Risk Factors for Poor Surgical Outcome of Pediatric Nasolacrimal Duct Obstruction

Down Syndrome: A Review of Key Perioperative Implications

Down syndrome (DS) is the most common chromosomal abnormality in humans that is compatible with life. This syndrome occurs when there is an extra copy of the 21st chromosome. Down syndrome is associated with numerous comorbidities that can pose challenges for the perioperative nurse caring for a patient with DS undergoing surgery. These challenges can affect the patient assessment, communication with the patient, and patient safety (eg, preventing complications). As the life expectancy of people with DS has increased, so too have the chances that perioperative nurses will care for a patient with this disorder. This article reviews the pathophysiology of DS, discusses common comorbidities that may directly affect perioperative care, and reviews an exemplar case study that demonstrates how personnel with knowledge of DS can positively influence surgical team decision making for these patients in the perioperative setting.

A Survey of Pediatric Ophthalmologists to Assess Practice Patterns for Primary Surgical Management of Nasolacrimal Duct Obstruction

PURPOSE

To survey current practice patterns of pediatric ophthalmologists regarding primary surgical management of infantile dacryostenosis.

METHODS

Responses to a five-question survey were cross-tabulated to compare surgery preferences across patient age ranges and intubation method. Surveys were submitted to members of the American Association for Pediatric Ophthalmology and Strabismus following institutional review board approval.

RESULTS

Results from 142 completed surveys were analyzed. A bimodal distribution of reported propensity to intubate the nasolacrimal duct during primary surgery for dacryostenosis was observed, with one group of ophthalmologists intubating frequently and a second group intubating rarely. For patients younger than 24 months, 33 of 142 surgeons (23%) preferred to intubate 91% or more of the time and 76 of 142 (54%) preferred to intubate 10% or less of the time. For patients older than 24 months, the overall preference for intubation increased compared to the younger patient age group (P < .0007). In older patients, 52 of 142 surgeons (37%) preferred to intubate 91% or more of the time and 45 of 142 surgeons (32%) preferred to intubate 10% or less of the time. The most common preferred intubation methods were self-threading monocanalicular stent (42%) and metal-swaged bicanalicular stent (21%). Surgeons who preferred self-threading monocanalicular stents more often also preferred intubation procedures.

CONCLUSIONS

Best practice for infantile dacryostenosis remains a surgeon preference, with some surgeons performing intubation frequently and others performing it rarely. Overall estimated intubation rates for primary surgery increased from 36% in children younger than 24 months to 50% at age 24 months or older. [J Pediatr Ophthalmol Strabismus. 2022;59(1):35-40.].

Success rates of probing for congenital nasolacrimal duct obstruction at various ages

BACKGROUND

Although nasolacrimal duct probing is the standard treatment for congenital nasolacrimal duct obstruction (CNLDO) among children, the optimal timing of this procedure has been a topic of debate. The aim of the study was to analyze the clinical efficacy of nasolacrimal duct probing among patients with CNLDO symptoms at various ages.

METHODS

An 8-year retrospective study involved 2434 patients (3009 eyes), who underwent nasolacrimal duct probing conducted under topical anesthesia in the operating theatre. The study group consisted of 1148 girls (47.2%) and 1286 boys (52.8%) from 2 weeks to 41 months (average age was 8 ± 5.6 months). The participants were divided into nine age groups: 0-2 months, 3-6 months, 7-9 months, 10-12 months, 13-15 months, 16-18 months, 19-21 months, 22-24 months and over 24 months.

RESULTS

Bilateral obstruction was present among 575 (23.6%) children and was associated with a higher percentage of unsuccessful procedures compared to patients with unilateral obstruction (16.9% vs 10.2%, p < 0.001 Chi-square test). The success rate of the initial probing was 87.2% for all children and it was shown that it decreased with age. In the above age groups, it was 87.9%; 91.4%; 89.6%; 86%; 76.3%; 71.3%; 70.3%; 70.2%; 65.4%, respectively.

CONCLUSIONS

Probing is a safe and effective procedure. However, age at the time of the initial intervention and bilateral surgery constitute significant risk factors for failed probing. Probing between 7 and 9 months appears to be reasonable treatment strategy for children without recurrent infections. Early surgical intervention may be considered for patients with additional signs.