryocystorhinostomy (DCR). Cultures and biopsies were performed on the removed stents, and the results of the secondary DCR were analyzed for a 6-month follow-up period. RESULTS: During stent removal surgery, various degrees of chronic inflammatory reaction and fibrous tissue formation were detected in the lacrimal sac and nasolacrimal duct. Formations of granuloma and fibrous tissue were found in 15 eyes, and culture-positive reaction were found in nine of the 15 eyes. Conventional dacryocystorhinostomy surgery was performed in nine of the 15 eyes and a silicone tube was located at the canaliculi. Subjective and objective outcome were favorable in 13 of the 15 eyes. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low. This may result from a chronic inflammatory reaction. Despite the low success rate of nasolacrimal polyurethane stent implantation, the success rate of endonasal DCR as a subsequent surgery is favorable.     

Balloon catheter dilation for treatment of persistent nasolacrimal duct obstruction

PURPOSE: To report the outcome of balloon catheter dilation of the lacrimal duct for treatment of children with persistent nasolacrimal duct obstruction after previous surgery. DESIGN: Interventional case series. METHODS: Thirty-two consecutive children with a history of persistent nasolacrimal duct obstruction following previous surgery were treated with nasolacrimal duct probing with balloon catheter dilation of the distal nasolacrimal duct. Patients were excluded from this study if they had a history of facial trauma, systemic disorders that involved the lacrimal system, or nasolacrimal duct cysts. Outcomes were considered excellent if the patient had complete symptomatic resolution of epiphora and dacryocystitis and normal tear drainage on examination, good if the patient had only minimal residual symptoms or a minimally delayed dye disappearance test, fair if the patient had moderate residual symptoms or delayed tear drainage, and poor if there was no improvement. RESULTS: Thirty-two children (20 with bilateral nasolacrimal duct obstruction and 12 with unilateral nasolacrimal duct obstruction) underwent balloon catheter dilation. Overall results were excellent in 9 (28%) patients, good in 15 (47%) patients, fair in 7 (22%) patients, and poor in 1 (3%) patient. Seven patients had undergone more than one previous procedure. Of these patients, 3 had excellent outcomes, 2 had good outcomes, 1 had a fair outcome, and 1 had a poor outcome following balloon catheter dilation. CONCLUSIONS: Balloon catheter dilation is a safe and generally effective treatment for children with persistent symptoms of nasolacrimal duct obstruction following previous surgery.     

Nasolacrimal duct obstruction in children: outcome of intubation.

BACKGROUND: Nasolacrimal silicone intubation is a treatment for congenital nasolacrimal duct obstruction (NLDO) after failed probing and irrigation. Functional outcome has been previously reported as poorer in children with Down syndrome. METHOD: The outcome of 122 cases of silicone bicanalicular nasolacrimal intubation, performed between 1988 and 2002 on 97 children aged 11 months to 9.5 years, was retrospectively reviewed. In all children, intubation was performed under direct vision using nasal endoscopy. Statistical analysis, including multiple logistic regression analysis, was used to assess the effects of duration of intubation, and age at surgery, on treatment outcome, and to determine potential predictors of treatment failure. RESULTS: The overall success rate was 85%, with 89% success for eyes in children with Down syndrome and 85% success for eyes in children without Down syndrome. Success rates were consistently high (83% to 100%) for children who underwent surgery between 1 and 4 years of age. The average duration of intubation was 5.5 months. Increasing duration of intubation was not associated with increasing chance of success, but with a significantly higher risk of failure if greater than 18 months (P = 0.03). Retention of stents for longer than 12 months was associated with a significantly lower success rate (67%). The presence of Down syndrome, increasing age at surgery, or gender were not predictive factors for treatment failure. Unplanned removal of tubes because of dislodgement was the most common complication, occurring in 25% of eyes, but did not affect functional outcome. CONCLUSIONS: Nasolacrimal silicone intubation, under direct nasal endoscopic visualization, is a consistently successful procedure for the treatment of NLDO among children aged older than 12 months of age. Tubing should be left in place for a maximum of 12 months because the success rate declines after this period and the risk of failure is significantly increased after 18 months of intubation. Prematurely dislodged tubes need not be replaced unless symptoms of nasolacrimal obstruction occur, because this does not lead to an increased risk of treatment failure.     

鼻泪管支架植入治疗鼻泪管阻塞的疗效观察

目的探讨鼻泪管支架留置时间长短与临床疗效的关系。方法鼻泪管阻塞90例（90眼）随机分为两组,A组鼻泪管支架植入术后2个月拔管,B组12个月拔管,分别随访1a观察其复发率。同时观察两组在鼻泪管支架植入时期的临床表现。结果 A组38例（38眼）,拔管后1a内有16眼复发,（42.l0%）。B组52例（52眼）拔管后1a内有8眼复发（15.38%）。两组复发率差异有统计学意义χ^2=4.85,P〈0.05。两组在鼻泪管支架植入时期治愈率92.33%。结论鼻泪管支架植入治疗鼻泪管阻塞效果良好,而在鼻泪管支架植入期间临床治愈率最高。因此鼻泪管支架长期植入是治疗泪道狭窄的有效方法。     

Nonendoscopic endonasal dacryocystorhinostomy: Outcome in 134 eyes

Aims:To evaluate the outcome of nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR) in patients with nasolacrimal duct obstruction (NLDO) in India.Methods:Retrospective case series of NEN-DCR between July 2012 and October 2014. All patients had follow-up >3 months. Success was defined anatomically as patency on irrigation and functionally as relief from epiphora.Results:A total of 122 patients (134 eyes; 81 female; mean age 37 ± 18 years) were included. Indications were primary acquired NLDO in 92 (68%) eyes of adults (>18 years), NLDO in children (<18 years) in 22 eyes (16%), acute dacryocystitis in 13 eyes, failed prior DCR in six eyes, and secondary acquired NLDO in one eye. Mean duration of surgery was 36 min (range: 16–92). At a median follow-up of 6 months (range: 3–15), 86% eyes had functional success and 85% had anatomical success. Revision NEN-DCR was successful in 13/16 eyes. All patients with acute dacryocystitis were completely symptom-free at final visit. In children, (17/22) 77% achieved functional success after primary NEN-DCR which improved to 100% after one revision. Tube-related epiphora and granuloma in ten eyes resolved after removal.Conclusion:NEN-DCR gives good outcome in primary NLDO and is also effective in those with acute dacryocystitis and in children with NLDO. The technique obviates the need for an endoscope and has an acceptable safety profile and thus may be particularly suited for the developing nations.     

The use of prophylactic Nunchaku stents to reduce the risk of nasolacrimal duct obstruction in patients with midfacial tumours undergoing radiotherapy

The treatment of midfacial tumours with radiotherapy, chemotherapy and radio-iodine can cause nasolacrimal duct fibrosis resulting in epiphora. Nasolacrimal patency can be maintained by stenting. We report our experience of prophylatic Nunchaku stent insertion in 5 patients prior to midfacial radiotherapy. Four out of 5 patients (80%) had patent nasolacrimal ducts without any symptoms of epiphora following removal of the stents. One patient was initially asymptomatic with patent nasolacrimal duct, but subsequently developed epiphora. Nunchaku stents may provide a simple and effective way of preventing epiphora, obviate the need for nasal retrieval that is required for other nasolacrimal stents, and reduce the risk of requiring further lacrimal surgery.     

鼻泪管内置入自制硅胶管支架治疗鼻泪管阻塞

目的观察鼻泪管内置入自制硅胶管支架治疗鼻泪管阻塞的疗效。方法对42例(47眼)因鼻泪管阻塞而致严重溢泪伴或不伴溢脓者施行鼻泪管内一端呈伞状硅胶管的置入手术。术前造影以了解泪囊的大小和阻塞的部位,以选择最佳手术适应证。以完全解决或最大程度地改善溢泪症状且泪道冲洗通畅为手术成功的标准。结果所有患者术中均成功地置入硅胶管,手术时间平均为20.51分钟。术后溢泪症状立即改善,泪道冲洗均通畅。观察8个月和15个月时治愈率分别为100.00%和89.36%。结论鼻泪管内置入硅胶管术是一种简单、安全、有效的治疗鼻泪管阻塞的方法,且对局部解剖结构影响较小。     

泪道激光联合新型泪道支架植入治疗鼻泪管阻塞

目的：探讨Nd:YAG激光联合新型泪道支架植入治疗鼻泪管阻塞的疗效。 方法：鼻泪管阻塞者26例29眼在激光泪道疏通后,植入新型泪道支架。术后定期冲洗泪道。 结果：随访9～12mo,治愈22眼,好转5眼,总有效率93％。无效2眼（7％）。 结论：泪道激光联合新型泪道支架治疗鼻泪管阻塞操作安全简便,对组织损伤小,是治疗鼻泪管阻塞、慢性泪囊炎的有效方法。     

鼻泪管支架植入术治疗鼻泪管阻塞性疾病的临床观察

目的:观察鼻泪管支架植入术治疗鼻泪管阻塞性疾病的临床疗效。方法:对76例92眼鼻泪管阻塞性疾病患者行鼻泪管支架植入术,术后随访1～21mo,观察其疗效。结果:对76例92眼行鼻泪管支架植入术,成功植入支架86眼,支架植入率为93%;术后显效74眼,显效率86%,有效12眼,有效率14%。结论:鼻泪管支架植入术是一种简单、安全及有效治疗鼻泪管阻塞性疾病的新方法。     

Ritleng 泪道插管术治疗结膜炎导致的儿童继发性泪道阻塞疗效观察

目的：探讨 Ritleng 泪道插管术治疗儿童结膜炎继发泪道阻塞的疗效。方法回顾性分析因结膜炎导致继发性泪道阻塞的患儿39例（42只眼）。所有患儿均行 Ritleng 泪道插管术,术后3-6个月拔管,并在拔管后1个月进行随访。以泪道冲洗和 DDT 检查结果最终确定其术后效果。结果患儿39例（42眼）成功置管,拔管后30眼治愈（71％）：泪道冲洗通畅,无流泪症状,DDT 试验阴性;4眼（10％）好转：患儿偶有流泪症状,泪道冲洗存在阻力,DDT 可疑阳性;8眼（19％）无效：拔管后,冲洗泪道不通畅,仍有分泌物、有流泪症状。DDT 阳性。所有患儿42只眼中,共14眼单纯性阻塞,包括4眼为泪小点闭锁;泪小管阻塞为6眼;鼻泪管阻塞有4眼。单纯性阻塞中12眼治愈;1眼好转、1眼无效;共28眼复杂性阻塞,其中18眼治愈,3眼好转,7眼无效。结论对于结膜炎引起的儿童泪道阻塞,Ritleng 泪道插管术存在一定效果,通过该手术可以减少由于未及时手术治疗而出现的不利因素,提高手术成功率。     

Efficacy of dye disappearance test and tear meniscus height in diagnosis and postoperative assessment of nasolacrimal duct obstruction

Objective: To evaluate the efficacy of the fluorescein dye disappearance test (FDDT) and measurement of tear meniscus height (TMH) in the diagnosis and postoperative assessment of nasolacrimal duct obstruction (NLDO). Methods: The study group included 42 eyes of 42 patients who had a diagnosis of primary acquired nasolacrimal duct obstruction (PANDO) or functional nasolacrimal duct obstruction (FNDO) and underwent endoscopic transnasal dacryocystorhinostomy. The control group included 38 eyes of 38 people without tearing. The values of the FDDT, TMH and tearing symptom score (TSS), which was evaluated in five levels based on patients’ history taking, were measured before surgery, and 1 day, 2 weeks, 1, 3 and 6 months after surgery. The values of the FDDT, TMH and TSS in the study group were compared with those of the control group. Results: The preoperative values of the FDDT, TMH and TSS were 0.7 ± 0.4, 0.22 ± 0.08 mm and 1.6, respectively, in the control group and 3.0 ± 0.8, 0.53 ± 0.15 mm and 4.4, respectively, in the study group. These differences were statistically significant. Also, at each follow‐up, the postoperative values of the FDDT and TMH decreased significantly compared to their preoperative values in the study group. The postoperative TSS decreased significantly compared to the preoperative values at each follow‐up except at postoperative 1‐day follow‐up. There were no significant differences in the preoperative values of the FDDT, TMH and TSS between the types of NLDO. The TSS had positive correlations with the FDDT and TMH before and after surgery. Conclusion: These results suggest that the FDDT and TMH measurement might be effective in the diagnosis and postoperative assessment of NLDO.     

Oral and topical antibiotic therapy of complete, primary acquired nasolacrimal duct obstruction in adults.

PURPOSE: To determine whether patients with complete, acquired nasolacrimal duct obstruction may be treated with broad spectrum oral antibiotics and office lacrimal irrigation. METHODS: In a retrospective review, patients with complete, primary acquired nasolacrimal duct obstruction (NLDO) were divided by predominant symptoms and signs into two main groups: (a) those with tearing and/or mucous discharge and (b) those with previous acute dacryocystitis and/or lacrimal sac mucocele. All patients received a therapeutic trial of oral and topical antibiotics followed by lacrimal irrigation. RESULTS: Five of 55 patients with tearing and/or mucous discharge showed significant improvement after treatment with a mean follow-up of 16.5 months. A sixth patient with mucous and tearing had resolution of the mucous discharge but persistent tearing and blockage of the nasolacrimal system to irrigation. Two of 20 patients with lacrimal sac mucocele or history of acute dacryocystitis avoided surgery while 18 opted for early lacrimal surgical intervention. CONCLUSIONS: Conservative management of complete acquired NLDO consisting of oral and topical antibiotics and appropriately timed office lacrimal drainage system irrigation may be considered in selected patients.     

Effect of short-duration silicone intubation in congenital nasolacrimal duct obstruction

PURPOSE: To determine the incidence of premature dislocation of silicone tubes used in the treatment of congenital nasolacrimal duct obstruction and investigate the effect of early dislocation on treatment outcome. METHODS: This retrospective review of 227 cases of silicone intubation in the treatment of 151 patients with congenital nasolacrimal duct obstruction. Specific attention was given to premature tube displacement, persistent epiphora, and the need for reoperation. The effect of the duration of silicone intubation and patient age on surgical outcome was assessed. Significance was determined using a Mantel-Haenszel chi-square test. RESULTS: Tube displacement and removal prior to postoperative day 31 occurred in 93 of 227 (41%) of eyes. Four of 24 eyes (17%) in children younger than 12 months who had premature dislocation of silicone tubes compared with 7 of 40 eyes (18%) that maintained silicone tubes for 31 days or greater had persistent epiphora (p = 0.932); in eyes of children from age 12 months to 23 months, 5 of 46 (11%) had persistent epiphora compared with 6 of 78 (8%) (p = 0.549); and in children age 24 months or older, 9 of 23 (39%) eyes had tearing compared with 3 of 16 (19%) (p = 0.181). Reoperation rates were 1 of 24 (4%) compared with 0 of 40 (0%) (p = 0.23) of eyes in children younger than 12 months; no difference between groups (0%) in children from age 12 months to 23 months; and 5 of 23 (22%) versus 0 of 16 (0%) (p = 0.049) of eyes in children age 24 months or older for early tube removal versus standard tube removal, respectively. CONCLUSION: Premature tube displacement and tube removal prior to day 31 does not increase the risk of persistent epiphora or reoperation in children younger than 24 months. Children older than 24 months who have early tube removal have poorer outcomes with a significantly higher reoperation rate.     

Lacrimal drainage obstruction and dacryocystorhinostomy in children

PURPOSE: To determine the outcome of dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO) in children. METHODS: A review of medical records of 104 cases (82 patients) of paediatric DCR who underwent DCR at the Sydney Eye Hospital from 1995 to 2004. The main outcome measures included post-operative symptomatic relief of presenting symptoms, complications, subjective visibility of any scar, and general satisfaction. Statistical methods included chi(2) tests, and Student's t-tests for the comparison of variables among groups. RESULTS: Ninety-four external, 10 endoscopic primary procedures, and five revision procedures were included. Fifty-six of the cases were primary NLDO, and 48 were secondary NLDO. The mean follow-up was 1.44 years. Average age at surgery was 6.6+/-4.2 years (mean+/-SD). Ninety-one eyes needed DCR for the involvement of the lower lacrimal outflow system, and 13 eyes were NLDO associated with congenital punctual/canalicular dysgenesis.Most of the complications of external DCR were related to Jones tube placement. Five cases (4.8%) needed DCR revision. There was a significantly higher incidence of revision surgery in the non-stented group (P<0.01), and the Jones tube group (P<0.001) as compared with the silicone intubation stent group. CONCLUSIONS: External DCRs have acceptable long-term clinical and cosmetic results, and low post-operative complication rate. Cases with punctal stenosis or those requiring Jones tube insertion are associated with a higher complication rate. Silicone intubation is associated with a lower need for operative revision.     

The polyurethane nasolacrimal duct stent for lower tear duct obstruction: long-term success rate and complications

Background: The polyurethane nasolacrimal duct stent is used as an alternative to conventional techniques for treatment of lower tear duct obstruction. The aim of this study was to evaluate the clinical success rate after a follow-up of 2 years. Methods: Nasolacrimal duct stent implantation was attempted in 19 patients with nasolacrimal duct obstruction proven by digital substraction dacryocystography. The median age of the patients was 50 years, and the minimum duration of symptoms was 3 months. Patients were followed up 1 week, 6 months, 1 year and 2 years after the procedure. Results: Eighteen stents were implanted in 17 patients without surgical complications. All stents were proven to be patent at the end of the procedure. Success rate, defined as proportion of patients free of symptoms, was 66.6%, 55.5% and 50% after 1 week, 6 months and 1 year, respectively, and remained unchanged thereafter. Three stents had to be removed between 6 months and 2 years after implantation. Histological examination showed granulation tissue growing into the opening and obstructing the stent in one case. Conclusion: Implantation of a polyurethane nasolacrimal duct stent is an alternative to conventional techniques in lower tear duct obstruction. Its overall success rate is lower than that reported after conventional dacryocystorhinostomy, but the procedure is fast, safe and reversible. Refinement of the surface and stent design may improve results in the future. Received: 8 February 2000 Revised: 12 April 2000 Accepted: 31 May 2000     

Comparison of monocanalicular stenting and balloon dacryoplasty in secondary treatment of congenital nasolacrimal duct obstruction after failed primary probing

PURPOSE: To determine the success of monocanalicular stenting and balloon dacryoplasty as secondary treatment options for congenital nasolacrimal duct obstruction after failed probing surgery. METHODS: An interventional case series of consecutive secondary balloon dacryoplasty and monocanalicular stenting for congenital nasolacrimal duct obstruction was reviewed. These secondary treatments were used in cases in which a bicanalicular stent would have been used in the past. Seventy-seven nasolacrimal systems in children with epiphora after probing and irrigation surgery were treated with a monocanalicular stent or balloon dacryoplasty. The patients were then evaluated at least 3 months after surgery or after stent removal by using a dye disappearance test. Cases in which there was no significant dye at 5 minutes were considered a success. Cases with residual dye or history of persistent tearing were considered failures. RESULTS: The monocanalicular stent was used in 35 nasolacrimal systems, whereas balloon dacryoplasty was used in 42 nasolacrimal ducts. The mean age of treatment was 25.2 months for the monocanalicular stent group and 25.8 months for the balloon group. Overall, 32 of 35 (91%) nasolacrimal ducts responded to monocanalicular stenting, whereas 36 of 42 (86%) responded to balloon treatment. When the patient group was further stratified by age, the monocanalicular stenting was 94% successful in children younger than age 2 years and 89% successful for children older than 2 years. The balloon treatment had a success rate of 91% in the younger group and 79% in the older group. Chi-square statistical analysis showed no significant difference between the two treatments or on the basis of age stratification within each treatment group. CONCLUSIONS: Monocanalicular stenting and balloon dacryoplasty are excellent secondary therapies for congenital nasolacrimal duct obstruction after initial probing and irrigation surgery has failed. These two treatment options are now our procedures of choice for secondary surgery.     

泪道探通联合硅胶管植入术治疗慢性化脓性泪囊炎的疗效观察

目的观察泪道探通联合硅胶管植入术治疗慢性化脓性泪囊炎的临床疗效。方法对30例(32眼)慢性化脓性泪囊炎患者行泪道探通联合硅胶管植入术,术后随访3-6个月。结果植入成功率100%。4眼于术后4～7d发生阻塞,及时行泪道冲洗后恢复通畅。硅胶管留置期间,其中溢泪、溢脓症状完全消除28眼,另外4眼仍有轻度溢泪。取出硅胶管后复发5眼占15%,治愈23眼,好转4眼,总有效率84%。结论应用硅胶管植入术治疗慢性化脓性泪囊炎手术时间短,出血少,安全性高,具有肯定的临床效果。值得推广。     

简化人工鼻泪管植入术治疗鼻泪管阻塞

目的：探索简化人工鼻泪管植入的方法和疗效。方法：选择2010-01/12由本人诊治的因鼻泪管阻塞或狭窄引起的34例37眼溢泪或溢泪伴溢脓的患者,采用钢尺测量法简化手术操作,术后观察人工鼻泪管的位置和手术效果。结果：患者37眼中2眼扩张鼻泪管失败,35眼扩张鼻泪管后,均成功植入人工鼻泪管,治愈25眼,显效4眼,进步3眼,无效3眼。结论：简化人工鼻泪管植入术操作简单,成功率高,值得临床推广。     

改良永久性人工鼻泪管植入术治疗慢性泪囊炎与鼻泪道阻塞

目的:探讨人工鼻泪管支架植入术的手术技巧,评价其疗效.方法:自2009/2011年选择42例42眼鼻泪管阻塞患者,在局部麻醉下,经鼻腔逆行植入永久性人工鼻泪管,术中使用带侧孔探针代替原包装中的直孔探针,通过调节探针侧孔的位置,使引导丝下端自下鼻道自行脱出,术后随访6mo,观察其临床疗效.结果:患者42例42眼成功植入人工鼻泪管,手术植入成功率100%.术后6mo进行随访,有效率100%.结论:改良永久性人工鼻泪管植入术治疗慢性泪囊炎与鼻泪道阻塞操作简单安全,疗效确切,有推广价值.     

Efficacy of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in treatment of acquired partial nasolacrimal duct obstruction in adults

Aim

To report the outcomes of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in patients with acquired partial nasolacrimal duct obstructions in adults.

Methods

Retrospective case series, included 21 eyes with partially obstructed nasolacrimal ducts of 12 patients. All the 21 ducts were initially probed and the probe confirmed with an endoscope in the inferior meatus. After confirming the presence of probe in the inferior meatus, a 3 mm balloon was used for dilating the distal and proximal portions of nasolacrimal duct, followed by stenting of ducts with Crawford tubes. Main outcome measures were anatomical patency of the passage and resolution of epiphora.

Results

Of the 12 patients, 9 had bilateral and 3 had unilateral acquired partial nasolacrimal duct obstructions. All the patients underwent bicanalicular stenting under endoscopic guidance which were retained for a period of 12 weeks. A minimum follow up of 6 months following stent removal was considered for final analysis. 15 of the 21 ducts (71%) were freely patent on irrigation but 13 of the 21 reported improvement of epiphora. Two nasolacrimal ducts showed similar partial regurgitation and partial patency on syringing as before with no improvement of symptoms. Four nasolacrimal ducts were completely obstructed with complete regurgitation of fluid on syringing with worsening of the epiphora. Two eyes persisted with symptoms of epiphora despite patent nasolacrimal duct with grade 2 dye retention on dye disappearance test.

Conclusions

3 mm balloon dacryoplasty is an alternative and safe way to manage partial nasolacrimal duct obstructions with an anatomical success in 71% and functional success in 62% of the patients. Further studies with a large sample size and longer follow-up are required to ascertain the long term benefits.