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Dikici O, Dikici GK. An Unusual Case: Nasolacrimal Stent Penetrating the Oral Cavity. Indian J Otolaryngol Head Neck Surg 2024; 76:2121-2123. [PMID: 38566694 PMCID: PMC10982260 DOI: 10.1007/s12070-023-04441-6] [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: 11/06/2023] [Accepted: 12/07/2023] [Indexed: 04/04/2024] Open
Abstract
Lacrimal bypass tubes create a fistula from the conjunctiva to the lacrimal sac or the nasal cavity. Fluoroscopic nonoperative placement of a plastic stent has shown successful results in the treatment of epiphora. Polyurethane lacrimal stents have been reported as a safe, easy, non-surgical treatment in the treatment of distal lacrimal obstruction. Recurrence due to stent occlusion of the granulation tissue is common. Stent displacement is very rare. We presented the first case of the stent protruded into the mouth in the literature.
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Affiliation(s)
- Oğuzhan Dikici
- Department of Otorhinolaryngology, Health Sciences University Bursa Yüksek İhtisas Training and Research Hospital, Mimarsinan Mahallesi, Emniyet Cd. No:35, Bursa, Yıldırım 16310 Turkey
| | - Gülçin Kazaz Dikici
- Department of Ophthalmology, Health Sciences University Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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The results of Ritleng bicanalicular silicone intubation for congenital and adult partially acquired nasolacrimal duct obstruction. North Clin Istanb 2021; 8:479-484. [PMID: 34909586 PMCID: PMC8630715 DOI: 10.14744/nci.2021.64624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/29/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE: Our aim was to evaluate the long-term results of Ritleng bicanalicular silicone intubation for congenital and adult partially acquired nasolacrimal duct (NLD) obstruction. METHODS: We evaluated 28 eyes of the 26 patients treated with lacrimal intubation with the Ritleng method retrospectively. Patients were divided into two groups. Patients with congenital NLD obstruction (n: 16) constituted Group 1 and patients with adult partially acquired NLD obstruction (n: 10) constituted Group 2. The Ritleng probe was inserted from the canaliculus into the inferior meatus. Success was defined within two parameters: (1) Intubation of the silicone tube without complications and (2) recovery of the previous signs and symptoms and a normal fluorescein dye test. RESULTS: Mean of the patients’ ages was 2.4±1.6 years in Group 1 and 49±15 years in Group 2. The intubation was successful in all of the patients (100%) in Group 1, meanwhile in Group 2, false passage was observed in 2 patients (20%). Silicone tube was removed through the punctum in outpatient clinic conditions between 2 weeks and 3 months (mean: 2.1 months) in Group 1 and 4–6 months (mean: 5.2 months) in Group 2. Patients in Groups 1 and 2 were followed for 26±18.6–36±25 months, respectively. Previous signs and symptoms were recovered in 75% of the patients in Group 1 and the dye tests of these patients were normal. In Group 2, only two patient’s symptoms were resolved (20%). For the adult patients whose symptoms were not resolved, an external dacryocystorhinostomy operation was performed. CONCLUSION: The Ritleng lacrimal intubation system is an effective procedure for the treatment of congenital NLD obstruction for both short and long term. On the other hand, the effectiveness of the procedure is limited for the adult partially acquired NLD obstruction.
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Trimarchi M, Giordano Resti A, Vinciguerra A, Danè G, Bussi M. Dacryocystorhinostomy: Evolution of endoscopic techniques after 498 cases. Eur J Ophthalmol 2019; 30:998-1003. [DOI: 10.1177/1120672119854582] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Endoscopic dacryocystorhinostomy is a well-known surgical practice used to treat nasolacrimal duct obstruction and widely considered as a valid alternative to external approaches. Purpose: We present a retrospective case series of 498 endoscopic dacryocystorhinostomies on 401 patients, from July 2004 to May 2018, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. Methods: Of the 498 procedures, 426 were unilateral and 72 were bilateral dacryocystorhinostomy. All patients underwent routine preoperative workup including fluorescein test (Jones test 1–2), probing and irrigation of the lacrimal way, nasal endoscopy, and maxilla-facial computed tomography scan. Surgical technique was based on nasal endoscopic dacryocystorhinostomy followed by positioning of a Catalano’s silicone stent, which was left in place for about 3 months. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. Results: Anatomic success was achieved in 91.54% cases in primary dacryocystorhinostomy and in 89.36% after revision, whereas functional success was obtained in 90.4% in primary and 85.1% in secondary dacryocystorhinostomies. After a second revision of endoscopic dacryocystorhinostomy, anatomical success was achieved in 90.1% and functional success in 88.7% of procedures. Conclusion: Our results confirm that endoscopic dacryocystorhinostomy can be considered as a valid surgical approach to primary nasolacrimal duct obstruction and revision cases. The key aspects in achieving functional and anatomical results are meticulous surgical procedure and precise follow-up.
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Affiliation(s)
- Matteo Trimarchi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Ophthalmology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Vinciguerra
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Giulia Danè
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Mario Bussi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
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4
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Park JH, Kang WS, Kim KY, Kang BC, Park JW, Kim MT, Bekheet NG, Hwang SJ, Choi J, Cho KJ, Park HJ, Song HY. Transnasal Placement of a Balloon-Expandable Metallic Stent: Human Cadaver Study of the Eustachian Tube. J Vasc Interv Radiol 2018; 29:1187-1193. [PMID: 30056936 DOI: 10.1016/j.jvir.2018.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To investigate the technical feasibility of stent placement in the cartilaginous portion of the Eustachian tube (ET). MATERIALS AND METHODS Twelve ETs of 6 cadavers were used. Two different-sized stents were placed on either the right (2.5 mm in diameter) or left (3.5 mm in diameter) side of the ET. The procedural feasibility was assessed by subtraction Eustachian tubography, computed tomography before and after the procedure, and fluoroscopic and endoscopic images. The stent location, inner luminal diameter of the stented ET, radiation dose, procedural time, and fluoroscopy time were analyzed. RESULTS Stent placement was successful in 11 of 12 cadaveric specimens without procedure-related complications. In the 1 specimen, the balloon catheter with crimped stent was passed into the bony canal of the ET without any resistance. The distal end of the stent was located in the middle ear cavity. Stents were located within the cartilaginous portion of the ET (n = 1), the proximal tip bridging the nasopharyngeal orifice of the ET (n = 5), or the proximal end of the stent protruded from the tubal orifice (n = 5). The mean luminal diameter in the outer segment was significantly smaller than in the middle (P < .001) and inner (P < .001) segments. The mean procedure time was 128 ± 37 seconds. The mean radiation dose and fluoroscopy time of each cadaver were 3235.4 ± 864.8 cGy/cm2 and 139 ± 49 seconds, respectively. CONCLUSIONS Stent placement of the ET under endoscopic and fluoroscopic guidance is technically feasible in a human cadaver model.
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Affiliation(s)
- Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Kun Yung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Byung-Chul Kang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jun Woo Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Min Tae Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Nadar G Bekheet
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung Jun Hwang
- Department of Anatomy and Cell Biology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Joonmyeong Choi
- School of Mechanical and Aerospace Engineering, Seoul National University, Seoul, 05505, Republic of Korea
| | - Kyu-Jin Cho
- School of Mechanical and Aerospace Engineering, Seoul National University, Seoul, 05505, Republic of Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Park JY, Lee JS. Results of the Cultured Nasolacrimal Polyurethane Stents (Song's stent®) in Nasolacrimal Duct Obstruction Treatment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.6.823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae Yeong Park
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Wang X, Bian Y, Yan W, Daniel P, Tu Y, Wu W. Endoscopic endonasal dacryocystorhinostomy with ostial stent intubation following nasolacrimal duct stent incarceration. Curr Eye Res 2014; 40:1185-94. [PMID: 25495271 DOI: 10.3109/02713683.2014.987873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To study the feasibility of endoscopic endonasal dacryocystorhinostomy (EE-DCR) with novel lacrimal ostial stent (LOS) intubation for patients with chronic dacryocystitis with incarceration of a previously implanted nasolacrimal duct stent (NDS). METHODS According to surgical procedure, 166 patients (167 eyes) were divided into two groups: EE-DCR with LOS intubation was performed on 126 patients (127 eyes) in the EE-DCR group; while external dacryocystorhinostomy (E-DCR) with silicone tube intubation was performed on 40 patients (40 eyes) in the E-DCR group. The LOS or silicone tube was retained for 3-6 months. All patients were followed up for 12-36 months. Success rate of tear drainage reconstruction (TDR) and complications were retrospectively compared. RESULTS Excluding patients with early detachment of the LOS or the silicone tube, or with incomplete follow-up period, 117 patients (117 eyes) in the EE-DCR group and 36 patients (36 eyes) in the E-DCR group were included. The mean surgical time was 45.8 ± 11.5 min in the EE-DCR group and 68.1 ± 23.8 min in the E-DCR group (p < 0.001). Intraoperatively, the lacrimal sac was observed to become very small and its walls were thin, hyperemic and fragile, firmly attaching to the NDS by fibrous bands in all eyes. Upon final review, success rate of TDR was 83.8% (98/117) in the EE-DCR group, while 58.3% (21/36) in the E-DCR group (p < 0.01). Failure of TDR due to ostial closure by excessive fibrosis occurred in 14 out of 19 patients in the EE-DCR group, significantly less than the 11 out of 15 patients with failed TDR in the E-DCR group (χ(2 )= 6.959, p < 0.01). No significant difference existed in failures due to granuloma occluding the ostium or common canaliculus obstruction. CONCLUSION EE-DCR with LOS intubation may be an effective procedure to manage the special subgroup of patients with chronic dacryocystitis with incarcerations of a previously implanted NDS.
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Affiliation(s)
- Xiaopeng Wang
- a Department of Ophthalmology , Jinhua Center Hospital , Jinhua , Zhejiang , People's Republic of China
| | - Yang Bian
- b Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , People's Republic of China and
| | - Wentao Yan
- b Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , People's Republic of China and
| | - Pelaez Daniel
- c Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Yunhai Tu
- b Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , People's Republic of China and
| | - Wencan Wu
- b Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , People's Republic of China and
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Ciampi JJ, Lanciego C, Navarro S, Cuena R, Velasco J, Perea M, García-García L. Treating epiphora in adults with the Wilhelm plastic nasolacrimal stent: mid-term results of a prospective study. Cardiovasc Intervent Radiol 2010; 34:124-31. [PMID: 20390276 DOI: 10.1007/s00270-010-9839-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
Abstract
The objective of the present study was to evaluate, in a prospective, single-center study, the effectiveness of the Wilhelm-type stent used in interventional radiology for the management of epiphora. Patients (n = 104; mean age 64 [range 25–88]; 33 male and 71 female) with severe epiphora had the stents inserted (135 stents in 115 eyes) to treat obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 83 cases, chronic dacryocystitis in 31, cases and postsurgical status in 1 case. The overall technical success rate of stent placement was near 94%. Resolution of epiphora was complete in 105 cases and partial in 3 cases. During a mean 13-month follow-up (range 1 week to 28 months), the median duration of primary patency was 11 months, and the percentage of patency at 6 months was 60.8%, at 1 year was 39.6%, and at 2 years was 25%. Stents malfunctioned in 54 cases, and all were easily withdrawn except in 1 case. Of these 27 cases, patency recovered spontaneously in 9 and by way of a second stent in 18. Secondary patency was 50%. Factors presdisposing to lower primary patency are inflammatory etiology and location of the obstruction. The benefit of stent deployment is clear with respect to the resolution of epiphora in candidate patients for percutaneous treatment. Technical and/or design improvements would be welcomed.
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Affiliation(s)
- Juan J Ciampi
- Interventional Radiology Unit, Department of Radiology, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Avda. De Barber 30, 45004 Toledo, Spain.
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8
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Lanciego C, Navarro S, Velasco J, Perea M, Cuena-Boy R, García-García L. Randomized comparison of nasolacrimal cryoplasty versus plastic lacrimal stenting in the management of epiphora in adults. J Vasc Interv Radiol 2009; 20:1588-96. [PMID: 19944984 DOI: 10.1016/j.jvir.2009.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 08/13/2009] [Accepted: 08/17/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy of plastic polyurethane stents compared with nasolacrimal cryoplasty in the management of epiphora in adults. MATERIALS AND METHODS Patients (N = 37; mean age, 64 years; range, 34-86 y; six men, 31 women) with severe epiphora with partial/complete obstruction of the nasolacrimal system were randomized to have a plastic stent inserted (n = 19) or to undergo balloon dilation cryoplasty (n = 18). Both procedures were conducted on an outpatient basis. Patency was assessed with Kaplan-Meier curves. RESULTS Initial technical success rate and immediate resolution of epiphora was complete in all cases. At 6 months of follow-up, outcomes were already significantly different between the treatment groups and hence the study was discontinued. Plastic stent placement achieved a primary patency rate of 59.6% at 6 months, compared with 12.4% in the cryoplasty group (P < .0004). Multivariate analysis indicated that other measured variables (sex, age, etiology, previous treatment, and the interventional radiologist's expertise) had no significant effect on the outcomes (P > .05). CONCLUSIONS Initial success was good in both treatment groups, with nasolacrimal plastic stent placement achieving a level of primary patency superior to the cryoplasty procedure for the relief of epiphora on short-term follow-up. However, long-term outcome evaluation is needed before stent placement can be recommended as an alternative to more established surgical procedures.
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Affiliation(s)
- Carlos Lanciego
- Department of Interventional Radiology, Hospital Virgen de Salud, Complejo Hospitalario de Toledo, Avenida de Barber 30, 45004 Toledo, Spain.
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Narioka J, Matsuda S, Ohashi Y. Inclination of the superomedial orbital rim in relation to that of the nasolacrimal drainage system. Ophthalmic Surg Lasers Imaging Retina 2008; 39:167-70. [PMID: 18435347 DOI: 10.3928/15428877-20080301-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The influence of the height of the superomedial orbital rim on the ease of nasolacrimal intubation has not been investigated. The authors measured the inclination of the height of the superomedial orbital rim and the nasolacrimal drainage system in 46 sides of Japanese cadavers. The inclinations to the coronal plane of the lacrimal sac and the nasolacrimal duct were measured. A straight probe was inserted into the lacrimal sac and allowed to rest on the superomedial orbital rim. The angle made by this probe and the coronal plane, defined as the inclination of the height of the superomedial orbital rim, was measured. The lacrimal sac was inclined 27.2 degrees +/- 7.6 degrees, the nasolacrimal duct was inclined 22.5 degrees +/- 9.7 degrees, and the height of the superomedial orbital rim was inclined 26.1 degrees +/- 9.1 degrees. For the height of the superomedial orbital rim-nasolacrimal duct angle, there were 33 sides with the anterior type and 13 sides with the posterior type. These results indicate that the height of the superomedial orbital rim may affect the ease of nasolacrimal intubation.
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Affiliation(s)
- Junji Narioka
- Department of Ophthalmology, Ehime University School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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10
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Suk KW, Kim SS. Long-term Outcome of Nasolacrimal Duct Obstruction Treated with Nasolacrimal Polyurethane Stents (Song's Stent). JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.8.1209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyung-Won Suk
- Department of Ophthalmology, Maryknoll Hospital, Pusan, Korea
| | - Sang-Soo Kim
- Department of Ophthalmology, Maryknoll Hospital, Pusan, Korea
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Narioka J, Matsuda S, Ohashi Y. Correlation between anthropometric facial features and characteristics of nasolacrimal drainage system in connection to false passage. Clin Exp Ophthalmol 2007; 35:651-6. [PMID: 17894686 DOI: 10.1111/j.1442-9071.2007.01558.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND To determine the correlation between the anthropometric facial features and the anatomy of the nasolacrimal drainage system. METHODS Forty-six mid-sagittal halves of 23 cadavers were studied. The inclination of the lacrimal sac (LS) and nasolacrimal duct (NLD), and the LS-NLD angle were measured in both the sagittal and coronal planes. For the facial features, the height, length and depth of the nose, the intercanthal distance, nasal breadth, nasofacial angle, distance between the external naris, and the inferior aperture of the NLD were measured. The correlations between the angles and the facial features were calculated. RESULTS The LS-NLD angle was classified into three anatomical types according to the inclination of the LS and the NLD in the sagittal and coronal planes; the anterior-inward type (43.5%), anterior-outward type (37.0%), and posterior-outward type (19.5%). The nasal depth was correlated with the sagittal LS-NLD angle, and the nasal height and length were correlated with the coronal LS-NLD angle. CONCLUSIONS There is a large variation in the LS-NLD angle, and nasal depth, height and length can be used to predict the direction of this angle.
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Affiliation(s)
- Junji Narioka
- Department of Ophthalmology and Division of Anatomy and Embryology, Ehime University School of Medicine, Ehime, Japan.
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Abstract
Acquired nasolacrimal duct obstruction is a common problem. Although tearing is the usual complaint, the clinical presentation can range from a patient having no symptoms to one with a life-threatening infection. Despite many studies providing useful clues, the exact pathophysiology of the obstructive process is incompletely understood. The clinician must be able to accurately make the diagnosis, which is often a clinical one, because many treatments with excellent success are available.
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Affiliation(s)
- David M Mills
- Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical Center, 1220 New Scotland Avenue, Suite 302 Slingerlands, NY 12159, USA.
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13
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Lanciego C, De Miguel S, Padilla M, Perea M, Rodriguez-Merlo R, García-García L. Nasolacrimal stenting: toward improving outcomes with a simple modification of the song stent. Cardiovasc Intervent Radiol 2006; 29:586-94. [PMID: 16565799 DOI: 10.1007/s00270-004-0297-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to evaluate, in a prospective, single-center study, the effectiveness of Song's polyurethane stents, modified "in-house," in the percutaneous management of epiphora. Patients (n = 170; age range 18-83, mean = 64; 50 male, 120 female) with severe epiphora had the modified stents inserted (183 eyes/195 stents) to treat unilateral/bilateral and complete/partial obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 119 cases (61%) and chronic dacryocystitis in 76 (39%). The set designed by Song was used in all patients but modified by us such that the extreme end is cone-shaped. The original technique was slightly modified by us and the procedure was conducted on an outpatient basis. The initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 180 eyes and partial in 3. On follow-up (mean = 18 months; range: 2 days to 24 months), 165 of 195 stents (85%) remained patent. Primary patency rates at follow-up were 86%, 84%, 84%, and 79% in the first 6 months, second and third 6 months, and the present (24 months), respectively. Stents became obstructed in 30 patients, but all but 2 were easily withdrawn and 20 of these patients remained asymptomatic for a mean of 14 months (secondary patency of 67%). Following stent removal, the withdrawn stent was replaced with a new stent in the same intervention on 14 occasions. In another six cases, patency was re-established without the need of a second stent. The procedure is simple and safe, both in stent insertion as well as in mechanical de-blocking and withdrawal when occluded. Success was >80 % in the short term (1-year follow-up). Stenting failure does not preclude other treatment because with the modification that we had introduced, the extreme end of the stent becomes more accessible to mechanical de-blocking, withdrawal, and relocation. The levels of primary and secondary patencies are promising and warrant more extensive investigation.
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Affiliation(s)
- Carlos Lanciego
- Unit of Interventional Radiology, Hospital Virgen de la Salud, Toledo, Spain.
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14
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Doganay S, Sarac K, Miman MC, Karadag N, Cokkeser Y. Polyurethane stent obstruction as a cause of recurrent epiphora. Case report. Interv Neuroradiol 2006; 12:69-72. [PMID: 20569556 DOI: 10.1177/159101990601200114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 02/15/2006] [Indexed: 11/17/2022] Open
Abstract
SUMMARY A Song's nasolacrimal duct stent was placed in a patient with epiphora due to primary nasolacrimal duct obstruction and the stent was kept for 32 months. Mitomycin C 0.02% eye drops four times a day were prescribed for four weeks following polyurethane stent placement procedure. No epiphora-related complaints occurred for thirty months after then the epiphora started. Nasolacrimal stent was removed from nasal cavity endoscopially and the tissues within the extruded stent were examined histopathologically. The patient's complaints were relieved following stent removal. Dacryocystogram revealed normal passage and a filling defect within the lacrimal sac. Macroscopic evaluation of the stent revealed a firm mass in the stent mushroom, causing complete obstruction. Pathological examination of the mass revealed chronic inflammation, increased connective tissue and vascular proliferation. Nasolacrimal polyurethane stents can be removed easily by nasal approach. Nasolacrimal passage may be left open temporarily after stent removal. The use of Mitomycin C drop is a novel approach in nasolacrimal stent placement cases. However, when the long-term results of endoscopic and external dacryocystorhinostomy are considered, further research is needed on the biocompatibility of stent material.
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Affiliation(s)
- S Doganay
- Associate Professor of Ophthalmology, Inonu University Medical Faculty,Turgut Ozal Medical Center, Research Hospital, Malatya, Turkey -
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15
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Pinilla I, Fernández-Prieto AF, Asencio M, Arbizu A, Peláez N, Frutos R. Nasolacrimal stents for the treatment of epiphora: technical problems and long-term results. Orbit 2006; 25:75-81. [PMID: 16754213 DOI: 10.1080/01676830500499232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE To evaluate the long-term effectiveness of nasolacrimal stents for the treatment of obstructive epiphora, and the complications related to the procedure. METHODS This study is a non-randomized prospective clinical trial. Eighty-five patients underwent fluoroscopally-guided placement of polyurethane stent in 86 lacrimal systems for the treatment of severe idiopathic obstructive epiphora. The sites of obstruction were: sac-duct junction (n = 65), sac (n = 10), and nasolacrimal duct (n = 11). The procedure was performed in an outpatient basis under local anesthesia. Patients were followed for a mean of 24 months (1-84) with clinical examinations and/or dacryocystography. Clinical success was defined as symptoms resolution or improvement, and the patency of the lacrimal system to irrigation. RESULTS Stent placement was technically successful in 76 (88.4%) eyes. Technical failures (11.6%) were caused by inability to pass the guide-wire through the lacrimal system. Immediate complications occurred in 19 (22%) eyes, were mild and included: self-limited epistaxis (7), mild palpebral hematoma (7), moderate pain (3), lacrimal puncta bleeding (1), palpebral emphysema (1), and false passage (1). Of the 76 inserted stents, 33 (43.4%) became occluded, and 43 (56.6%) remained patent after a mean of 24 months. Mean duration of stent patency was 38 months. Clinical success was achieved in 40 (52.6%) of the successfully implanted stents. CONCLUSIONS The procedure is well tolerated and can be performed on an outpatient basis. Patency decreases with follow-up, and, in the long-term, the success rate is inferior to that achieved by external dacryocystorhynostomy. However, it many be considered as a valid alternative to surgery in selected patients.
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16
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Giuliano EA, Pope ER, Champagne ES, Moore CP. Dacryocystomaxillorhinostomy for chronic dacryocystitis in a dog. Vet Ophthalmol 2006; 9:89-94. [PMID: 16497232 DOI: 10.1111/j.1463-5224.2006.00443.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 10-year-old female spayed Vizsla had intermittent mucoid ocular discharge from the right eye for 7 years. History, clinical findings, imaging studies, and culture and histopathology results confirmed chronic dacryocystitis with granuloma. A dacryocystomaxillorhinostomy was performed to preserve the functional portions of the nasolacrimal system remaining in this patient, as well as to promote healing of the lacrimal sac granuloma and secondary infection. Complete resolution of the clinical abnormalities was achieved, and the dog remains healthy 3 years postoperatively.
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17
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Lee JH, Kang MS, Yang JW. Clinicopathologic findings after nasolacrimal polyurethane stent implantations. KOREAN JOURNAL OF OPHTHALMOLOGY 2006; 19:252-7. [PMID: 16491813 DOI: 10.3341/kjo.2005.19.4.252] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the results of nasolacrimal polyurethane stent implantations for the treatment of primary acquired nasolacrimal duct obstruction, and to determine the effects of various surgical procedures, including stent removal, in subsequent nasolacrimal duct obstruction. METHODS This study included 15 patients who had nasolacrimal polyurethane implantations for the treatment of primary acquired nasolacrimal duct obstruction. Occluded stents were removed either by nasal endoscopy or during dacryocystorhinostomy (DCR). Cultures and biopsies were performed on the removed stents, and the results of the secondary DCR were analyzed for a 6-month follow-up period. RESULTS During stent removal surgery, various degrees of chronic inflammatory reaction and fibrous tissue formation were detected in the lacrimal sac and nasolacrimal duct. Formations of granuloma and fibrous tissue were found in 15 eyes, and culture-positive reaction were found in nine of the 15 eyes. Conventional dacryocystorhinostomy surgery was performed in nine of the 15 eyes and a silicone tube was located at the canaliculi. Subjective and objective outcome were favorable in 13 of the 15 eyes. CONCLUSIONS The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low. This may result from a chronic inflammatory reaction. Despite the low success rate of nasolacrimal polyurethane stent implantation, the success rate of endonasal DCR as a subsequent surgery is favorable.
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Affiliation(s)
- Jeong Heon Lee
- Department of Ophthalmology, Inje University College of Medicine, Busan, Korea
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18
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Bertelmann E, Rieck P. Polyurethane stents for lacrimal duct stenoses: 5-year results. Graefes Arch Clin Exp Ophthalmol 2005; 244:677-82. [PMID: 16240124 DOI: 10.1007/s00417-005-0139-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 08/23/2005] [Accepted: 08/24/2005] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To present 5-year results of polyurethane stent implantation for treatment of postsaccal lacrimal duct stenoses. METHODS Ninety-two consecutive patients admitted to our hospital for stent implantation between 1997 and 2001 were retrospectively analysed. The patients who were not re-treated in our clinic were asked by questionnaire about their satisfaction and complaints. RESULTS In 5 patients (5.4%) the implantation was not completed, 38 patients (41.3%) were re-treated due to relapsing epiphora during follow-up, and 11 stents (12.0%) were removed by dacryocystorhinostomy (DCR). Five stents (5.4%) were extracted transnasally. Four stents (4.3%) were removed in another hospital. Eighteen patients (19.6%) had relapsing epiphora but have not been re-treated so far. Forty-nine of 92 patients (53.3%) were not re-treated in our clinic and were interrogated by means of a questionnaire. Twenty-seven answered (55.1%), 8 did not answer (16.3%) and 14 patients (28.6%) did not receive the letter because they had moved away or died. Only 12 of the patients who answered the questionnaire had no or slight complaints (44.4%, or 18.5% of all treated patients). CONCLUSIONS The long-term success rate of polyurethane stent implantation is very low (18.5%).
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Affiliation(s)
- Eckart Bertelmann
- Department of Ophthalmology, Charité University School of Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Ilgit ET, Onal B, Coskun B. Interventional radiology in the lacrimal drainage system. Eur J Radiol 2005; 55:331-9. [PMID: 16129243 DOI: 10.1016/j.ejrad.2005.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/07/2005] [Accepted: 03/10/2005] [Indexed: 11/28/2022]
Abstract
This article presents a review of the interventional radiological procedures in the lacrimal drainage system. Balloon dacryocystoplasty and nasolacrimal polyurethane stent placement are the main fluoroscopically guided interventions for the treatment of epiphora by recanalizing the obstructed LDS. These procedures can also be used for dacryolith removal and lacrimal sac abscess treatment.
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Affiliation(s)
- Erhan T Ilgit
- Department of Radiology, School of Medicine, Gazi University, Besevler 06510, Ankara, Turkey.
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Lachmund U, Ammann-Rauch D, Forrer A, Grob M, Petralli C, Remonda L, Roeren T, Wilhelm K. Minimal-invasive Therapie der Epiphora durch Ballonkatheterdilatation und Stentimplantation. Ophthalmologe 2005; 102:375-86. [PMID: 15599560 DOI: 10.1007/s00347-004-1111-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the clinical outcome of the ballon dilatation in stenosis and obstruction of the nasolacrimal duct. MATERIAL AND METHODS 63 patients (69 nasolacrimal duct systems) with epiphora and proven obstruction of the nasolacrimal duct were treated with ballon dilatation, respectively Stentimplantation. In 55 cases there was a pre- or postsaccal stenosis, in 14 cases an occlusion of the nasolacrimal duct system. The diagnosis was established by dacryocystography. RESULTS Technical success was obtained in 61 cases (n=50/55 stenosis; n=11/14 occlusions). Over a mean follow-up of 6 months patency of the nasolacrimal duct system was achieved in 83,6% (46/55) in stenosis. In occlusion the clinical outcome was 42,9% (6/14). CONCLUSION Balloon dacryocystoplasty and Stentimplantation are minimal-invasive alternatives, performed in local anesthesia that recover the normal anatomy of the nasolacrimal duct system. They are a good alternative in the treatment of epiphora caused by nasolacrimal duct obstructions.
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Affiliation(s)
- U Lachmund
- Augenklinik, Kantonsspital St. Gallen, Schweiz.
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Oztürk S, Konuk O, Ilgit ET, Unal M, Erdem O. Outcome of Patients with Nasolacrimal Polyurethane Stent Implantation: Do They Keep Tearing? Ophthalmic Plast Reconstr Surg 2004; 20:130-5. [PMID: 15083082 DOI: 10.1097/01.iop.0000115597.92546.d5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the results of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction and the effects of obstructed nasolacrimal stent on subsequent dacryocystorhinostomy (DCR). METHODS This study was designed as a nonrandomized, prospective clinical trial. Stent implantation was attempted in 53 obstructed lacrimal drainage systems of 47 patients. Stent placement was performed in a retrograde fashion through the external nare over a guide wire, which was introduced from the upper punctum. Occluded stents were removed either with nasal endoscopy or during DCR. External DCR surgery with silicone intubation was performed in cases with stent failure. RESULTS The mean follow-up period was 23.4 months. The success rate of stent implantation was 60.4%, 37.5%, and 31.2% at 6-, 12-, and 18-month follow-up, respectively. Stent obstruction developed in 33 eyes. Twenty underwent external DCR with silicone intubation. During DCR surgery, varying degrees of chronic inflammatory reaction were detected in the lacrimal sac and nasolacrimal duct. The mean follow-up period after DCR was 10.3 months. Epiphora was relieved with DCR in all but one eye. CONCLUSIONS The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low and may induce inflammation and fibrous tissue formation. Although this may cause further difficulties in subsequent lacrimal surgery, epiphora could be relieved with meticulous technique.
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Affiliation(s)
- Sertaç Oztürk
- Department of Ophthalmology, Gazi University Medical School, Ankara, Turkey
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Lanciego C, Toledano N, De Miguel S, Perea M, Padilla M, Rodriguez-Merlo R, Dávila J, Ibarburen C, Cano C, García IR, García LG. Resolution of Epiphora with Nasolacrimal Stents: Results of Long-term Follow-up in a Multicenter Prospective Study. J Vasc Interv Radiol 2003; 14:1417-25. [PMID: 14605107 DOI: 10.1097/01.rvi.0000096763.74047.ef] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate in a prospective, multicenter setting the long-term effectiveness of polyurethane stents in the percutaneous management of epiphora. MATERIALS AND METHODS Patients (n = 426; age range, 19-88 years, mean, 48; 91 men, 335 women) with severe epiphora had stents (470 eyes/496 stents) inserted to treat unilateral or bilateral and complete or partial obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 280 cases (59.5%) and chronic dacryocystitis in 190 (40.4%). The stent set designed by Song was used in all patients, and the original technique was slightly modified by us and conducted on an outpatient basis. RESULTS The initial technical success rate of stent placement was 95%. The average time of the procedure was 6 minutes (range, 3-70). Resolution of epiphora was complete in 452 eyes and partial in 18. On follow-up (mean, 24 months; range, 1 week to 67 months), 340 of 496 stents remained patent (68.5%). Segregating primary patency by year of follow-up, the rates were 75.6%, 68.4%, 64.8%, 60.1%, and 59.2% in the first, second, third, fourth, and the current (67 months) years, respectively. Minor complications such as moderate pain (21 cases), epistaxis (75 cases), palpebral edema and hematoma (31 cases), and headache (four cases) and two acute dacryocystitis events were recorded. Of the 156 obstructed stents, 114 were withdrawn, and 49 of these patients remained asymptomatic for a mean of 27 months (secondary patency, 31.4%). After stent removal, the sac configuration was unchanged in 93 (81.5%), contracted in 11 (9.6%), and widened in 10 (8.8%) cases. CONCLUSIONS The procedure is simple and safe, both in stent insertion and in withdrawal when occluded. The success rate was >75% in the short term and >55% in the long term. Although not totally without concerns, the technique is attractive for most patients who prefer not to undergo surgery or are unsuitable surgical candidates. Stent failure does not preclude subsequent treatment options and is an excellent first-line treatment of epiphora.
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Affiliation(s)
- Carlos Lanciego
- Vascular Interventional Radiology Unit, Hospital Virgen de la Salud, Toledo, Spain.
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Abstract
This review covers evolving concepts in lacrimal outflow obstruction. Recent studies have increased our understanding of the surgical anatomy and pathophysiology of the lacrimal drainage system through radiologic, clinical, and microbiologic techniques. While external dacryocystorhinostomy remains an important treatment for nasolacrimal duct obstruction, there have been a number of therapeutic developments worthy of review, including advances in endoscopic and transcanalicular dacryocystorhinostomy, conjunctivodacryocystorhinostomy, and the use of mitomycin C in these procedures. In addition, we summarize recent advances in minimally invasive techniques for lacrimal outflow obstruction, including balloon dacryocystoplasty, lacrimal stents, and conjunctivoplasty. Finally, the roles of probing versus irrigation, nasal endoscopy, and endoscopic dacryocystorhinostomy in children are discussed.
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Affiliation(s)
- John T H Mandeville
- Ophthalmic Consultants of Boston and the Center for Eye Research, Boston, Massachusetts, USA
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Yazici Z, Yazici B, Parlak M, Tuncel E, Ertürk H. Treatment of nasolacrimal duct obstruction with polyurethane stent placement: long-term results. AJR Am J Roentgenol 2002; 179:491-4. [PMID: 12130461 DOI: 10.2214/ajr.179.2.1790491] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the long-term efficacy of polyurethane stent placement in adults with nasolacrimal duct obstruction. SUBJECTS AND METHODS Polyurethane stents were placed under fluoroscopic guidance in 52 eyes of 49 patients (mean age, 43 years) with severe epiphora due to idiopathic nasolacrimal duct obstruction. The obstruction was complete in 44 eyes and partial in eight. Clinical success was defined as complete resolution of or great improvement in the symptoms of epiphora and the patency of the lacrimal system to irrigation. Mean follow-up was 23 months (range, 14-44 months). RESULTS Stent placement was technically successful in 50 eyes (96%). The mean fluoroscopy screening time was 2.2 min (range, 0.2-5.8 min). Two patients were lost to follow-up. Clinical success was obtained in 33 (69%) of 48 eyes. Lacrimal symptoms developed in 23 (70%) of these 33 eyes at least once during the follow-up, but these patients responded well to topical drug treatment and lacrimal irrigation. External dacryocystorhinostomy was performed in 13 eyes after failure of the stents. At surgery, lacrimal sacs were shrunken, hyperemic, and fragile in all eyes, making it difficult to anastomose with nasal mucosa. Histologic examination showed granulation tissue and chronic inflammation of the sac epithelium. CONCLUSION The success rate of the nasolacrimal stent decreases as follow-up lengthens. After stent treatment, lacrimal symptoms frequently develop, even if the stent remains patent, and require multiple office visits and therapy. The polyurethane stent may induce a chronic inflammatory response in the lacrimal sac, which can interfere with subsequent dacryocystorhinostomy.
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Affiliation(s)
- Zeynep Yazici
- Department of Radiology, Uludag University, School of Medicine, Gorukle, 16059, Bursa, Turkey
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Ghazi-Nouri S, Thompson G. Spontaneous displacement of polyurethane. Eye (Lond) 2001; 15:684. [PMID: 11702999 DOI: 10.1038/eye.2001.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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