Duration 5min, Q&A 3min
Success Rates of Nasolacrimal Duct Intubation Using a Lacrimal Endoscope for Treatment of Complete Lacrimal Passage Obstructions
To show obstruction pathology variation in patients with epiphora, and to determine success rates of nasolacrimal duct intubation depending on the pathology.
A retrospective study using patients´ records concerning surgical outcome of nasolacrimal duct intubation was conducted, focusing on the relationship between intraoperative lacrimal endoscopy findings and the anatomic success rates following the procedure. This study included 162 eyes of 133 patients with epiphora who underwent the intubation using a lacrimal endoscope for the treatment of lacrimal passage obstructions, including common canalicular obstruction (CCO) and nasolacrimal duct obstruction (NLDO), at Yame General Hospital between April 2010 and July 2012. Patients´ age ranged from 34 to 91 years with an average of 72.6±11.1. Patients with a positive irrigation test were excluded.
All procedures were performed using a lacrimal endoscope (Fiber Tech Co.¸ Ltd.¸ Tokyo) to examine the obstruction pathology and to accurately intubate with a self-retaining lacrimal stent (Toray industries inc.¸ Tokyo). The intubation period varied from 11 days to 211 days with an average of 72±30. After removing the stent, the anatomic patency was evaluated with an irrigation test at every postoperative visit. Mean observation period following the procedure was 316±235 days. To investigate the pathology-outcome relationship, intraoperative lacrimal endoscopy findings were categorized into four pathologies: CCO without NLDO; CCO with NLDO including the duct stenosis; focal blockage of NLDO (focal NLDO); and generalized blockage of NLDO (generalized NLDO). The Kaplan-Meier survival analysis was conducted on each pathology, defining negative patency as failure.
Results and Conclusion
The variety of epiphora pathology examined using the lacrimal endoscope was 30 cases of CCO w/o NLDO¸ 18 cases of CCO with NLDO¸ 48 cases of focal NDLO¸ and 66 cases of generalized NLDO. Significant differences were noted among each group´s Kaplan-Meier survival curves (p<0.0001, log-rank test). The success rates at post-op 2 years calculated by the survival curves were 100% in CCO w/o NLDO¸ 89.9% in focal NLDO¸ 65.5% in CCO with NLDO¸ and 30.5% in generalized NLDO. No complication was noted both intra and post operatively.
The success rate of nasolacrimal duct intubation correlated with the pathology. CCO w/o NLDO showed the best success rate and focal NLDO was better compared to CCO with NLDO and generalized NLDO. Intraoperative lacrimal endoscopy gives us significant prognostic information regarding nasolacrimal duct intubation.
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