Monocanalicular Stents in Eyelid Lacerations: A Report by the American Academy of Ophthalmology

Bicanalicular stent versus mono-canalicular stent for post-oncological lacrimal duct reconstruction: A retrospective cohort study

BACKGROUND

Bicanalicular and mono-canalicular stent intubations were developed for post-oncological lacrimal duct reconstruction; however, comparative analysis between the two surgical modalities is lacking. This study aimed to compare the surgical outcomes between the two types of stents at a single institution.

MATERIALS AND METHODS

Briefly, 75 eyes of 75 patients who underwent lacrimal reconstruction combined with lacrimal stent intubation were enrolled in this study and were divided into bicanalicular stent intubation and mono-canalicular stent intubation groups. The clinical characteristics, follow-up, and prognosis were compared between the two groups.

RESULTS

Bicanalicular and mono-canalicular stent intubations were performed in 36 eyes (36 patients; Group A) and 39 eyes (39 patients; Group B), respectively. The difference in stent duration between Groups A and B was statistically significant. Three eyes in Group A and one eye in Group B experienced postoperative stent prolapse. Two eyes in Group B showed punctum stenosis and one eye had punctal ectropion. Seven eyes in Group A had canalicular slitting. There were no statistically significant differences in the mean preoperative Munk scores between the two groups. There were no statistically significant differences in the mean Munk scores and mean VAS scores at 1 week postoperatively, before stent removal, and 3 months after stent removal between the two groups.

CONCLUSION

Bicanalicular and mono-canalicular stent intubations were equally effective in ensuring lacrimal duct patency and in preventing postoperative epiphora. Appropriate cases and stent selection can reduce the incidence of postoperative complications.

Canalicular laceration repair using a novel bicanalicular silicone stent versus traditional bicanalicular stent with nasal fixation

PURPOSE

To compare the clinical effects of two types of lacrimal stents in the repair of canalicular lacerations.

METHODS

A retrospective analysis was conducted on patients with canalicular lacerations between January 2017 and December 2022. The canalicular reconstruction was performed using either the Runshi-RS bicanalicular silicone stent or the traditional bicanalicular silicone stent with nasal fixation, under a surgical microscope. The stent was placed for 3 months, and patients were followed up for more than 3 months after extubation. The anatomical and functional success rates were compared between the two groups. Anatomical success was assessed through diagnostic probing and irrigation of lacrimal passage, while functional success was determined by the patient's subjective symptoms of epiphora.

RESULTS

The study included 315 patients (315 eyes) undergoing canalicular laceration repair. The Runshi-RS stent was utilized in 147 patients (46.7%), while the traditional stent with nasal fixation was employed in 168 patients (53.3%). The anatomical success rates (99.3% vs 98.8%, P = 0.642) and functional success rates (87.2% vs 88.1%, P = 0.926) were similar between the RS group and the traditional stent group. Postoperative complications were fewer (4.1% vs 10.1%, P = 0.04) and the operation time was shorter (67.1 ± 35.3 min vs 86.1 ± 43.4 min, P < 0.001) in the RS group.

CONCLUSION

The Runshi-RS tube demonstrates favorable surgical outcomes for the repair of canalicular lacerations. Compared to the traditional stent with nasal fixation, the RS stent allows for shorter operation times and fewer postoperative complications in the repair of canalicular lacerations.

Balloon Dacryocystoplasty with Pushed Monocanalicular Intubation as a Primary Management for Primary Acquired Nasolacrimal Duct Obstruction

Given the improvement in the instrument and techniques, novel surgical interventions emerged to avoid the osteotomy from the gold standard dacryocystorhinostomy (DCR) for treating primary acquired nasolacrimal duct obstruction (PANDO). This study's aim is to compare the surgical outcomes of antegrade balloon dacryocystoplasty (DCP) with pushed monocanalicular intubation (MCI) to balloon DCP alone in patients with complete PANDO. Adult patients with complete PANDO receiving balloon DCP followed by pushed MCI or balloon DCP alone from December 2014 to May 2019 were retrospectively reviewed. A total of 37 eyes of 29 patients were treated with balloon DCP with pushed MCI for 1 month, whereas 35 eyes of 28 patients were treated with balloon DCP alone. The success rates at 1 month, 3 months, and 6 months after operation were 89.2%, 73.0%, and 70.2%, respectively, in balloon DCP with MCI group, and 62.9%, 62.9%, and 60.0%, respectively, in the balloon DCP alone group. The balloon DCP with pushed MCI group had a better success rate but only reached statistical significance at 1 month postoperatively (p < 0.01). Subgroup analysis was performed based on age. The success rate in those under 65 in the combined balloon DCP with MCI group was significantly higher than in balloon DCP alone group (72.7% vs. 9.1%, p = 0.004), whereas there was no significant difference between those aged at least 65 in the combined group and the balloon DCP alone group (69.2% vs. 83.3%, p = 0.2). Conclusively, there was no significant difference in the success rate between antegrade balloon DCP with and without pushed MCI in general. Nevertheless, the former procedure was associated with significantly higher surgical success rate than the latter in younger patients.

Pediatric Eyelid and Canalicular Lacerations: Epidemiology and Outcomes

PURPOSE

To characterize the epidemiology of eyelid lacerations, identify risk factors for canalicular involvement, and describe postoperative complications following laceration repair.

METHODS

All patients undergoing eyelid laceration repair at a tertiary care, level I trauma center children's hospital from November 2010 to April 2021 were identified by a Current Procedural Terminology code search. Patient characteristics, surgical characteristics, and surgical outcomes were collected via chart review. Univariate analysis and multivariate logistic regression were performed to identify risk factors for canalicular involvement and postoperative complication.

RESULTS

A total of 165 patients were identified, of whom 136 had at least 1 week of follow-up and were further assessed for postoperative complications. The most common mechanisms of injury were dog bites (62, 38%), falls (33, 20%), and being struck by an object (22, 13%). Eyelid margin involvement was present in 108 patients (65%) and canalicular involvement in 77 patients (47%). Risk factors for canalicular involvement were hook-related injury, eyelid margin involvement, and lower eyelid injury. Thirty-three patients (24%) had postoperative complications, most commonly ptosis (7, 5%), premature stent loss (7, 5%), and eyelid margin notching (6, 4%). There was no association between postoperative complication and antibiotic use, delayed repair, or wound class.

CONCLUSIONS

Hook-related injury, eyelid margin involvement, and lower eyelid injury are risk factors for canalicular involvement. Postoperative complications of eyelid lacerations are generally minor and are not associated with perioperative factors. Close postoperative follow-up is needed to monitor for complication development. [J Pediatr Ophthalmol Strabismus. 2023;60(1):33-38.].

Outcomes of lacrimal punctal tumors treated with a superpulse CO2 laser

Literature on lacrimal punctal tumors is limited due to their rarity. Our aim in this study was to evaluate the clinicopathological characteristics of these tumors and assess functional and aesthetic outcomes after CO₂ laser ablation with silicone stent intubation. A retrospective consecutive study was conducted from December 2013 to November 2020. All patients who received CO₂ laser ablation with silicone intubation for their punctal tumors at National Cheng Kung University Hospital, a tertiary hospital in Taiwan, were included in this study. Demographic and clinical information was gathered during preoperative and follow-up visits. Thirty-three Han Chinese patients with a solitary punctal tumor were included in this study. Demographically, we found a female predominance (75.8%), and most tumors were located at the lower punctum (69.7%). The incidence of melanocytic nevus was higher in punctal tumors (78.8%) than in benign eyelid tumors (22.3%). Irrigation tests were performed in the 33 patients during follow-up visits, all of whom exhibited patency of the lacrimal system. No patient complained of epiphora after surgery. Thirty-two patients (97%) were satisfied with the aesthetic outcome after surgery. Superpulse CO₂ laser ablation followed by silicone stent intubation is a safe and effective treatment for benign punctal tumors. In addition, compared to those of eyelid tumors, the clinicopathological characteristics of lacrimal punctal tumors are different, and melanocytic nevus was the main cause of these tumors.

Canalicular laceration repair using a self-retaining, bicanalicular, hydrophilic nasolacrimal stent

Purpose: To evaluate outcomes of primary eyelid and canalicular laceration repair using a self-retaining bicanalicular hydrophilic nasolacrimal stent.Methods: This study is a retrospective review of seven patients with canalicular laceration primarily repaired with a self-retaining bicanalicular nasolacrimal stent within 72 hours of initial injury. After lacrimal intubation, repair was performed by reapproximation of the lacerated tissues. Data collection included ophthalmic examination, mechanism of injury, involvement of upper/lower/common canaliculi, symptoms of epiphora, operative time, stent extrusion and canalicular irrigation.Results: Seven patients with monocanalicular laceration were repaired using the self-retaining bicanalicular nasolacrimal stent. The stent was left in place an average of 5 months. The average operative time was 29.3 minutes. None of the stents extruded prior to removal. After 5 months, the stent was removed successfully without difficulty. All patients reported subjective improvement in epiphora, with complete resolution of symptoms. Anatomic success was confirmed with irrigation in all cases. There were no complications associated with usage of the self-retaining bicanalicular nasolacrimal stent.Conclusions: Primary repair of canalicular lacerations can be successfully performed with a self-retaining bicanalicular nasolacrimal stent. This stent has several advantages, including potentially faster operative times, no need for intranasal fixation or retrieval, easier intubation in the lacrimal system, and improved anatomic reapproximation of lacerated tissues.