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Griffin MJ, Sims JR, Spaulding SL, Baik FM, Elahi E, Urken ML. Management of orbital complications in palatomaxillary reconstruction: A review of preemptive and corrective measures. Head Neck 2019; 42:556-568. [PMID: 31837075 DOI: 10.1002/hed.26015] [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: 05/31/2019] [Revised: 09/20/2019] [Accepted: 10/30/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Reconstruction of orbit-sparing palatomaxillary defects requires consideration of globe dystopia, orbital volume, eyelid position and function, and the nasolacrimal system to preserve and optimize vision, globe protection, and appearance. We describe the fundamentals of orbital and eyelid anatomy, common orbital complications related to palatomaxillary reconstruction, and preemptive and corrective surgical techniques to be utilized during and after globe-sparing palatomaxillary reconstruction. METHODS We present a review of the literature supplemented by clinical case examples. RESULTS We advocate for the use of preemptive and corrective techniques to ensure optimal aesthetic and functional outcomes for patients with orbital defects. CONCLUSIONS Recognition and anticipation of problems in patients undergoing midface ablative and reconstructive procedures are vital to the implementation of corrective measures. Incision choice, orbital volume restoration, appropriate orbital floor reconstruction, and permanent or temporary lower eyelid suspension during the primary surgery can all significantly impact the development of long-term orbital complications.
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Affiliation(s)
- Martha J Griffin
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - John R Sims
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | - Sarah L Spaulding
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Fred M Baik
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | - Ebrahim Elahi
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
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Patella F, Panella S, Zannoni S, Jannone ML, Pesapane F, Angileri SA, Sbaraini S, Ierardi AM, Soldi S, Franceschelli G, Carrafiello G. The role of interventional radiology in the treatment of epiphora. Gland Surg 2018; 7:103-110. [PMID: 29770306 DOI: 10.21037/gs.2017.09.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epiphora is a relatively common ophthalmologic affection representing almost 5% of clinical consultations in ophthalmology and it consists in the complete or partial obstruction of nasolacrimal duct, leading to insufficient drainage of tears. The traditional treatment is represented by surgery namely, external dacryocystorhinostomy (DCR). Despite the high success rate DCR has many disadvantages and limitations since it requires general anesthesia, it may arise in a permanent facial scar and it is often affected by the reobstruction of the anastomotic tract by fibrotic scars and osteogenic activity. Fluoroscopically guided interventional procedures are a therapeutic alternative to surgery for lacrimal duct system obstructions that can consist either in balloon dacryocystoplasty or in nasolacrimal stent placement. In both cases, a pre-operative imaging characterization of the occlusion is needed for a correct treatment planning. In this review, we propose to highlight the role of interventional radiology in the treatment of epiphora and the role of computed tomography dacryocystography (CTD) in depiction and the pre-interventional planning.
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Affiliation(s)
| | - Silvia Panella
- Postgraduation School of Radiodiagnostic of Milan, Milan, Italy
| | | | | | | | - Salvatore Alessio Angileri
- Postgraduation School of Radiodiagnostic of Milan, Milan, Italy.,Diagnostic and Interventional Radiology Service, San Paolo Hospital, Milan, Italy
| | - Sara Sbaraini
- Postgraduation School of Radiodiagnostic of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Service, San Paolo Hospital, Milan, Italy
| | - Simone Soldi
- Diagnostic and Interventional Radiology Service, San Paolo Hospital, Milan, Italy
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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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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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Die Bedeutung bildgebender Diagnostik und interventioneller Therapie bei Erkrankungen der ableitenden Tränenwege. Radiologe 2008; 48:1155-60. [DOI: 10.1007/s00117-008-1695-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kim KR, Song HY, Shin JH, Kim JH, Choi EK, Lee YJ. Efficacy of mitomycin C irrigation after removal of an occluded nasolacrimal stent. J Vasc Interv Radiol 2007; 18:519-25. [PMID: 17446543 DOI: 10.1016/j.jvir.2007.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Mitomycin C (MMC) acts as a potent fibroblastic inhibitor, and topical application of MMC is effective in preventing scar formation. The purpose of this study was to evaluate the safety and efficacy of MMC irrigation after removal of an occluded nasolacrimal stent from the lacrimal system. MATERIALS AND METHODS A total of 57 lacrimal systems after removal of an occluded stent were assigned to one of two groups: 23 lacrimal systems were irrigated with MMC after stent removal (MMC group), and 34 lacrimal systems were not irrigated with MMC after stent removal (non-MMC group). In the MMC group, the lacrimal systems were irrigated with 0.2 mg/mL MMC through the inferior lacrimal punctum for 3 minutes in three different sessions: immediately, 1 week, and 1 month after stent removal. The mean and cumulative patency rates after stent removal were calculated using the Kaplan-Meier method and were compared between the two groups using the log-rank test. RESULTS Stent removal and MMC irrigation were technically successful in all lacrimal systems. There were no side effects or complications associated with MMC use. The mean patency rate after stent removal was higher in the MMC group than that of the non-MMC group: 10.5 months (95% CI: 7.04, 13.91) versus 4.5 months (95% CI: 2.40, 6.63), respectively. There was a statistically significant difference in the cumulative patency rates after stent removal between the two groups (P = .005, log-rank test). CONCLUSIONS Mitomycin C irrigation is safe and effective in increasing patency rate of lacrimal systems after removal of an occluded nasolacrimal stent.
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Affiliation(s)
- Kyung Rae Kim
- Department of Radiology and Research, Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea
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8
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Kim KR, Song HY, Shin JH, Kim JH, Choi EK, Yang ZQ, Lee YJ. Efficacy of mitomycin-C irrigation after balloon dacryocystoplasty. J Vasc Interv Radiol 2007; 18:757-62. [PMID: 17538138 DOI: 10.1016/j.jvir.2007.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of mitomycin-C irrigation after balloon dacryocystoplasty in the treatment of epiphora caused by obstruction of the lacrimal system. MATERIALS AND METHODS Thirty-five lacrimal systems in 33 patients with obstruction of the lacrimal system were assigned to one of two groups: 17 lacrimal systems were irrigated with mitomycin-C after balloon dacryocystoplasty (mytomycin-C group), and 18 were not irrigated with mitomycin-C after balloon dacryocystoplasty (non-mitomycin-C group). In the mitomycin-C group, the lacrimal systems were irrigated with 0.2 mg/mL mitomycin-C via the inferior lacrimal punctum in three different sessions: immediately, 1 week, and 1 month after balloon dacryocystoplasty. The cumulative patency rates after balloon dacryocystoplasty were calculated by using the Kaplan-Meier method and were compared between the two groups with use of the log-rank test. RESULTS Balloon dacryocystoplasty and subsequent mitomycin-C irrigation were technically successful in all lacrimal systems. There were no side effects or complications associated with mitomycin-C use. The cumulative patency rate in the mitomycin-C group was significantly higher than that in the non-mitomycin-C group after balloon dacryocystoplasty (P = .0150, log-rank test). CONCLUSIONS Mitomycin-C irrigation is safe and effective in increasing the patency rate of the lacrimal system after balloon dacryocystoplasty.
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Affiliation(s)
- Kyung Rae Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea
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Savino G, Messina L, Colucci D, Balia L, Balestrazzi E. Surgical treatment of obstruction of the nasolacrimal ducts in patients with anatomical endonasal variants. ACTA ACUST UNITED AC 2007; 41:10-3. [PMID: 17484179 DOI: 10.1080/02844310601127458] [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] [Indexed: 10/23/2022]
Abstract
The presence of anatomical endonasal variants (concha bullosa, nasal septal deviation, or hypertrophic turbinates) may cause more complications in patients with epiphora who have external dacryocystorhinostomy (DCR). The purpose of this study was to assess the results of surgical placement of a stent in 28 patients. They were randomised into two groups and had either DCR or placement of a Song's polyurethane stent. They were followed up for 18 months. Twenty-six patients had a good result. The success rate was 13/14 for those who had DCR and 13/14 for those who had a stent. Operating time was significantly less for placing a stent (mean (SD) 15 (2) minutes) compared with 40 (3) minutes for DCR (p <0.01). Placement of a polyurethane stent is an effective and short procedure for nasolacrimal obstruction, which is suitable for patients with unusual intranasal conditions.
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Affiliation(s)
- Gustavo Savino
- Department of Ophthalmology, Catholic University of Sacred Heart, Rome, Italy.
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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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Wilhelm KE, Grabolle B, Urbach H, Tolba R, Schild H, Paulsen F. Evaluation of Polyurethane Nasolacrimal Duct Stents: In Vivo Studies in New Zealand Rabbits. Cardiovasc Intervent Radiol 2006; 29:846-53. [PMID: 16794895 DOI: 10.1007/s00270-005-0232-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to evaluate the radiographic and biological effects of different polyurethane nasolacrimal duct stents in an animal model. Fifteen polyurethane nasolacrimal duct stents (n = 5 mushroom-type stents, n = 5 newly designed S-shaped TearLeader stents without hydrophilic coating, and n = 5 S-shaped TearLeader stents with hydrophilic coating) were implanted in the nasolacrimal ducts of eight unaffected New Zealand rabbits. One nasolacrimal system served as control. Clinical and radiographic follow-up was performed at 1-, 2-, and 4-week intervals, then after a 3-month interval, after which the animals were euthanized. All stents were implanted without major periprocedural complications. The stents proved to be patent by the end of the procedure. During follow-up, all mushroom-type stents were occluded at 4 weeks. None of these stents opened to forced irrigation. Clinically, all rabbits demonstrated severe dacryocystitis. Three out of five TearLeader stents without hydrophilic coating were blocked at 4 weeks; one out of five was open to irrigation. Best results were observed in the stent group with hydrophilic coating. Follow-up dacryocystography demonstrated patent stents in nasolacrimal ducts of all animals after 4 weeks. In only one of five cases, the coated stent became partially occluded after 2 months. These animals were free of clinical symptoms. After 3 months, at least three out of five stents still opened to forced irrigation and only one stent was completely blocked. Dislocation of the stents was not observed. Refinement of the stent surface and stent design improves the results of nasolacrimal duct stenting in this animal model. Implantation of hydrophilic-coated S-shaped stents is highly superior to conventional mushroom-type stents and noncoated stent types. Hydrophilic coating seems to prevent foreign-body reactions, resulting in maximized stent patency.
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Affiliation(s)
- K E Wilhelm
- Department of Radiology, University Hospital Bonn, Bonn, Germany.
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Kim JH, Shin JH, Song HY, Kang W, Lim JO, Park SH, Ko GY, Yoon HK, Sung KB. Long-term results and factors affecting patency after removal of nasolacrimal stents. J Vasc Interv Radiol 2006; 17:1125-30. [PMID: 16868165 DOI: 10.1097/01.rvi.0000228340.31347.40] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To retrospectively evaluate the long-term patency and prognostic factors affecting patency after removal of nasolacrimal stents. MATERIALS AND METHODS Lacrimal polyurethane stents were removed from 317 lacrimal drainage systems of 275 patients because the stent ceased to function, and immediate and maintained patency were determined with follow-up dacryocystography (DCG) after stent removal. Prognostic factors for patency after stent removal were evaluated by univariate and multivariate analyses for immediate patency and Kaplan-Meier survival analysis and multivariate analysis for maintained patency. RESULTS All stents were successfully removed under fluoroscopic or endoscopic guidance. After stent removal, 243 lacrimal systems (77%) showed immediate patency. The size of the lacrimal sac was the same (65% of cases), widened (2%), or contracted (33%) after stent removal. The shape of the lacrimal sac was normal in 30% and irregular in 70% of cases after stent removal. Seven-day follow-up DCG was obtained in 169 cases, and maintained patency of the lacrimal system was confirmed on 7-day follow-up DCG in 125 cases. Epiphora recurred in 70 cases (56%) during the mean 8-month follow-up period (range, 1-48 months). The mean maintained patency period after stent removal was 15.7 +/- 2.1 months. The maintained patency rates were 41% at 1 year, 31% at 2 years, and 14% at 4 years after stent removal. Multivariate analysis showed that the size of the lacrimal sac (P < .001) was the only factor affecting immediate and maintained patency after stent removal. CONCLUSIONS After stent removal in patients with nasolacrimal stent obstruction, the immediate patency rate was 77%; however, the rate of maintained patency decreased progressively with time. The major factor negatively affecting immediate and maintained patency after stent removal was contraction of the lacrimal sac at the time of stent removal.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology, Armed Forces Byukjae Hospital, Goyang, Korea
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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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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: 2] [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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Lanciego C, Bracamonte A, Méndez-Cendón JC, Gómez C, Padilla M, García-García L. Loss of Vision as a Complication of Nasolacrimal Stent Placement. J Vasc Interv Radiol 2004; 15:1027-8. [PMID: 15361577 DOI: 10.1097/01.rvi.0000140933.60560.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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