[Minimally invasive bypass surgery for nasolacrimal duct obstruction : Transcanalicular laser-assisted dacryocystorhinostomy]

[Recanalisation by Probing with a Bicanalicular Silicone Tube (Oggel Silicone Intubation) in Patients with Acquired Lacrimal Stenosis]

OBJECTIVES

Recanalisation and bicanalicular splinting with silicone tube is one therapeutic option for acquired lacrimal duct stenosis, and restenosis is frequently achieved. The aim was to determine the therapeutic success of Oggel silicone intubation after lacrimal syringing and probing. We also analysed other characteristics of the complaint and compared the therapeutic success with published results.

METHODS

Therapeutic success was defined as subjective absence of complaints. Other complaint features - directly after explantation of the Oggel tube, one month after explantation and one year after explantation - were retrospectively collected by a patient questionnaire, and a questionnaire for the attending ophthalmologist. These were completed with information from the patient's file. We included 82 procedures performed at the Dept. of Ophthalmology, University of Ulm, between 2006 and 2015. Statistical testing of the impact of risk factors on therapeutic success was performed, using logistic regression analysis and the Mann-Whitney U test. Subgroups were compared using Pearson-Chi-square and Fisher's exact tests and a Kaplan-Meier analysis was also performed.

RESULTS

Therapeutic success could be documented in 80.8% of patients after explantation of the Oggel tube, in 61.6% of patients after one month and in 42.5% of patients at one year (n = 82). There were no significant differences between the subgroups of stenosis localisation, or the patients' age or sex. There was also no significant influence of the patient's age, the preoperative duration of complaints or risk factors predisposing for lacrimal duct stenosis. For the observation period of one year, the Kaplan-Meier analysis gave a probability of complaint-freeness of 52.2% for the patient group, as well as a mean duration of the complaint-free period of 34.2 weeks.

CONCLUSION

The results allow a prognostic assessment of the therapeutic success in the absence of significant differences in the subgroups. The therapeutic success of bicanalicular silicone intubation with the Oggel tube was in the lower third of comparable studies. The results conform to the observation that there is a progressive decline of therapeutic success. The comparison of the literature turned out to be methodically more difficult due to differences in study characteristics. Standardisation would make sense for future studies.

Mechanical transnasal endoscopic dacryocystorhinostomy versus transcanalicular multidiode laser dacryocystorhinostomy: long-term results of a prospective study

The purpose of this study is to compare two dacryocystorhinostomy (DCR) techniques in epiphora treatment. This study is a prospective randomized trial. Twenty-nine patients presenting persistent epiphora due to primary acquired nasolacrimal duct obstruction (PANDO) were included in the study. Two groups each consisting of 15 eyes were formed. Mechanical transnasal endoscopic DCR (MTE-DCR) was applied to the first group, while transcanalicular dacryocystorhinostomy with multidiode laser (TCML-DCR) techniques is employed in the second group. Follow-up is conducted in the first day, first week, and first month of the dacryocystorhinostomy which is followed by 4-month follow-up period, and results were compared using statistical methods. The main outcome measures were the elimination of epiphora and unrestricted flow of irrigated saline to the nose. Seven patients were male, 22 were female, and the mean age was 39.3 ± 12.5 years. Mean follow-up times were 111.3 ± 10.5 months and 93 ± 2.9 months in group 1 and group 2, respectively. Complete resolution is achieved in group 1, whereas failures stemming from canalicular stenosis and fibrosis at osteotomy site are recorded in two cases in group 2. Occlusion occurred in the fifth month in both cases. Thus, long-term success rates were 100% in the first and 86.6% in the second group (P = 0.483). MTE-DCR is a strong substitute for external DCR. Although TCML-DCR shows promising results, it is far away from becoming the gold standard technique in epiphora treatment.