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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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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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Abu Serhan H, AlSamhori JF, Siddiq A, Hassan AR, Irshaidat S, Abu Serhan L, Alawadhi A, Abdelaal A, Al-Thawabieh W. Preferred Practice Patterns of Congenital Nasolacrimal Duct Obstruction in Jordan. Clin Ophthalmol 2023; 17:2309-2322. [PMID: 37593358 PMCID: PMC10429064 DOI: 10.2147/opth.s421054] [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: 05/12/2023] [Accepted: 06/23/2023] [Indexed: 08/19/2023] Open
Abstract
Purpose Congenital nasolacrimal duct obstruction (CNLDO) is fairly common in newborns. The main aim of this cross-sectional study is to assess the preferred practice patterns of CNLDO among ophthalmologists in Jordan. Methods This cross-sectional study was conducted across all ophthalmological practices in Jordan, using convenience sampling. An online questionnaire, designed through Google Forms, was distributed through social media. The survey contained four domains: baseline characteristics of participants and the diagnosis (7 items), medical management (3 items), and surgical management (11 items) of CNLDO. Descriptive statistics were conducted using SPSS (IBM SPSS Corp, SPSS Statistics ver. 26, USA). Results Eighty-three physicians responded to the survey, with an average age of 40.6 ± 8.6. More than half of the participants (53.0%, n = 44) were general ophthalmologists. Only 37.3% of our sample (n = 31) regularly evaluated the refraction of a child presenting with epiphora suggestive of CNLDO. Criggler's nasolacrimal duct massage was recommended by 62.7% of respondents (n = 52) for up to 12 months. In addition, 72.3% of respondents (n = 60) recommended 12 months as the minimum age for primary probing of CNLDO. Silicon intubation was considered for primary probing starting at 24 months by 31.3% of ophthalmologists (n = 20). Monocanalicular stent was preferred by 42.2% of respondents (n = 27) while 31.3% (n = 20) preferred bicanalicular stent. Conclusion There is considerable variability in preferred practice patterns regarding the diagnosis and management of CNLDO in Jordan. Our findings highlight the gaps in optimum practices which need to be addressed for better management.
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Affiliation(s)
- Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporations, Doha, Qatar
| | | | | | - Abdul Rhman Hassan
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sara Irshaidat
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | | | | | | | - Wejdan Al-Thawabieh
- Department of Ophthalmology, Dr. Sulaiman Al Habib Hospital, Riyadh, Saudi Arabia
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Natarajan K, Kasturi N, Sistla S. Assessment of Perinatal Clinical Characteristics, Perinatal Risk Factors, and Microbial Profile in Congenital Nasolacrimal Duct Obstruction in a Tertiary Care Center: A Descriptive Study. KOREAN JOURNAL OF OPHTHALMOLOGY 2022; 36:366-373. [PMID: 35959546 PMCID: PMC9388893 DOI: 10.3341/kjo.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the perinatal risk factors, clinical characteristics, and microbial profile in congenital nasolacrimal duct obstruction (CNLDO). Methods A prospective observational study was conducted in pediatric patients of age <5 years. After a thorough clinical evaluation, the diagnosis of the CNLDO was confirmed by a Jones dye test or fluorescein dye disappearance test. A microbiological culture of lacrimal sac resurge was done with a sterile swab stick without touching the lid margins. Antibiotic susceptibility was then performed for the standard antibiotics. Results Seventy-one eyes of 52 children were included in the study. The mean age was 3.4 months. Our research found an equal number of cases born via spontaneous vaginal delivery and Caesarean section. Nine children (17.3%) had associated systemic and ocular anomalies. The number of cultures that were positive for any growth was 19 (27%). The most common isolate was Streptococcus pneumoniae which constituted eight cases (42%), followed by Pseudomonas aeruginosa (15.8%), and Escherichia coli (10.5%). Other organisms that grew were Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis and nonfermenting gram-negative bacilli. Gram-positive organisms were susceptible to ciprofloxacin, amoxiclav, and oxacillin, and most of them were resistant to erythromycin. In comparison, gram-negative organisms showed 62.5% resistance and 37.5% susceptibility to ciprofloxacin. Conclusions CNLDO was more commonly unilateral, in male, preterm, and normal birth weight infants. Bilateral CNLDO was more commonly associated with coexisting ocular or systemic anomalies. Prematurity, delivery by Caesarean section, and presence of congenital anomalies were associated with a prolonged course. S. pneumoniae was the predominant isolate in our patient population.
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Affiliation(s)
- Kaviyapriya Natarajan
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry,
India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry,
India
| | - Sujatha Sistla
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry,
India
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Success rates of probing for congenital nasolacrimal duct obstruction at various ages. BMC Ophthalmol 2020; 20:403. [PMID: 33032542 PMCID: PMC7542772 DOI: 10.1186/s12886-020-01658-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Abdu L, Bawahab N, Mohammed Hussain RW, Qary H, Saeedi A, Alhibshi N. Prevalence and Treatment Outcome of Nasolacrimal Duct Obstruction in Saudi Children with Down Syndrome. Cureus 2020; 12:e6672. [PMID: 31976186 PMCID: PMC6968829 DOI: 10.7759/cureus.6672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction Congenital nasolacrimal duct obstruction (CNLDO) is one of the most common congenital abnormalities encountered by pediatric ophthalmologists, occurring in 20-30% of all neonates (range: 6-84%). The majority of the cases (up to 90%) resolve within the first year of birth. Many syndromes, such as Down syndrome, are associated with congenital lacrimal anomalies. The prevalence of nasolacrimal anomalies in Down syndrome has been reported to be 22%. Methods This was a retrospective study of all children diagnosed with Down syndrome at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia between 2010 and 2015. Result The total sample size was 175 patients; 15 patients were diagnosed with CNLDO with a prevalence of 8.57%. The prevalence among the gender was 53.3% male and 46.7% female, with a median age of eight years. Regarding ocular disorders, 20.0% cases were diagnosed with refractive error, 13.3% with nystagmus, and 13.3% with blepharitis. Myopia, strabismus, conjunctivitis, and cataract were observed in four different patients, and the remaining four cases reported no other ocular disorders. Tearing, alone or associated with other symptoms, was the main presentation of CNLDO (86.7%). Bilateral CNLDO was the most commonly observed abnormality, alone or associated with others. The median age at diagnosis was one year. Of the cases, 53.3% were treated medically, 26.7% by surgical correction, and 13.3% required both. Conclusion Bilateral CNLDO is the most observed disease pattern among children with Down syndrome. In our study, tearing was the most common clinical presentation and most cases were treated medically. Down syndrome patients should be carefully examined for nasolacrimal duct obstructions and treated medically.
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Affiliation(s)
- Lujain Abdu
- Medicine, King Abdulaziz University, Jeddah, SAU
| | - Noor Bawahab
- Pediatric, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Hesham Qary
- Medicine, King Abdulaziz University, Jeddah, SAU
| | - Asalh Saeedi
- Medicine, King Abdulaziz University, Jeddah, SAU
| | - Nizar Alhibshi
- Ophthalmology, King Abdulaziz University Hospital, Jeddah, SAU
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Alakus MF, Dag U, Balsak S, Erdem S, Oncul H, Akgol S, Diri H. Is there an association between congenital nasolacrimal duct obstruction and cesarean delivery? Eur J Ophthalmol 2019; 30:1228-1231. [PMID: 31744323 DOI: 10.1177/1120672119889522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to research the relationship between types of birth and congenital nasolacrimal duct obstruction. METHOD The study enrolled 665 infantile patients with prediagnosis of congenital nasolacrimal duct obstruction due to associated ophthalmic symptoms. Age, gender, family history, delivery type, and patient medical records were investigated. Patients were grouped and compared according to their birth type and whether it was the first birth. RESULTS The number of the infants with and without congenital nasolacrimal duct obstruction was 227 (34.1%) and 438 (65.9%), respectively. Comparison of the congenital nasolacrimal duct obstruction and non-congenital nasolacrimal duct obstruction groups according to the first births showed that ratio of cesarean section was significantly higher in the congenital nasolacrimal duct obstruction group than the non- congenital nasolacrimal duct obstruction group (58.7% and 20.7%, respectively). Number with positive family history also was significantly higher in the congenital nasolacrimal duct obstruction group. CONCLUSION Cesarean section in first birth and positive family history of congenital nasolacrimal duct obstruction appear to be important risk factors in the etiopathogenesis of congenital nasolacrimal duct obstruction.
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Affiliation(s)
- Mehmet Fuat Alakus
- Department of Ophthalmology, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Umut Dag
- Department of Ophthalmology, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Selahattin Balsak
- Department of Ophthalmology, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Seyfettin Erdem
- Department of Ophthalmology, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Hasan Oncul
- Department of Ophthalmology, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Sedat Akgol
- Department of Obstetrics and Gynecology, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Halit Diri
- Department of Endocrinology and Metabolic Diseases, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
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Heichel J, Bachner F, Schmidt-Pokrzywniak A, Struck HG, Stuhlträger U, Bredehorn-Mayr T. [Treatment of congenital lacrimal duct obstruction: A prospective clinical cohort study]. Ophthalmologe 2015; 112:840-7. [PMID: 26070835 DOI: 10.1007/s00347-015-0067-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pressurized probing and irrigation is the method of choice for congenital lacrimal duct obstruction after conservative therapeutic strategies have failed. The aim of this study was to evaluate age dependence and success rates of different therapeutic options. MATERIAL AND METHODS A prospective cohort study of children with congenital lacrimal duct obstruction was performed. All children treated during the period between May 2009 and June 2010 were included. Surgical success was defined as the absence of epiphora and mucous discharge for a postoperative follow-up of 3 months. Odds ratios (OR) and 95 % confidence intervals (CI) of different variables were estimated using logistic regression. RESULTS A total of 111 children (137 eyes) underwent treatment for congenital lacrimal duct obstruction. The mean age of the children was 7.7 months (range 1-30 months). The success rate of probing under local anesthesia was 85.5 % (n = 100). Probing under general anesthesia without intubation of the lacrimal pathway was successful in 28.6 % (n = 2). Treatment under general anesthesia with intubation of the lacrimal pathway had a success rate of 94.2 %. If the primary treatment was complicated the OR was 1.9 (95 % CI: 0.7-5.1), for males the OR was 1.7 (95 % CI: 0.8-3.5) and in cases of a positive family history the OR was 1.5 (95 % CI: 0.7-3.3). With every increasing month of age the risk not to be treated successfully increased (OR: 1.3, 95 % CI: 1.2-1.5). CONCLUSION Syringing under local anesthesia is an effective therapy. The highest success rates were found at the ages of 1-6 months. Therapy with additional silicone tube intubation was highly successful.
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Affiliation(s)
- J Heichel
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - F Bachner
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - A Schmidt-Pokrzywniak
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - H-G Struck
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - U Stuhlträger
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - T Bredehorn-Mayr
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
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