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Alruwaili R, Alanazi F, Alrashidi A, Hazazi M, Alenezi M. Comparative Analysis of Silicone Tube Intubation Versus Probing and Balloon Dilation for Congenital Nasolacrimal Duct Obstruction: A Systematic Review and Meta-Analysis. J Craniofac Surg 2024; 35:1114-1119. [PMID: 38727216 DOI: 10.1097/scs.0000000000010273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/13/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE Congenital nasolacrimal duct obstruction (CNLDO) is a pediatric disorder with a wide range of pathology. If untreated, the condition may end up with serious complications. Multiple treatment options for CNLDO exist throughout the literature, and there is an ongoing debate on the best intervention for each disease subgroup and the best timing of such interventions. This study compares the success and failure rates of silicone tube intubation (STI) against probing and balloon dilation (BD). METHODS The authors searched the literature for relevant articles using PubMed, Scopus, web of Science, and Cochrane Library until January 2024. Using RevMan 5.4, the authors compared STI's success and failure rates to probing and BD using risk ratios (RRs) and a random-effect model. In addition, the complication rate of monocanalicular intubation (MCI) versus bicanalicular intubation (BCI) was investigated. The authors used the leave-one-out method to check for influential studies and to resolve heterogeneity. RESULTS The screening process resulted in 23 eligible articles for inclusion in the authors' review. Silicone tube intubation had a higher chance of resolving the symptoms of CNLDO than probing (RR = 1.11; 95% CI: 1.04, 1.20; P = 0.004) while having less risk of surgical failure (RR = 0.48; 95% CI: 0.30, 0.76; P = 0.002]. Monocanalicular intubation showed no statistically significant difference when compared with BCI in terms of surgical success and failure; however, MCI had a lower risk of complications (RR = 0.68; 95% CI: 0.48, 0.97; P = 0.04). In addition, STI did not demonstrate any significant difference from BD. CONCLUSION There was no significant difference in success/failure between MCI and BCI; monocanalicular had fewer complications. Silicone tube intubation did better in terms of surgical success than probing, especially in children over 12 months, suggesting that it is the preferred intervention for older patients with CNLDO.
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Affiliation(s)
- Rahaf Alruwaili
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh
- Department of Ophthalmology, King Abdulaziz Specialist Hospital
| | - Farhan Alanazi
- Department of Otolaryngology-Head and Neck Surgery, Prince Mohammed Medical City, Jouf
| | - Ali Alrashidi
- Department of Otolaryngology-Head and Neck Surgery, King Salman Specialist Hospital, Hail
| | - Mohammed Hazazi
- Department of Otolaryngology-Head and Neck Surgery, Prince Sultan Medical Military City, Riyadh
| | - Mazyad Alenezi
- Department of Otolaryngology-Head and Neck Surgery, Collage of Medicine, Qassim University, Buriyadh, Qassim, Kingdom of Saudi Arabia
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Boniao ELO, Gungab AGNL, Lim BXH, Sundar G, Ali MJ. Scanning electron microscopic features of lacrimal drainage silastic stents: Comparison of various Crawford and large-diameter stents. PLoS One 2023; 18:e0295285. [PMID: 38060492 PMCID: PMC10703212 DOI: 10.1371/journal.pone.0295285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE This study aimed to examine the differences in the biofilms and physical deposits on Crawford stents compared to large-diameter stents. METHODS A prospective interventional study was performed on a series of patients undergoing external or endoscopic dacryocystorhinostomy (DCR) and endoluminal lacrimal duct recanalization (ELDR) with either Crawford or large-diameter stents. All the Crawford stents were retrieved at six weeks and the large-diameter ones at eight weeks following the surgical intervention. There was no evidence of post-operative infection in any of the patients. Following extubation, standard protocols of scanning electron microscopy were used to assess the biofilms and physical deposits on the stents. RESULTS A total of 15 stents were studied. Of these, twelve were Crawford, and three were large-diameter stents. The Crawford stents were from two different manufacturers. All the stents demonstrated evidence of biofilm formation and physical deposits. The Crawford stents showed thin biofilms and sparse physical deposits, but there were no demonstrable differences amongst stents from different manufacturers. However, the deposits and biofilms were thicker and more extensive in the large-diameter stents than the Crawford ones. The biofilms from all stents showed the presence of polymicrobial communities within the exopolysaccharide matrix. CONCLUSIONS The present study found differences in biofilms and physical deposits between Crawford and large-diameter stents. These differences can be partly explained by stent duration, size, and their tissue interactions.
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Affiliation(s)
- Emmanuel Lee Ong Boniao
- Orbit, Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore, Singapore
| | | | - Blanche Xiao Hong Lim
- Orbit, Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore, Singapore
| | - Gangadhara Sundar
- Orbit, Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore, Singapore
| | - Mohammad Javed Ali
- Orbit, Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore, Singapore
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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Thompson JP, Pharo AM, Ingram EE, Bozner EM, Avdic A, Ellis GS. A Modified Bicanalicular Crawford Placement Method for Congenital Nasolacrimal Duct Obstruction: Reducing Need for Operative Room Removal. Ophthalmic Plast Reconstr Surg 2023; 39:628-631. [PMID: 37450637 DOI: 10.1097/iop.0000000000002460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
PURPOSE This study introduces a method for Crawford bicanalicular stent placement for congenital nasolacrimal duct obstruction by looping the ends to themselves which are tied together with dissolvable sutures to ease in-office removal. METHODS This is a single institution, retrospective study that evaluates outcomes of patients aged 5 years and under who underwent bicanalicular stenting for congenital nasolacrimal duct obstruction by a single surgeon (G.S.E.) between 2004 and 2020. Only primary surgeries were included in the analysis. Stenting could be accompanied by balloon dilatation and/or turbinate infracture. Age, sex, follow-up time, complications, type of intervention, extrusion, recurrence, and operative room removal were recorded. RESULTS This study included 56 eyes from 54 patients with a mean age of 19.0 ± 9.5 months (range, 8-50 months). There was a 30.3% extrusion rate, a 5.4% rate of recurrence of disease, and a 3.6% rate of operative room removal. The average follow-up time was 25.1 ± 39.8 months (range, 1-132 months). For patients with or without extrusion, there were no significant differences between age, sex, laterality, type of intervention, follow-up time, or rate of recurrence. Each eye that had recurrence (3 total) or needed operative room removal (2 total) underwent only bicanalicular stenting without accompanying procedures, although the difference in rates between procedures was also not statistically significant. CONCLUSIONS This method had a low recurrence and operative room removal rate, with similar extrusion and complication rates to other bicanalicular stent and intubation methods for the treatment of congenital nasolacrimal duct obstruction.
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Affiliation(s)
- John P Thompson
- Department of Ophthalmology, Louisiana State University at New Orleans, New Orleans, Louisiana
| | - Austin M Pharo
- Department of Ophthalmology, Louisiana State University at New Orleans, New Orleans, Louisiana
| | - Ellen E Ingram
- Department of Ophthalmology, Louisiana State University at New Orleans, New Orleans, Louisiana
| | - Elizabeth M Bozner
- Department of Ophthalmology, Louisiana State University at New Orleans, New Orleans, Louisiana
| | - Armin Avdic
- Department of Ophthalmology, Louisiana State University at New Orleans, New Orleans, Louisiana
| | - George S Ellis
- Department of Ophthalmology, Children's Hospital of New Orleans, Louisiana, U.S.A
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Yavuz S, İlhan HD, Ersoy M. Factors affecting the need for silicon tube implantation in cases of congenital dacriostenosis: time of delivery, type of delivery and age of operation. Int Ophthalmol 2023; 43:3747-3754. [PMID: 37382816 DOI: 10.1007/s10792-023-02785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To evaluate the delivery time, type of delivery, age at the time of operation, and surgical methods applied in cases of congenital nasolacrimal duct obstruction (CNLDO). METHODS This study retrospectively included a total of 207 eyes of 160 cases who underwent surgery for CNLDO between February 2012 and April 2021. According to their age at the time of operation, the cases were divided into 0-12, 12-24, 24-36, 36-48 and > 48 months groups. The cases were evaluated as term/preterm according to the delivery time and cesarean section/vaginal delivery according to the type of delivery. The surgical methods applied were examined as probing alone and probing plus silicone tube implantation. RESULTS Of the cases, 146 (91.2%) were born at term and 14 (8.7%) were born preterm, and there was no statistically significant difference in the silicone tube implantation rates according to the time of delivery. The rate of silicone tube implantation was statistically significantly higher in the vaginal delivery group than in the cesarean section group (p = 0.001; p < 0.01). The rate of silicone tube implantation was higher in those who were older than the age of the operation. CONCLUSIONS Although the rate of those who were born by cesarean section was higher in probing cases, those who required silicone intubation were more common in those who were born vaginally. This suggests that dacryostenosis in the vaginally born cases resulted from a persistent structural and anatomical obstruction despite the presence of a high intrauterine pressure increase and enzymatic lysis.
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Affiliation(s)
- Sibel Yavuz
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey.
| | | | - Merve Ersoy
- Gaziantep Cengiz Gökçek Obstetrics and Gynecology and Pediatrics Hospital, Gaziantep, Turkey
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Arici C, Oto BB. Nasal endoscopy-guided primary nasolacrimal duct intubation for congenital nasolacrimal duct obstruction in children older than 4 years. Int Ophthalmol 2022; 43:1005-1011. [PMID: 36053476 DOI: 10.1007/s10792-022-02503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of endoscopic guided primary bicanalicular intubation (BCI) for congenital nasolacrimal duct obstruction (CNLDO) in children older than 4 years. METHODS A total of 40 eyes from 33 children (18 males, 15 females) with CNLDO who underwent bicanalicular intubation were evaluated. The type of CNLDO was determined by endonasal endoscopic visualisation. The mean silicone tube removal time was 4.3 ± 0.9 months (ranging from 3 to 6 months). The children were followed up for 6 months after the removal of tubes. Therapeutic success was defined as the normal result of the fluorescein dye disappearance test and complete resolution of previous lacrimal symptoms and signs. RESULTS The median age was 80 [48] (range 48-156) months. Treatment success was achieved in 32 of 40 eyes (80.0%). A statistically significant correlation was observed between the age and success rate (p = 0.006). The success rate was lower in older children. Membranous type of CNLDO was observed in 47.5% (19/40) of the cases. The median age of patients with a membranous and complex type of CNLDO were 60 [30] months and 96 [53] months, respectively. Surgical success was 100% in the membranous type of CNLDO and 61.9% in the complex CNLDO group. CONCLUSIONS Primary BCI using nasal endoscopic visualisation has a favourably high success rate for treating CNLDO in children aged 4 to 13 years. Treatment success was found to be related to both the type of CNLDO and age.
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Affiliation(s)
- Ceyhun Arici
- Department of Ophthalmology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, 34098, Fatih, Istanbul, Turkey.
| | - Bilge Batu Oto
- Department of Ophthalmology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, 34098, Fatih, Istanbul, Turkey
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Chi YC, Lai CC. Endoscopic dacryocystorhinostomy with short-term, pushed-type bicanalicular intubation vs. pulled-type monocanalicular intubation for primary acquired nasolacrimal duct obstruction. Front Med (Lausanne) 2022; 9:946083. [PMID: 35966838 PMCID: PMC9367212 DOI: 10.3389/fmed.2022.946083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Dacryocystorhinostomy (DCR) has been a primary treatment for adults with nasolacrimal duct obstruction, while the optimal approach and technique remain controversial. With the advancement of endoscopic DCR and the silicone stents, an update of the surgical outcomes and preferable approaches is required. This study aims at comparing the surgical outcomes of endoscopic DCR using pushed bicanalicular intubation (BCI) to pulled monocanalicular intubation (MCI) in adults with primary acquired nasolacrimal duct obstruction (PANDO). Forty five eyes of 45 patients were enrolled, including 22 eyes of 22 patients treated with endoscopic DCR with pulled MCI and 23 eyes of 23 patients with pushed BCI from January 2014 to June 2021. The success rates at stent removal, 1 month and 3 months after removal were 95, 91, and 82%, respectively, in the MCI group, and 100, 87, and 87% in the BCI group. The BCI group had better success rates but failed to reach a significant difference (p = 0.49, p = 0.67, p = 0.24, respectively). After analyzing with binary logistic regression, the implant material was demonstrated as the predictive of surgical success (p = 0.045). There was no significant difference in success rates between patients with dacryocystitis and those without dacryocystitis. We conclude that endoscopic DCR with pushed BCI is easily manipulated and has a promising surgical outcome over pulled MCI. Stent indwelling duration as well as history of dacryocystitis have less influence on the success rates.
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Affiliation(s)
- Yi-Chun Chi
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Chieh Lai
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Chun-Chieh Lai
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Hamed Azzam S, Hartstein M, Dolmetsch A, Mukari A. Assessment of Lacrijet monocanalicular intubation for congenital nasolacrimal duct obstruction. Eur J Ophthalmol 2022; 32:3340-3345. [PMID: 35102761 DOI: 10.1177/11206721221076941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the success rate and complications of Lacrijet monocanalicular stent (FCI S.A.S, Paris, France) intubation in children treated for congenital nasolacrimal duct obstruction (CNLDO). METHODS Retrospective review study which included children with CNLDO that were intubated with Lacrijet monocanalucilar silicone tube.The Lacrijet tube remained in place for 11-15 weeks post operatively and was removed in the clinic with topical anesthesia. Operative time was recorded for each case. All children were evaluated using the following parameters preoperatively and postoperatively: tear meniscus height, Fluorescein dye disappearance test (FDDT), and MUNK score. RESULTS The study included 20 eyes with mean age of 26.25 ± 11.25 months. 17 eyes (85%) had undergone probing previously. Mean operation time of Lacrijet intubation was 8.5 min (95% CI 7.04-9.95). Mean follow-up period was 204.65 ± 105.27 days. Lacrijet intubation resulted in statistically significant improvements in tear meniscus height (P < .001), FDDT (P < 0.001), and MUNK score (P < 0.001) in all children. Two different sizes of Lacrijet intubations were used. Complete success was obtained in all cases. No complications were observed. CONCLUSIONS Lacrijet lacrimal intubation has a high rate of success, shortens surgical time and has a low rate of complications in children with CNLDO.
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Affiliation(s)
- Shirin Hamed Azzam
- Ophthalmology Department, 243586Baruch Padeh Medical Center, Poriya, Israel.,Affilitated to the Faculty of Medicine, Bar Ilan University, Israel
| | - Morris Hartstein
- Ophthalmology Department, Shamir Medical Center, Tzrifin, Israel
| | - Angela Dolmetsch
- Oculoplastic Department, 58817Clinica de Oftalmologica de Cali, Colombia, South America
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Gandhi K, Dzioba A, Husein M, Makar I, Sharan S. Effectiveness of pediatric Crawford tube implants when endoscopically assisted by ENT surgeons. CANADIAN JOURNAL OF OPHTHALMOLOGY 2022; 58:245-251. [PMID: 35038411 DOI: 10.1016/j.jcjo.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Epiphora in pediatrics is commonly treated with silicone nasolacrimal stents. The most common treatment duration is 3 months, but tubes are often unintentionally removed earlier and are still effective. There is no consensus on how long tubes need to be in situ and what factors influence treatment success. METHODS A retrospective chart review of patients who underwent Crawford tube placement over a 10-year period (2009-2019) was conducted. Patients were age >18 years and had Crawford tubes placed in conjunction with an otolaryngologist, who performed nasal endoscopy for direct visualization when retrieving Crawford tubes and infracture of the inferior turbinate. Bicanalicular intubation was attempted in all cases; if not possible, monocanalicular intubation was performed. RESULTS Forty-two patients were included in this study, representing 50 eyes. Spontaneous extrusion of tubes occurred in 54% of eyes. Tubes remained in situ for an average of 17.1 weeks (0-113 weeks). Symptoms resolved in 86% of patients, similar to procedures without endoscopy. There were no intraoperative complications. There was no association between the rate of persistent symptoms and duration of treatment. CONCLUSION Nasolacrimal duct intubation using Crawford tubes performed under direct endoscopic visualization is consistently successful for the treatment of epiphora. Although epiphora can be self-resolving, persistent symptoms typically lasting past the first year of birth, warrant treatment. Children who receive Crawford tubes for epiphora commonly have spontaneous tube extrusion before treatment duration is complete. However, treatment success was not related to the length of time the tubes were in situ. Endoscopic visualization can help prevent intraoperative complications.
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Affiliation(s)
- Karan Gandhi
- Department of Otolaryngology- Head and Neck Surgery, Western University, London, Ont..
| | - Agnieszka Dzioba
- Department of Otolaryngology- Head and Neck Surgery, Western University, London, Ont
| | - Murad Husein
- Department of Otolaryngology- Head and Neck Surgery, Western University, London, Ont
| | - Inas Makar
- Department of Ophthalmology, Western University, London, Ont
| | - Sapna Sharan
- Department of Ophthalmology, Western University, London, Ont
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Dryden SC, Meador AG, Awh C, Smith BD, Eder AE, Bohn SN, Hoehn ME, Fowler B, Fleming JC. Effect of Premature Tube Extrusion for Simple Congenital Nasolacrimal Duct Obstruction: A Comparison of Monocanalicular and Bicanalicular Intubation. J Craniofac Surg 2021; 33:211-213. [PMID: 34292239 DOI: 10.1097/scs.0000000000007915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The objective of this article is to compare the incidence of premature dislocation of silicone tubes and the effect on treatment success between monocanalicular (MCI) and bicanalicular (BCI) intubation in pediatric patients with simple congenital nasolacrimal duct obstruction. Retrospective comparative case series of 108 eyes of 78 pediatric patients with simple congenital nasolacrimal duct obstruction who underwent probing with either BCI (n = 38 eyes) or MCI (n = 70 eyes) from 2017 to 2020. Premature tube extrusion was defined as any tube removed prior to the 3 month postoperative appointment. Success was defined as resolution of tearing 3 months post tube removal. Ages ranged from 10 months to 5.35 years (mean, 1.95 years; Standard deviation (SD), 0.91). Premature tube extrusion occurred in 15 eyes with BCI and 29 eyes with MCI. Success rates were not significantly different regardless of intubation type between the planned tube removal (90.6%) and the premature tube extrusion cohorts (84.1%), P = 0.89. There was no significant difference in treatment success between the planned tube removal (92.7% MCI, 87% BCI) and the premature tube extrusion cohorts (86.2% MCI, 80% BCI). Complications included 2 infections (1 MCI, 1 BCI) and 2 cases of tube related keratopathy (1 MCI, 1 BCI) that all resolved with tube removal. There were 2 BCI patients that presented to the emergency department for premature tube extrusion. Silicone intubation regardless of stent type is an effective treatment for simple congenital nasolacrimal duct obstruction. There was no significant difference in treatment success between tubes that extrude prematurely, and tubes removed at term based on type of intubation.
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Affiliation(s)
| | | | | | | | | | - Shiva N Bohn
- Department of Ophthalmology.,Le Bonheur Children's Hospital Department of Ophthalmology, University of Tennessee, Memphis, Hamilton Eye Institute, Memphis, TN
| | - Mary E Hoehn
- Department of Ophthalmology.,Le Bonheur Children's Hospital Department of Ophthalmology, University of Tennessee, Memphis, Hamilton Eye Institute, Memphis, TN
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Mihailovic N, Grenzebach UH, Eter N, Merté RL. Application Possibilities of a New Preloaded Nasolacrimal Duct Intubation System. Klin Monbl Augenheilkd 2021; 238:48-54. [PMID: 33506448 DOI: 10.1055/a-1274-0773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The LacriJet (FCI S. A. S. - France Chirurgie Instrumentation, Paris, France) represents a novel, simplified and preloaded system for monocanalicular or monocanaliculonasal nasolacrimal duct intubation. It is a further development of the Masterka and shall reduce the intubation time during the surgical procedure. The aim of the present study was to present first experiences with this system for different indications. MATERIAL AND METHODS All patients who underwent nasolacrimal duct intubation with the LacriJet at the University of Muenster Medical Center in the period from March to November 2019 were included. The postoperative outcome was evaluated 3 to 6 months later. RESULTS In total, 12 nasolacrimal duct intubations with the LacriJet were performed at our center in the above-mentioned period. The main indication for intubation was congenital nasolacrimal duct obstruction (CNLDO). In addition, intubation was performed in cases with eye lid tumors involving the nasolacrimal duct, in a case of canalicular laceration and in a case of canaliculitis. In 3 cases, there was an early dislocation or a complete loss of intubation. Of these, 2 were cases with CNLDO and the third dislocation was due to manipulation by the patient. All in all, the functional results were satisfying. SUMMARY The use of the LacriJet is highly suitable for the treatment of CNLDO, stenting in canalicular laceration or lid tumours involving the lacrimal drainage system. However, the known disadvantages of monocanalicular intubation (dislocation, early loss of intubation) also occur with this type of system and a system briefing seems useful. The LacriJet therefore represents a modern and simple method for nasolacrimal duct intubation and can be used for various indications.
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Affiliation(s)
- Natasa Mihailovic
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | | | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
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Jamshidian Tehrani M, Eshraghi B, Tayebi F, Momenaei B. Monocanalicular intubation in children with incomplete complex congenital nasolacrimal duct obstruction older than five years of age. J Curr Ophthalmol 2021; 33:481-484. [PMID: 35128198 PMCID: PMC8772484 DOI: 10.4103/joco.joco_52_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the role of monocanalicular intubation (MCI) in congenital nasolacrimal duct obstruction (CNLDO) in children older than 5 years of age. Methods: A retrospective case series study was done on children over 5 years of age diagnosed with CNLDO who underwent MCI. Success rates were evaluated subjectively by asking their parents about persistent symptoms and objectively using the dye disappearance test in clinical examination. Results: A total of 43 eyes of 37 patients with a mean age of 7.42 ± 2.33 (range, 5–15 years of age) were included. The success rate was 60.46%, and the rate of secondary surgical intervention was 25% of all cases (61.11% of failed cases). Conclusion: Primary MCI maintains a reasonable success rate in incomplete complicated CNLDO regardless of age.
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The Use of Stents in Children with Nasolacrimal Duct Obstruction Requiring Surgical Intervention: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031067. [PMID: 32046207 PMCID: PMC7037191 DOI: 10.3390/ijerph17031067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. It is managed conservatively in the first year of life, after which surgical treatment is classically based on a stepwise paradigm of probing, intubation, and dacryocystorhinostomy. This systematic review aims to present the current role of intubation in the management of children with NLDO requiring surgical intervention. A search for English-language articles from the electronic databases PubMed, SCOPUS, and the COCHRANE library was conducted over a period of five months in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. The following keywords were used to aid retrieval: stents, children, lacrimal intubation, endoscopic dacryocystorhinostomy, external dacryocystorhinostomy, NLDO, dacryocystitis, congenital, acquired. The primary outcome was defined as the success of the intervention, determined by resolution of symptoms and patency of the lacrimal anatomy confirmed by the fluorescein dye disappearance test or syringing. Secondary outcomes included the presence of complications. A total of 144 articles were identified; of these, 35 fulfilled the study criteria. The majority of the included studies involved lacrimal intubation alone, followed by intubation as an adjunctive procedure to balloon dacryoplasty and dacryocystorhinostomy. The overall success rate of these procedures ranged from 41.1% to 100%. Post-operative complications were reported in 65.7% of the included studies. Lacrimal intubation was most commonly performed as a primary procedure in children with NLDO, with high success rates. The main complication was stent dislodgement. There is lack of evidence regarding the benefit of intubation over probing as primary treatment of congenital NLDO. In the absence of high-quality evidence, the decision of whether to perform lacrimal intubation in children with NLDO requiring surgical intervention depends on clinical judgement and other low-level evidence, such as observational non-randomised trials.
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Singh M, Sharma M, Kaur M, Grewal AM, Yadav D, Handa S, Yangzes S, Zadeng Z, Gupta P. Nasal endoscopic features and outcomes of nasal endoscopy guided bicanalicular intubation for complex persistent congenital nasolacrimal duct obstructions. Indian J Ophthalmol 2019; 67:1137-1142. [PMID: 31238429 PMCID: PMC6611323 DOI: 10.4103/ijo.ijo_1819_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: To study the clinical presentation, nasal endoscopic features, and outcomes of nasal endoscopy guided (NEG) bicanalicular intubation (BCI) in children with complex persistent congenital nasolacrimal duct obstruction (pCNLDO). Methods: A prospective, interventional study including eligible children (age ≤ 12 years) having complex pCNLDO. The demographics, number of previous probings, nasal endoscopy findings, and outcomes; were noted in all children who underwent NEG-BCI with Crawford's stents. Matting of eyelashes (MoE, upper, and lower eyelid), tear-film height (TFH), and fluorescein dye disappearance test (FDDT) was assessed pre and postoperatively. The minimum stent in-situ period was 12 weeks, and the minimum follow-up was 6 months (after stent removal). Results: Total 32 children (36 eyes) including 18 females (56.25%) were studied. At a mean age of 4.9 years, all children had epiphora and discharge with MoE (both upper and lower), raised TFH and positive FDDT. Previously, all children underwent conventional probing (s)- once in 12 (33.3%), twice in 18 (50%) and thrice in 6 (16.7%) eyes. The general ophthalmologists performed the majority (n = 21, 58.33%) of those. The BCI was performed under GA in all eyes, and at a mean follow-up of 8.5 months, the “complete” success was noted in 29 eyes (80.5%), ‘partial’ success in 4 (11.1%) and failure in 3 (8.3%). The stent prolapse was seen in three. Conclusion: NEG-BCI may provide a satisfactory resolution to complex pCNLDO after single or multiple failed probings. NEG provides confident and efficient management of coexistent intranasal complexities related to the inferior turbinate and meatus.
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Affiliation(s)
- Manpreet Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjula Sharma
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Mehta Grewal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Yadav
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sabia Handa
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonam Yangzes
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Zoramthara Zadeng
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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