A comparison of the success rates of endoscopic-assisted probing in the treatment of membranous congenital nasolacrimal duct obstruction between younger and older children and its correlation with the thickness of the membrane at the Valve of Hasner

Congenital nasolacrimal duct obstruction (CNLDO) remains the most common cause of epiphora in infants. This retrospective study compares the success rate of nasal endoscopic-assisted probing between younger (3 years and below) and older (above 3 years) children with membranous CNLDO and its correlation with the thickness of the membrane at the valve of Hasner. Case records of a total of 38 eyes in 34 children with membranous CNLDO who underwent endoscopic nasolacrimal duct probing and irrigation under general anesthesia were analyzed. The cases were divided into two groups, Group Y (20 cases of children 3 years and below) and Group O (18 cases of children above 3 years). The success of the procedure was defined as complete remission of symptoms and a clinical examination of eye to rule out the presence for discharge or watering after three months of the procedure. Overall, 35 cases (92.1%) were successfully treated with a success rate of 95% in Group Y and 88.9% in Group O. The mid-P exact test p value for the success rate between the two cohorts was not statistically significant (p = 0.59). The thick membrane was observed in 50% cases in Group Y and 33.33% cases in Group O (p = 0.34). There is no age related decline in the overall success rate for nasal endoscopic-assisted probing and irrigation in cases of membranous CNLDO. The thickness of the membrane may be a factor for failed blind probing, but it has no correlation with the success rate if probing is done under endoscopic guidance.     

Nasal endoscopy in the management of congenital nasolacrimal duct obstruction

Probing is a reliable surgical intervention for the management of congenital nasolacrimal duct obstruction (CNLDO). However, it is a blind procedure that carries the risk of false passage formation. Moreover, its success rate is variable, with unexplained causes of failure. Recent literature suggests the use of nasal endoscopic-assisted probing to minimize nasal mucosal trauma, decreases the chance of creating a false passage and provides the optimum management option of different congenital variants of nasolacrimal duct obstruction. Nasal endoscopic-assisted probing has more or less consistent success rates varied between 85% and 98% compared with probing success rates, which vary between 55% and 95% despite having almost the same age range.     

Comparison of balloon dacryocystoplasty to probing as the primary treatment of congenital nasolacrimal duct obstruction.

PURPOSE: In children older than 18 months, primary probing procedures for congenital nasolacrimal duct obstruction (CNLDO) are thought to have lower rates of success. This study compares the results of primary probing to balloon dacryocystoplasty (DCP) in children stratified by age category. METHODS: In a retrospective chart review, 29 eyes with CNLDO that underwent balloon DCP in children older than 18 months were identified and age-matched to 29 eyes that underwent probing. The eyes were divided into 3 age categories: category 1 (18-24 months), category 2 (24-36 months), and category 3 (>36 months). RESULTS: Of the 29 eyes treated with balloon DCP (mean age, 37.1 months), 26 were successfully treated. Twenty-five of the 29 matched probed eyes (mean age, 31.1 months) were successfully treated, resulting in an overall success rate of 90% for balloon DCP and 86% for primary probing. Within each age category, the success rate varied but did not show an advantage to balloon DCP. The presence of crusting and expressible discharge from the puncta during preoperative evaluation predicted a successful probing (OR, 16; 95% CI, 1.3-192). CONCLUSION: Overall, balloon DCP did not appear to present an advantage as compared with primary probing as the initial treatment in these children. Primary probing has an impressive overall success rate that did not diminish in the children older than 36 months.     

Pushed monocanalicular intubation versus probing for the treatment of simple and incomplete complex types of congenital nasolacrimal duct obstruction in children older than 18 months old

This article compares the success rate of pushed monocanalicular intubation (Masterka) versus probing for the treatment of congenital nasolacrimal duct obstruction (CNLDO) in children older than 18 months. In a non-random comparative study, 90 eyes with CNLDO underwent either Masterka (45 eyes) or probing (45 eyes). All procedures were performed by one oculoplastic surgeon. The tubes were removed 2 months after the operation. Complete resolution was defined as complete absence of clinical signs and symptoms of CNLDO at 6 months after the procedure. The mean age at the time of treatment was 28 ± 18.2 months for Masterka and 26.7 ± 18.6 months for probing group. Treatment success was achieved in 33 of 45 eyes (73.3%) in the Masterka group compared with 22 of 45 eyes (48.9%) in the probing group. The difference between the two groups was statistically significant (p = 0.017). For the treatment of CNLDO, Masterka might be more effective than probing in children older than 18 months.     

Endoscopic-assisted probing for congenital nasolacrimal duct obstruction

PURPOSE: To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction (CNLDO) at different ages using nasal endoscopy, and to identify the anatomical sites of blockage within the drainage system. METHODS: A total of 87 eyes from 67 consecutive children with CNLDO underwent endoscopic nasolacrimal duct (NLD) probing under general anaesthetic. Patients who had had previous probings were excluded from the study. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test (FDDT). Cure was judged as complete or near-complete remission of symptoms and signs and a normal FDDT. RESULTS: The age range was 12-91 months (mean 32.3 months). The success rates of probing were: 100% (58/58) for atresia and stenosis at the lower NLD, 100% (13/13) for punctal stenosis, 55.6% (5/9) for functional epiphora, and 0% (0/7) for canalicular and upper NLD obstruction. Age was not found to significantly affect the outcome of probing, whereas site did. Obstruction at canalicular or upper NLD level became more common with increasing age. CONCLUSION: Probing of the nasolacrimal system using the endoscopic approach allows direct visualisation of the distal nasolacrimal duct, which facilitates diagnosis of the anomaly at this site. More complex proximal anomalies became increasingly prevalent in older children, which accounted for the poorer results with increasing age. Site of obstruction has a greater bearing on outcome than patient age.     

Retrospective analysis of silicon intubation by Ritleng probe and Sutupak suture fixed in silicone tube in congenital nasolacrimal duct obstruction

Purpose:The aim of this study was to perform a retrospective review of the outcome of silicon intubation using the Ritleng probe and a modified braided silk suture (Ethicon Sutupak) fixed in a silicone tube in children with congenital nasolacrimal duct obstruction (CNLDO).Methods:Records of all children between 1 and 12 years of age who underwent silicone tube intubation with the Ritleng probe and Ethicon Sutupak suture (2-0) fixed in silicone tube for CNLDO with a minimum of 1-year follow-up were identified. The hollow Ritleng probe was inserted via the canaliculus into the inferior meatus. The Sutupak thread-guide, attached to the silicone tube, was advanced through the probe lumen and retrieved using a hook under endoscopic visualization. The tube ends were tied to each other and tube removal was planned after 3 months. Absence of watering, discharge, and matted lashes after removal of silicone tube was defined as success.Results:One hundred and fifty-two eyes of 152 children with a mean age of 3.26 ± 2.3 years were included in the study. The procedure was successful in 145 eyes (95%) after removal of the silicone intubation with relief of symptoms observed in most patients by fifth-day follow-up (n = 120 eyes, 83%). The mean duration of follow-up was 3.48 ± 1.3 years. No other significant differences were observed between patients who did (n = 47) and did not (n = 105) have previous probing including success rates (95% vs. 96%, P = 0.89).Conclusion:Silicone intubation with Ritleng probe and Sutupak suture fixed in silicone tube was successful in resolution of symptoms of CNLDO in majority of patients. Using a low-cost suture did not affect success rates.     

Comparison of the success rate between monocanalicular and bicanalicular intubations in incomplete complex congenital nasolacrimal duct obstruction

This article compares the success rate between monocanalicular (MCI) and bicanalicular intubations (BCI) in incomplete complex congenital nasolacrimal duct obstruction (CNLDO) and evaluate the factors responsible for the success of intubation. First, 99 patients with incomplete complex CNLDO underwent MCI (Monoka) or BCI (Crawford). Therapeutic success was defined as dye disappearance test grade 0-1 and complete resolution of previous symptoms at 12 months’ follow-up. The success rates were compared between two groups. In all cases, the correlation of the age, gender, history of probing, and the presence of purulent discharges with the improvement in CNLDO symptoms were evaluated. 52 cases in the MCI and 47 cases in the BCI group were included. Then, 48 patients (48.5%) had history of probing. 26 patients (26.3%) had purulent discharges. The patients in the MCI group had lower success rate (59.6%) than the patients in the BCI group (74.4%) but the difference was not significant (p = 0.11). No complication occurred in the BCI group. In 4 cases (7.6%) in the MCI group, the tubes were lost before time of planned removal. In all cases, only preoperative absence of the pus was significantly correlated with success (p = 0.09 and OR = 0.39). BCI may be a better treatment for the patients with incomplete complex CNLDO. In silicone intubation for these cases, preoperative absence of purulent discharges could increase the success rate.     

A comparison between monocanalicular and pushed monocanalicular silicone intubation in the treatment of congenital nasolacrimal duct obstruction

AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation (PMCI) of the nasolacrimal duct for congenital nasolacrimal duct obstruction (CNLDO).METHODS: In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation (MCI) (n=28 eyes) or PMCI (n=25 eyes). All procedures were performed by 1 oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal.Results: The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25±10.08mo (range, 13-49mo) for MCI and 26.85±12.25mo (range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes (90.0%) in the MCI group compared with 10 of 20 eyes (50%) in the PMCI group (P=0.01). In the PMCI group, the tube loss (30%) was greater than the MCI group (5%), however the differences between the 2 groups proved to be not significant (P=0.91).CONCLUSION: Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.     

Clinical outcomes of initial and repeated nasolacrimal duct office-based probing for congenital nasolacrimal duct obstruction

Purpose

To characterize the outcomes of initial and repeated office-based probing as a primary treatment for congenital nasolacrimal duct obstruction (CNLDO) in children.

Methods

The medical records of patients who underwent nasolacrimal duct office-based probing for CNLDO between March 2004 and January 2008 were reviewed retrospectively. Nasolacrimal duct probing was performed on 244 eyes from 229 consecutive patients with CNLDO. Patients who were refractory to the first probing underwent a second probing 4 to 8 weeks later.

Results

Based on exclusion criteria, 244 eyes from 229 patients (117 males and 112 females), aged 6 to 71 months (mean, 12.4 ± 8.36) were included. The success rate of the initial probing was 80% (196 of 244) for all patients, 82% (111 of 136) in the 6 to 12 month age group, 79% (64 of 81) in the 13 to 18 months age group, and 78% (21 of 27) among individuals older than 19 months (p = 0.868, Pearson chi-square test). The success rate of the second probing was 61% (25 of 41) for all patients, 74% (17 of 23) in the 6 to 12 months age group, 58% (7 of 12) in the 13 to 18 months age group, and 17% (1 of 6) among individuals older than 19 months (p = 0.043, Fisher''s exact test).

Conclusions

While the success rate of initial nasolacrimal duct probing is not affected by age, the rate of success rate with a second probing was significantly lower in patients older than 19 months. Based on the results, authors recommend further surgical interventions, such as silicone tube intubation or balloon dacryocystoplasty, instead of repeated office probing for patients older than 19 months, if an initial office probing has failed.     

先天性鼻泪管阻塞治疗探讨

目的 探讨先天性鼻泪管阻塞的不同治疗方法和治疗时机.方法 回顾分析了735例837只眼在复旦大学附属儿科医院诊断为先天性鼻泪管阻塞的患儿,平均首诊年龄4.5月.根据首诊年龄和症状分别采用保守治疗、加压泪道冲洗法和泪道探通法,经随访3～16月,平均6.4月.以溢泪症状完全消失作为治愈指标.结果 保守治疗的有效率为14.7%;加压泪道冲洗法的有效率为25.4%;泪道探通法的有效率为97.2%;15只眼未愈.早期探通(<6月龄组)1次成功率为87.7%;后期探通(>7月龄组)1次成功率为56.6%.结论 泪道探通法治疗先天性鼻泪管阻寒安全有效,最佳干预时机为4～6月龄.     

Prevalence of amblyopia in children undergoing nasolacrimal duct irrigation and probing

Purpose:

To investigate ambylopia and amblyopia risk factors of children who underwent nasolacrimal duct (NLD) irrigation and probing for congenital nasolacrimal duct obstruction (CNLDO).

Materials and Methods:

The medical records of patients who had undergone NLD irrigation and probing for CNLDO at an age of 3 years or younger were reviewed, and 51 of the patients were recalled between October 1 and December 31, 2011 for a detailed ophthalmic examination to determinate amblyopia or amblyopia risk factors. Amblyopia was accepted as difference in visual acuity of two or more Snellen lines between the two eyes or visual acuity of 20/30 or worse in either eye.

Results:

The median age of the 51 patients to whom NLD irrigation and probing were attempted for CNLDO was 23 months. CNLDO affected a total of 70 eyes. All patients were reviewed for best-corrected visual acuity, refractive errors, and strabismus at a median age of 70.5 months (range 31-95 months). Amblyopia or amblyopia risk factors were identified in 14 patients (27.5%). One child (7.15%) had only strabismus, six children (42.8%) had only amblyogenic refractive errors, two (14.3%) had a combination of two, one child (7.15%) had a family history for amblyopia, but four children (28.6%) had no amblyopia risk factors but had amblyopia.

Conclusion:

Amblyogenic risk factors are found higher in patients with CNLDO and patients undergoing NLD irrigation and probing in comparison to normal population. Therefore, we recommend these children to routinely undergo cycloplegic refractions and full ophthalmic examinations.     

Factors affecting treatment outcome in congenital nasolacrimal duct obstruction: A retrospective analysis from South India

Purpose:

To investigate outcomes for different treatment modalities in congenital nasolacrimal duct obstruction (CNLDO) in an Indian population.

Design:

Retrospective, interventional, case series.

Materials and Methods:

In an institutional setting, case records of patients with CNLDO from January 2008 to 2012, were reviewed, and data on patient demographics, clinical presentation, and treatment details (sac massage, probing, and/or dacryocystorhinostomy) were recorded. Success of treatment was defined as complete resolution of symptoms and negative regurgitation on pressure over lacrimal sac (ROPLAS) area.

Results:

Two hundred and ninety-eight eyes of 240 patients with a mean age of 22.2 ± 26.14 months (median = 12 months, interquartile range = 17) were analyzed. Sac massage (n = 226) was successful in 67 eyes (30%). Multivariable logistic regression analyses showed that children with mucoid ROPLAS were almost 6 times more likely (odds ratio [OR] = 5.55 vs. clear ROPLAS, 95% confidence interval [CI] = 2.35–13.09, P < 0.001) to experience failure of sac massage. Overall probing (n = 193) was successful for 143 (74%) eyes. Multivariable logistic regression showed that older children were 25% more likely to experience probing failure (OR = 1.25 for every 6 months increment in age, 95%, CI = 1.09–1.42, P = 0.001).

Conclusion:

Sac massage is successful in only a third of our patients and those with mucoid ROPLAS are more likely to experience failure. Probing is successful in three-quarter of our subjects, and its success declines with a progressive increase in age. Lower socioeconomic status, poor general health, and recurrent respiratory infections are unique to our population and may influence outcomes.     

Value of microbiology study in congenital nasolacrimal duct obstruction

PurposeEvaluation of the effect of different microorganisms on congenital nasolacrimal duct obstruction (CNLDO) tightness and whether probing or silastic intubation is likely to fail in a particular microorganism infection.MethodsThe culture and sensitivity results of lacrimal drainage system (LDS) discharge samples from patients with CNLDO were reviewed. Different microorganisms were correlated with the severity of nasolacrimal duct (NLD) obstruction observed during surgical intervention. The success rates of probing and silastic intubation as a primary procedure for each identifiable microorganism were documented. Statistical analysis was conducted to correlate the type of microorganism with the tightness of CNLDO and treatment failure.ResultsOut of 181 specimens, 22 had no growth (12.1%). LDS with positive culture had 76.6% successful probing (n = 49) and 82.1% successful silastic intubation (n = 78). Gram-positive and Gram-negative species were almost equally detected. The most prevalent organisms were Streptococcus pneumoniae and Hemophilus influenzae (48.1% and 39.2%, respectively). Tight CNLDO was more prevalent in Serratia marcescens (n = 2; 100%) and Staphylococcus aureus (n = 4; 33.3%) infections with a 7.75 Odds ratio [95% confidence interval (CI), 1.67–34.63]. Staphylococcus aureus had 37.5% successful probing; however, success was achieved in all cases with silastic intubation. Serratia marcescens infections had 100% successful silastic intubation.ConclusionMicrobiology study can predict tight CNLDO and helps in choosing the most successful treatment option. CNLDO with Staphylococcus infection and Serratia marcescens were likely to have tight NLD obstruction and silastic intubation had better outcomes.     

鼻内镜辅助RS泪道插管术治疗儿童先天性鼻泪管阻塞

目的:探讨鼻内镜辅助RS泪道插管术治疗泪道探通无效的儿童先天性鼻泪管阻塞的有效性和安全性,指导临床应用。方法:回顾性系列病例研究。选取2016-09/2019-09在我院就诊的泪道探通无效的先天性鼻泪管阻塞患儿158例158眼作为研究对象,患儿均行鼻内镜辅助RS泪道插管术治疗。术后1、3、6mo定期随访。观察患儿性别、年龄、既往泪道探通次数、术前泪道有无分泌物、治疗效果、并发症、鼻泪管阻塞类型。对年龄、探通次数与手术有效率之间的关系做Spearman秩相关系数计算与分析,对不同类型鼻泪管阻塞的手术有效率采用Fisher确切概率法检验,对有无脓性分泌物的手术有效率做χ2检验。结果:总手术有效率为89.9%(142/158)。手术有效率随着年龄增长呈下降的趋势(rs=-1.000,P<0.01)。手术有效率随着泪道探通次数增多呈下降的趋势(rs=-1.000,P<0.01)。膜性鼻泪管阻塞手术有效率高于复杂性鼻泪管阻塞(P<0.05)。有无脓性分泌物两种症状的手术有效率无差异(P>0.05)。主要并发症有:假道16眼(10.1%)、泪道引流管提前脱出14眼(8.9%)、眼红、刺激性溢泪18眼(11.4%)、上下泪点对合黏连3眼(1.9%)、泪点肉芽肿1眼(0.6%)。结论:鼻内镜辅助RS泪道插管术治疗泪道探通无效的儿童先天性鼻泪管阻塞有较高有效率,较好的安全性。手术有效率随着年龄增长而下降,随着泪道探通次数增多而下降,膜性鼻泪管阻塞手术有效率高于复杂性鼻泪管阻塞。     

The prevalence of amblyogenic factors in children with persistent congenital nasolacrimal duct obstruction

Background

To evaluate the prevalence of amblyopia risk factors in children that underwent probing for persistent congenital nasolacrimal duct obstruction (CNLDO).

Methods

The medical records of children with CNLDO (after 1 year of age) that underwent probing were reviewed. Amblyopia risk factors, based on the American Association for Pediatric Ophthalmology and Strabismus referral criteria in 2013, were sought in the patients? records before probing. The proportion of the patients with anisometropia >1.5 diopters (D) was separately calculated. In unilateral cases of CNLDO, sphere, astigmatism, and spherical equivalent of the eyes with CNLDO were compared with contralateral eyes in order to assess the effect of CNLDO on refractive error. In the follow-up examinations, the success of the probing or the need for additional procedures (Crawford intubation, Monoka intubation, or dacryocystorhinostomy) was evaluated. The prevalence of anisometropia between ‘successful probing’ and ‘failed probing’ groups was compared.

Results

A total of 433 cases were included in the study. 41 cases (9.46 %) had amblyopia risk factors. Twenty-four cases (5.5 %) had anisometropia >1.5 D (spherical or cylindrical). In unilateral cases of CNLDO, the sphere and spherical equivalent of the eyes with CNLDO were significantly greater than those of the contralateral eyes (p?p?=?0.03).

Conclusions

The findings of greater prevalence of anisometropia >1.5 D (compared with the prevalence in the general population) and significantly greater sphere and spherical equivalents in the eye with CNLDO (compared with contralateral eye) in unilateral cases with CNLDO, suggested some relationships between anisometropia and long-term untreated CNLDO. The finding of more anisometropia in failed probing cases may support the theory of structural abnormality as an explanation for the possible relationship between congenital nasolacrimal duct obstruction and anisometropia.     

Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure?

AIMS: To find the cure rate of late (second year of age) and very late (3-5 years of age) initial probing for congenital nasolacrimal duct obstruction (CNLDO) and to identify the factors contributing to the failure rate of the probing in older children. METHODS: In a prospective interventional case series study, 169 eyes of 125 consecutive patients (1-5 years old) with CNLDO underwent probing under general anaesthesia. Cure was defined as absence of tearing and discharge in the affected eye. RESULTS: 138 eyes of 101 patients aged 13-60 months (mean 23.4 (SD 10.2)) were included. Of 15 eyes (10.8%) with complex CNLDO, 80% presented after 24 months of age (p<0.0001). The cure rate was 89% in patients 13-24 months of age and 72% after the age of 24 months (p = 0.01). It was 90.2% in the membranous and 33.3% in the complex CNLDO in both late and very late probing (p<0.0001). There was a high correlation (r = 0.97) and no significant difference between the cure rate at 1 week and final follow up. CONCLUSION: Accumulation of the complex CNLDO is the main risk factor for failure of probing in the older children. The outcome of the nasolacrimal duct probing at 1 week follow up is highly indicative of the final outcome.     

Curative effects of probing alone and probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital duct obstruction of children from 3-12 months of age

Background: To investigate the 1-time success rate of probing alone and nasolacrimal duct probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital nasolacrimal duct obstruction (CNLDO) in young children. Methods: A retrospective case series was performed on 494 cases (647 eyes) of 3–12 month-old children with CNLDO between July 2014 and July 2015. Material obtained from the lacrimal sac was cultured to isolate infectious agents. Susceptibility testing was done. Children from 3–12 months of age who were found to be sensitive to Levofloxacin (n=493 eyes) were separated into two groups: 3–6 months of age (276 eyes) and 7–12 months of age (217 eyes). Each of the groups were then randomized into group A (138 eyes of 3–6 months of age; 102 eyes of 7–12 months of age) and group B (138 eyes of 3–6 months of age; 115 eyes of 7–12 months of age). Children in group A underwent nasolacrimal duct probing alone; those in group B underwent nasolacrimal duct probing plus nasolacrimal duct injection of levofloxacin and the efficacy of probing was evaluated. Results: The average detection rate of pathogenic bacteria in dacryocystitis was 75.1%, andStaphylococcus aureuswas found to be the main pathogenic bacteria (42.59%, 106 cases). Among children from 7–12 months of age, the 1-time success rate of nasolacrimal duct probing alone was 88.24% and the 1-time success rate of probing combined with nasolacrimal duct injection of levolfoxacin ophthalmic gel was 96.52% (statistical signiifcance, P=0.02<0.05). Conclusions: Most pathogenic bacteria (96.81%) were sensitive to levofloxacin. Nasolacrimal duct probing combined with nasolacrimal duct injection of levolfoxacin may improve the success rate of probing in children older than 6 months of age.     

Initial nasolacrimal duct probing in children under age 5: Cure rate and factors affecting success

AIMS: To evaluate the success rate of initial probing and the factors affecting the success rate for congenital nasolacrimal duct obstruction (CNLDO)in children under the age of 5 years. METHODS: In a prospective uncontrolled interventional case series, 207 eyes from 161 consecutive patients with CNLDO underwent nasolacrimal duct probing under brief general anesthesia. Based on exclusion criteria, 180 eyes from 139 patients were included in the study. Diagnoses were made according to the patients' histories, clinical examinations, and modified dye disappearance tests. The state of the punctum, the canaliculus, the sac, and the nasolacrimal duct were recorded. The main outcome measure was the complete disappearance of tearing and discharge in the affected eye. The patients were followed at 1 week, 1 month, and 3 months postoperatively. RESULTS: The age range was 5 to 60 months (mean, 19.1 +/- 11.2 months). The cure rates were 92% in the first year, 84.5% in the second year, 65% in the third year, and 63.5 in the fourth and fifth years of age. The patient's age, nonmemberanous CNLDO, and canalicular stenosis were correlated with the success of initial nasolacrimal duct probing (P <.05). CONCLUSIONS: Based on the results, simplicity of probing, and absence of significant complications, initial nasolacrimal duct probing is advised up to the age of 5 years. Increasing age, nonmembranous CNLDO, and canalicular stenosis increase the failure rate (P <.05).     

鼻泪管探通术治疗先天性鼻泪管阻塞的疗效研究

目的：研究探通术与灌溉对儿童先天性鼻泪管阻塞(congenital nasolacrimal duct obstruction, CNDO)的成功率及相关因素。

方法：从2005/2011年,患有CNDO的儿童235例261眼行鼻泪管探通术。患者按年龄分为3组：组1,131眼为12～24月龄; 组2,82眼为>24～48月龄; 组3,48眼为>48～120月龄。在全身麻醉下进行上、下泪小点探通术。术后1d; 1,2wk; 1,3mo进行随访。通过Mann Whitney U检验和卡方检验分析手术成功率与年龄的相关性。

结果：儿童235例(女性122例,男性113例)的平均年龄为27.6±10.7(12～120)mo。3组患儿一次探通术后的成功率分别为90.1%、85.4%和47.6%,并且组1 、组2成功率显著高于组3(P<0.05)。患儿53例(20.3%)再次行探通术,3组的成功率分别为：61.5%、58.3% 和25.0%。

结论：鼻泪管探通术是治疗CNDO的有效方法,特别是对于小于2岁的患儿。手术成功率随着年龄增加而降低,但是上下泪小管二次探通术可以提高术后效果。     

鼻泪管探通术治疗先天性鼻泪管阻塞的疗效观察

目的:研究探通术与灌溉对儿童先天性鼻泪管阻塞(congenital nasolacrimal duct obstruction,CNDO)的成功率及相关因素。方法:从2005/2011,患有CNDO的儿童235例261眼行鼻泪管探通术。患者按年龄分为3组:组1,131眼为12～24月龄;组2,82眼为24～48月龄;组3,48眼为48～120月龄。在全身麻醉下进行上、下泪小点探通术。术后1d;1、2wk;1、3mo进行随访。通过Mann Whitney U检验和卡方检验分析手术成功率与年龄的相关性。结果:儿童235例(女性122例,男性113例)的平均年龄为27.6±10.7(12～120)mo。3组患儿一次探通术后的成功率分别为90.1%、85.4%和47.6%,并且组1、组2成功率显著高于组3(P<0.05)。患儿53例(20.3%)再次行探通术,3组的成功率分别为:61.5%、58.3%和25.0%。结论:鼻泪管探通术是治疗CNDO的有效方法,特别是对于小于2岁的患儿。手术成功率随着年龄增加而降低,但是上下泪小管二次探通术可以提高术后效果。