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Oklar M, Kocabas S, Ozen MC, Ozgur OR. Surgical Outcomes in Congenital Nasolacrimal Duct Obstruction After Probing Failure: A One-Stage Approach. Beyoglu Eye J 2024; 9:38-47. [PMID: 38504962 PMCID: PMC10944852 DOI: 10.14744/bej.2024.74384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 03/21/2024]
Abstract
Objectives This study evaluates the outcomes of a one-stage obstruction-based strategy for congenital nasolacrimal duct obstruction (CNLDO) in children who have prior probing failure. The objective is to assess the success rates of probing, balloon dacrioplasty (BDP), monocanalicular intubation (MCI), and external dacryocystorhinostomy (external DCR) performed in the same anesthesia session. Methods A retrospective analysis included 55 eyes (45 patients, aged 12-120 months) with initial probing at another center. Procedures involved probing, probing plus BDP, MCI, and external DCR. For membranous obstruction (MO), the procedure concludes after probing; for incomplete complex obstruction (ICO) it includes BDP or MCI; and for complete complex obstruction (CCO), external DCR is performed. Success rates were assessed based on obstruction types and age groups, with improvement in symptoms and signs as the measure of success. Statistical analysis utilized Kruskal-Wallis, Fisher's exact test, and logistic regression. Results The overall success rate for all procedures was 72.7%. Success rates were 77.8% for MO, 66.7% for ICO, and 100% for CCO, introducing a promising perspective for the management of different CNLDO types. External DCR exhibited a 100% success rate, highlighting its effectiveness in cases of CCO. Success rates for interventions were 77.8% for probing, 61.5% for probing plus BDP, and 73.1% for MCI, emphasizing the feasibility and success of one-stage obstruction-based treatments. Age did not significantly correlate with success rates. Conclusion The one-stage obstruction-based approach, which demonstrated favorable success rates in treating CNLDO and introduced a paradigm shift in the treatment strategy after probing failure, underscores the importance of tailoring interventions to the specific obstruction type. The study also highlights the feasibility and cost-effectiveness of performing multiple BDP, MCI, or external DCR procedures concurrently during the same anesthesia session, further emphasizing the crucial role of customizing treatments based on the nature of the obstruction.
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Affiliation(s)
- Murat Oklar
- Department of Ophthalmology, University of Health Sciences Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkiye
| | - Seyhan Kocabas
- Department of Ophthalmology, Dunyagoz Hospital, Adana, Turkiye
| | - Mehmet Can Ozen
- Department of Ophthalmology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkiye
| | - Ozlen Rodop Ozgur
- Department of Ophthalmology, Hisar Hospital Intercontinental, Istanbul, Turkiye
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Ueta Y, Watanabe Y, Kamada R, Tanaka N. Assessment of Office-Based Probing with Dacryoendoscopy for Treatment of Congenital Nasolacrimal Duct Obstruction: A Retrospective Study. J Clin Med 2023; 12:7048. [PMID: 38002662 PMCID: PMC10672542 DOI: 10.3390/jcm12227048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
We aimed to evaluate the safety and efficacy of office-based probing with dacryoendoscopy under local anesthesia for congenital nasolacrimal duct obstruction (CNLDO). This single-institution study retrospectively reviewed data on 72 eyes of 64 consecutive children (38 boys, 43 eyes; 26 girls, 29 eyes), aged between 6 and 17 (mean age: 10.0 ± 2.7) months with suspected CNLDO, from July 2016 to February 2022. These patients underwent probing with dacryoendoscopy under local anesthesia. CNLDO was diagnosed clinically based on the presence of epiphora and sticky eyes due to mucous discharge commencing within the first 3 months of life, increased tear meniscus height, and fluorescein dye disappearance test results. A total of 63 of the 72 eyes had narrowly defined CNLDO, and 9 eyes had other types of obstructions. The intervention success rate was 100% (63/63 eyes) for patients with typical CNLDO and 97.2% (70/72 eyes) for the entire study cohort. Moreover, CNLDO was classified into five types based on the features of the distal end of the nasolacrimal duct. Probing with dacryoendoscopy is safe and yields a high success rate in pediatric patients with CNLDO. This is the first study to assess the safety and efficacy of probing with dacryoendoscopy under local anesthesia in pediatric patients with CNLDO.
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Affiliation(s)
- Yoshiki Ueta
- Department of Ophthalmology, Shinseikai Toyama Hospital, 89-10 Shimowaka, Imizu 939-0243, Toyama, Japan
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Zhou J, Wang Y, Zhang Y, You D, Wang Y. Case report: ADULT syndrome: a rare case of congenital lacrimal duct abnormality. Front Genet 2023; 14:1150613. [PMID: 37920856 PMCID: PMC10618556 DOI: 10.3389/fgene.2023.1150613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/15/2023] [Indexed: 11/04/2023] Open
Abstract
Acro-dermato-ungual-lacrimal-tooth (ADULT) syndrome is a rare autosomal dominant inherited disease caused due to mutations in the TP63 gene. More commonly, mutations in the TP63 gene result in ectodermal dysplasia and/or orofacial cleft. ADULT syndrome is a type of ectoderm-related tissue dysplasia. This case report describes a patient with chronic tearing, congenital atresia, and obstruction of the lacrimal ducts, which are the main clinical manifestations of ADULT syndrome. This patient also presented with some clinical manifestations that were different from those of ADULT syndrome, namely, mild eyelid fusion and abnormal development of the fifth finger (a stiff fifth finger with camptodactyly that was shortened in length). The gene mutation in this patient was also at a site different from those usually reported in the literature. In this patient, c.518G > T resulted in p. G173V (accession number: NM_003722; exon4). We performed successful dacryocystorhinostomy and artificial lacrimal duct implantation. As shown above, we discussed the clinical characteristics and genetics of the disease in detail. In sharing this case, we aim to contribute to the current understanding of the genes and clinical manifestations of ADULT syndrome and to assist clinicians in the clinical diagnosis of TP63 mutation-related diseases.
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Affiliation(s)
- Jichao Zhou
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yuchen Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yinghong Zhang
- Department of Otolaryngology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Debo You
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yi Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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Kaptı HB, Erdem B. Evaluation of the Reliability and Quality of YouTube Videos on Congenital Nasolacrimal Duct Obstruction. Cureus 2023; 15:e36365. [PMID: 36945232 PMCID: PMC10024941 DOI: 10.7759/cureus.36365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/20/2023] Open
Abstract
Introduction Congenital nasolacrimal duct obstruction (CNLDO) causes excessive eye tearing or mucoid discharge. Twenty percent of one-year-olds globally have CNLDO. There are many sources that offer information to parents. This study evaluates the quality and accuracy of CNLDO-related YouTube videos. Methods The first 100 videos that appeared after typing "congenital nasolacrimal duct obstruction" in the YouTube search engine were evaluated. These videos were also analyzed and scored using the DISCERN, Journal of the American Medical Association (JAMA), and Global Quality Scoring (GQS) systems. Results Forty videos met the inclusion criteria. The mean DISCERN score was 47.3 ± 9.15, JAMA was 1.72 ± 0.87, and GQS was 3.1 ± 0.81. The duration of the videos uploaded by the non-physician group was significantly longer (p = 0.04). In addition, the JAMA score of the videos uploaded by the physician group was significantly higher than that of the other group (p = 0.03). Theoretical videos were longer than surgical videos (p = 0.02). DISCERN, JAMA, and GQS scores were statistically higher in the theoretical video group (p = 0.002, p = 0.04, and p = 0.03, respectively). Conclusion According to our research, the quality of YouTube videos about congenital nasolacrimal duct obstruction is average. This information source can be improved by making videos with more detailed information about the disease and theoretical information, as well as by having health professionals look over the content that has been uploaded.
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Katowitz WR. Editorial counterpoint to CNLDO: choose endoscopy-guidance and NOT a blind procedure. Orbit 2021; 41:395-396. [PMID: 34511024 DOI: 10.1080/01676830.2021.1973515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- William R Katowitz
- Department of Ophthalmology, The Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, USA
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Lee C, Jeong SM, Kim GJ, Joo EY, Song MH, Sa HS. Efficacy and Safety of Inhalation Sedation during Office Probing for Congenital Nasolacrimal Duct Obstruction. J Clin Med 2021; 10:jcm10081800. [PMID: 33924278 PMCID: PMC8074913 DOI: 10.3390/jcm10081800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
We compared the effectiveness of inhaled sevoflurane versus physical restraint during probing in children with congenital nasolacrimal duct obstruction (CNLDO). We performed a retrospective review of children with CNLDO who underwent office probing procedures by a single surgeon under sedation or restraint. Patients’ characteristics at the time of probing, including age, sex, laterality, previous non-surgical treatment, presence of dacryocystitis, outcomes of probing, and complications were compared between the sedation and restraint groups. A multivariable logistic regression analysis was performed to investigate the prognostic factors associated with the success of probing. A subgroup analysis by 12 months of age was also conducted. The overall success rate was 88.6% in 202 eyes of 180 consecutive children (mean age, 15.1 ± 7.7 months). The sedation group had a marginally higher success rates than the restraint group (93.8% vs. 85.1%, p = 0.056). The success rate was not significantly different between the two groups in children aged <12 months (90.9% vs. 93.1%, p = 0.739), but it was significantly higher in the sedation group (94.7% vs. 77.8%. p = 0.006) in children aged ≥12 months. Inhalation sedation was the most potent factor associated with success (adjusted odds ratio = 5.56, 95% confidence interval = 1.33–23.13, p = 0.018) in children aged ≥12 months. There were no surgical or sedation-related complications intra- and postoperatively. Inhaled sevoflurane sedation resulted in more successful, controlled, painless probing, particularly in children aged ≥12 months. It represents a safe, efficient alternative to general anesthesia.
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Affiliation(s)
- Chunghyun Lee
- Department of Ophthalmology, Gangneung Asan Hospital, Gangneung 25440, Korea;
| | - Su-Min Jeong
- Department of Family Medicine, Samsung Medical Center, Seoul 06351, Korea;
| | - Gye Jung Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Eun-Young Joo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (E.-Y.J.); (M.H.S.)
| | - Myung Hee Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (E.-Y.J.); (M.H.S.)
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
- Correspondence: ; Tel.: +82-2-3010-3680; Fax: +82-2-470-6440
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Gupta N, Singla P, Ganesh S. Usefulness of high definition sialoendoscope for evaluation of lacrimal drainage system in congenital nasolacrimal duct obstruction. Eur J Ophthalmol 2021; 32:11206721211008047. [PMID: 33827297 DOI: 10.1177/11206721211008047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Sialoendoscope was used as a dacryoendoscope, high- definition images of the lacrimal drainage system (LDS) were captured and its performance in congenital nasolacrimal duct obstruction (CNLDO) is reported. METHODS Nasal endoscopy was done as the first in all the cases using a 0°, 2.7 mm nasal endoscope (Karl Stroz Tutlingan Germany). This was followed by Dacryoendoscopy (DEN) of the lacrimal drainage system from puncta till the valve of Hasner. DEN was performed under general anaesthesia in 26 children (including 17 primary and 9 failed probing cases). All cases were examined using 0.8 mm sialoendoscope (Karl Storz, Tuttlingen, Germany) with fibreoptic light transmission with a side port for irrigation. RESULTS We were able to obtain high-definition images of canaliculi, lacrimal sac, sac duct junction, proximal, mid and distal segments of nasolacrimal duct in all the children with CNLDO.In 17 primary cases 16 had distal membranous obstruction and I case had proximal canalicular obstruction. In nine children with history of failed probing, five had membranous obstruction, two had dacryoliths, two had NLD malformation at different levels. An overall success rate of 88.4% was achieved. CONCLUSION Sialoendoscope can be used as high-definition dacryoendoscope for diagnostic and therapeutic use in CNLDO. Useful information can be obtained on dacryoendoscopy in complex CNLDO cases.
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Affiliation(s)
- Nishi Gupta
- Dr Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Suma Ganesh
- Dr Shroff's Charity Eye Hospital, New Delhi, India
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Pensiero S, Diplotti L, Visalli G, Ronfani L, Giangreco M, Barbi E. Minimally-Invasive Surgical Approach to Congenital Dacryostenosis: Proposal for a New Protocol. Front Pediatr 2021; 9:569262. [PMID: 33681096 PMCID: PMC7928362 DOI: 10.3389/fped.2021.569262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Congenital dacryostenosis is one of the most common ophthalmological disorders in infants, with a high spontaneous resolution rate. In patients unresponsive to conservative treatment, the first-line approach is lacrimal drainage system probing, thought there is no clear consensus on optimal timing of surgery. The optimal treatment of patients unresponsive to primary probing is also controversial. Objectives: The aim of this study is to assess the optimal timing of probing in children with congenital dacryostenosis. Other purposes are to evaluate the efficacy of repeated probing and dacryointubation in patients unresponsive to the initial surgery without evident lacrimal outflow dysgenesis, and to determine the epidemiology of these maldevelopments. Methods: A retrospective consecutive cohort study was conducted in 625 eyes of 457 patients aged 7-48 months who underwent surgery for dacryostenosis. Patients were divided into 4 cohorts according to the timing of surgery. Data were analyzed using Fisher's test. Results: The success rate of primary probing was high, without significant differences between cohorts. One-third of recurrences were related to maldevelopments, the other two-thirds were treated with a second probing or dacryointubation, with high success rates, that did not significantly differ between the procedures. All cases unresponsive to the second surgery were resolved with dacryointubation. Conclusions: Probing is highly effective and its outcome is not affected by timing of surgery. Nevertheless, we advocate for early intervention, in order to identify possible maldevelopments, which require more invasive management. In patients unresponsive to primary probing, without evident maldevelopments, repeated probing should still be considered as the first-line approach, since it's less invasive but similarly effective to dacryointubation.
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Affiliation(s)
- Stefano Pensiero
- Department of Ophthalmology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Laura Diplotti
- Department of Ophthalmology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Gianluca Visalli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.,Department of Pediatrics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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Szalai I, Maneschg OA, Nagy ZZ. Monocanalicular silicone stent implantation in children with congenital nasolacrimal duct obstruction. Orv Hetil 2020; 161:2037-2042. [PMID: 33249409 DOI: 10.1556/650.2020.31906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/20/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Csecsemőkorban a könnyezés gyakori oka a könnycsatorna veleszületett elzáródása, mely az esetek nagy részében 1 éves korra spontán oldódik. Célkitűzés: Retrospektív tanulmányunk célja a monocanalicularis szilikonsztent (Masterka®) implantációjával kapcsolatos eredményeink bemutatása. Módszer: 2015. január 1. és 2020. január 30. között monocanalicularis szilikonsztent implantációján átesett gyermekek adatait dolgoztuk fel. Bevonási kritériumként szerepelt a legalább 6 hónapja fennálló, konzervatív kezelésre nem szűnő könnyezés és emiatt előzetesen elvégzett szondázás, mely után a panaszok kiújultak. Kizárási kritérium volt a csontosan elzárt ductus nasolacrimalis és a hibás szemhéjállás. A műtét hatékonyságát a szilikonsztent eltávolítását követő legalább 2 hónap panaszmentességgel definiáltuk. Eredmények: 25 gyermek (10 lány [40%] és 15 fiú [60%]) összesen 30 szemén végeztünk szilikonsztent-beültetést. Az átlagéletkor 4,92 ± 3,03 év (1,5-12 év, n = 25) volt. Minden páciens a születése óta könnyezett. A műtét előtt váladékképződést 20 (66,67%, n = 30), krónikus szemhéj- és kötőhártya-gyulladást 10 (33,33%, n = 30) esetben észleltünk. Tompalátást, jelentős astigmiát nem találtunk. A sztentet átlagosan 3,5 ± 1,0 (n = 30) hónap után távolítottuk el. A műtétet követően 1 héttel 24 (80%, n = 30), 3 hónappal 28 (93,33%, n = 30) és 6 hónappal 24 (88,89%, n = 27) szem volt tünetmentes. Következtetés: A Masterka® implantációja egyszerűen kivitelezhető, kifejezetten hatékony módszer lehet az 1 évnél idősebb gyermekek veleszületett könnycsatorna-szűkületének megoldására, különösen olyan esetekben, amikor a korábbi szondázás nem vezetett eredményre, valamint hosszabb szakaszon észlelünk szűkületet. Ez utóbbi esetekben megfontolandó lenne a primer szilikonsztent-implantáció is. Orv Hetil. 2020; 161(48): 2037-2042. SUMMARY INTRODUCTION Congenital nasolacrimal duct obstruction is a common cause of epiphora in infants. In most cases, spontaneous resolution occurs by 1 year of age. OBJECTIVE Retrospective evaluation of clinical outcomes of monocanalicular lacrimal duct stent implantation (Masterka®). METHOD Data of patients undergoing monocanalicular silicone stent implantation between 1st January 2015 and 30th January 2020 were evaluated. Inclusion criteria were resistant tearing to conservative therapy which had been persisting at least for 6 months, and previous probing did not resolve the symptoms. Exclusion criteria were associated bony obstruction or eyelid malposition. Treatment success was defined as complete resolution of epiphora at least two months after the procedure. RESULTS Implantation was performed on 30 eyes of 25 children (10 females [40%] and 15 males [60%]). The mean age was 4.92 ± 3.03 years (1.5-12 years, n = 25). Epiphora was a persistent symptom in every patient since birth. Preoperatively, discharge was observed in 20 (66.6%, n = 30) patients, while chronic blepharitis and conjunctivitis occurred in 10 (33.33%, n = 30) children. Amblyopia or significant astigmatism was not observed in any case. Stent was removed after 3.5 ± 1.0 (n = 30) months. At one week postoperatively 24 (80%, n = 30), at 3 months 28 (93.33%, n = 30) and at 6 months 24 (88.89%, n = 27) eyes were asymptomatic. CONCLUSION Implantation of monocanalicular silicone stent is effective and easy-to-perform. It can resolve congenital tear duct stenosis, especially where previous probing was not successful and where stenosis is longer or occurs in several localizations. In the latter cases, primary stent implantation should be considered. Orv Hetil. 2020; 161(48): 2037-2042.
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Affiliation(s)
- Irén Szalai
- 1 Általános Orvostudományi Kar, Szemészeti Klinika, Semmelweis Egyetem, Budapest, Mária u. 39., 1085
| | - Otto Alexander Maneschg
- 1 Általános Orvostudományi Kar, Szemészeti Klinika, Semmelweis Egyetem, Budapest, Mária u. 39., 1085
| | - Zoltán Zsolt Nagy
- 1 Általános Orvostudományi Kar, Szemészeti Klinika, Semmelweis Egyetem, Budapest, Mária u. 39., 1085
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Meier-Girard D, Gerstenberg G, Stoffel L, Kohler T, Klein SD, Eschenmoser M, Mitter VR, Nelle M, Wolf U. Euphrasia Eye Drops in Preterm Neonates With Ocular Discharge: A Randomized Double-Blind Placebo-Controlled Trial. Front Pediatr 2020; 8:449. [PMID: 32850558 PMCID: PMC7431947 DOI: 10.3389/fped.2020.00449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: To investigate whether the early administration of Euphrasia eye drops® in preterm neonates presenting with ocular discharge fosters the resolution of the ocular discharge and reduces the need for topical antibiotic therapy, as compared to placebo. Methods: We conducted a randomized double-blind placebo-controlled trial at the University Children's Hospital Bern, Switzerland. Preterm neonates with white, yellow, or green ocular discharge were included. Infants were randomly assigned (1:1) to the Euphrasia arm (Euphrasia eye drops®, Weleda AG, Arlesheim) or the placebo arm (NaCl 0.9%). Euphrasia or placebo was administrated at a dose of one drop in each eye four times a day over a period of 96 h. The primary outcome was the treatment success, defined as no ocular discharge at 96 h and no use of topical antibiotic therapy during the 96-h intervention. Results: A total of 114 neonates were screened and 84 were randomized. Among neonates in the Euphrasia arm, 22 (55.0%) achieved our primary outcome compared to 21 (51.2%) in the placebo arm (p = 0.85). In the Euphrasia arm, time to resolution of reddening tended to fall within the shorter bracket of 24 to 48 h (24 (92.3%) vs. 12 (80.0%) in the placebo arm, p = 0.34) and relapse or first signs of reddening during the 96-h intervention tended to be lower [3 (7.9%) eyes vs. 8 (18.2%) eyes in the placebo arm, p = 0.17]. Tearing at 96 h tended to be lower in the Euphrasia arm [5 (12.8%) eyes in the Euphrasia arm vs. 12 (27.3%) eyes in the placebo arm, p = 0.10]. Discussion: Euphrasia did not significantly improve treatment success, defined as no ocular discharge at 96 h and no use of topical antibiotic therapy during the 96-h intervention. However, results suggest that Euphrasia may be of benefit for symptoms such as reddening and tearing, and thus improve the comfort of patients. Trial Registration: The trial is registered at the US National Institutes of Health (ClinicalTrials.gov) NCT04122300 and at the portal for human research in Switzerland SNCTP000003490.
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Affiliation(s)
- Delphine Meier-Girard
- Anthroposophically Extended Medicine, Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Gisa Gerstenberg
- Anthroposophically Extended Medicine, Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Liliane Stoffel
- Department of Neonatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Therese Kohler
- Department of Neonatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabine D. Klein
- Anthroposophically Extended Medicine, Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | | | - Vera Ruth Mitter
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mathias Nelle
- Neonatology Division, University Hospital of Zurich, Zurich, Switzerland
| | - Ursula Wolf
- Anthroposophically Extended Medicine, Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
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Gupta N, Ganesh S, Singla P, Kumar S. A rare association of blepharophimosis-ptosis-epicanthus inversus case with congenital nasolacrimal duct obstruction. Eur J Ophthalmol 2019; 31:NP8-NP11. [PMID: 31752537 DOI: 10.1177/1120672119886427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of reporting this case is to describe a rare combination of blepharophimosis-ptosis-epicanthus inversus syndrome with congenital nasolacrimal duct obstruction. A variety of lacrimal anomalies have been seen in blepharophimosis-ptosis-epicanthus inversus syndrome but the occurrence of nasolacrimal duct obstruction is rare. METHOD The blepharophimosis-ptosis-epicanthus inversus syndrome is an autosomal dominant rare genetic defect with clinical manifestation of dysplasia of the eyelids, palpebral fissures, flat nasal bridge, and ptosis. A 20-month-old boy was referred with the complaints of watering and discharge from his right eyes since birth. On examination, the child had all the features of blepharophimosis-ptosis-epicanthus inversus syndrome with right congenital nasolacrimal duct obstruction in line with the published reports. RESULT On endoscopic probing and irrigation, the probe could not be visualized into the inferior meatus. On dacryoendoscopy, the membranous part of the nasolacrimal duct was found to be completely obliterated with no light transmission into the nose indicating a malformed nasolacrimal duct. The child was managed by endoscopic dacryocystorhinostomy. We could find only one case report published so far on the combination of congenital nasolacrimal duct obstruction with blepharophimosis-ptosis-epicanthus inversus syndrome. This study adds one more case of blepharophimosis-ptosis-epicanthus inversus syndrome with congenital nasolacrimal duct obstruction and adjuvant use of dacryoendoscopy.
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Affiliation(s)
- Nishi Gupta
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Suma Ganesh
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Sunil Kumar
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Dolar Bilge A. Mode of delivery, birth weight and the incidence of congenital nasolacrimal duct obstruction. Int J Ophthalmol 2019; 12:1134-1138. [PMID: 31341804 DOI: 10.18240/ijo.2019.07.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/01/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To study any possible association of congenital nasolacrimal duct obstruction (CNLDO) with mode of delivery, birth weight and gestational age. METHODS We retrospectively reviewed charts of all patients (n=2591) under the age of 3y who were born between April 2015 and May 2017 and were examined at the Ophthalmology Clinic of Emsey Hospital Istanbul, Turkey. We identified patients (n=105) who were diagnosed as CNLDO. The mode of delivery, birth weight and gestational age along with any adverse event during or after delivery or any other health history were determined. Birth statistical data were obtained from the hospital's medical records database. RESULTS Gestational age of babies who were born via cesarean section (CS) was lower than gestational age of babies who were born via normal spontaneous vaginal delivery (NSVD; P=0.002). Babies who were born via CS were found to have 3.75 times higher risk of developing NLDO when compared to babies who were born via NSVD (OR=3.754). CONCLUSION There is a possible association between CS and CNLDO.
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Affiliation(s)
- Ayse Dolar Bilge
- Department of Ophthalmology, Emsey Hospital, Istanbul 34912, Turkey
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AlHammad F, Al Tamimi E, Yassin S, AlBadri K, AlJarudi S, AlShawaf M, Khandekar R. Unilateral Congenital Nasolacrimal Duct Obstruction, Is It An Amblyogenic Factor? Middle East Afr J Ophthalmol 2019; 25:156-160. [PMID: 30765954 PMCID: PMC6348941 DOI: 10.4103/meajo.meajo_3_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/AIMS To evaluate the refractive status, axial length, and prevalence of amblyopia among Saudi children with unilateral congenital nasolacrimal duct obstruction (UCNLDO) compared to the unaffected fellow eye. METHODS A retrospective chart review was performed for children with UCNLDO at two eye institutes in Eastern Saudi Arabia from 2009 to 2015. The outcomes of syringing determined UNCLDO. The risk factors for amblyopia were defined as anisometropia of (spherical equivalent) >1.5 D, hyperopia >3.5 D, myopia >3.0 D, astigmatism >1.5 D at 90° or 180°, >1.0 D, any manifest strabismus, any media opacity >1 mm, or ptosis 1 mm or less margin reflex distance 1 along with blunting of vision in that eye. Matched-pair analysis was performed to correlate variables. P < 0.05 was considered statistically significant. RESULTS We included 39 children with UNCLDO. The mean axial length was 21.4 ± 1.3 mm for the eyes with UCNLDO and 21.6 ± 1.0 mm for the fellow eye (P = 0.4). Hyperopia >+2 D was present in 17 (44%) eyes with UCNLDO and none of the fellow eyes. None of the participants had strabismus. CONCLUSION Axial length and risk factors of amblyopia such as anisometropia, hyperopia, and strabismus were not associated with UCNLDO. UCNLDO is likely an isolated defect.
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Affiliation(s)
- Fatimah AlHammad
- Oculoplastic and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Elham Al Tamimi
- Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Sanaa Yassin
- Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Khadija AlBadri
- Oculoplastic Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Saleh AlJarudi
- Optometry Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Mohammed AlShawaf
- Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Xiang Q, Hu D, Gao X. Tobramycin/dexamethasone eye drops as a better choice for lacrimal duct probing in persistent congenital nasolacrimal duct obstruction: A consort study. Medicine (Baltimore) 2019; 98:e14188. [PMID: 30732134 PMCID: PMC6380727 DOI: 10.1097/md.0000000000014188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Congenital nasolacrimal duct obstruction (CNLDO) is common and. lacrimal duct probing is the major treatment. But persistent CNLDO in older children makes the success rate rapidly decreased due to long-term chronic inflammation. To improve the success rate, probing combined with tobramycin/dexamethasone ointment is considered effective. But in practice, we found a lot of problems in using the ointment. So we tried tobramycin/dexamethasone eye drops as a replacement. The results is surprising, so we hope to do some further research in order to prove it is worth to clinical application. OBJECTIVE To evaluate the effect of lacrimal duct probing combined with tobramycin/dexamethasone eye drops or ointment on persistent CNLDO in children older than 1-year-old. METHODS This randomized controlled study included 409 subjects (496 eyes) older than 1-year-old with persistent CNLDO in southwest China, and classified into 3 groups: 96 cases (123 eyes) were the tobramycin/dexamethasone eye drops group (drops group), 88 cases (104 eyes) were the tobramycin/dexamethasone ointment group (ointment group), and 225 cases (269 eyes) were control group which probing with normal saline (NS group). The data of age, sex, and laterality were analyzed through pairwise comparison. Then the 3 groups were divided into 2 subgroups by age, 12 to 24 months and 25 to 36 months. The surgical findings and success rate in two subgroups were compared. RESULTS The success rates in the tobramycin/dexamethasone eye drops group in both 2 age subgroups were significantly higher than that in the ointment group and NS group (P < .05). CONCLUSIONS Probing combined with tobramycin/dexamethasone eye drops was effective and easy-to-perform in the clinic, and it may be a better choice for persistent CNLDO.
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Affiliation(s)
- Qin Xiang
- Department of Ophthalmology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Dan Hu
- Department of Ophthalmology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xu Gao
- Department of Ophthalmology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Vagge A, Ferro Desideri L, Nucci P, Serafino M, Giannaccare G, Lembo A, Traverso CE. Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review. Diseases 2018; 6:E96. [PMID: 30360371 DOI: 10.3390/diseases6040096] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 12/03/2022] Open
Abstract
Congenital nasolacrimal duct obstruction (CNLDO) is a common condition causing excessive tearing or mucoid discharge from the eyes, due to blockage of the nasolacrimal duct system. Nasolacrimal duct obstruction affects as many as 20% children aged <1 year worldwide and is often resolved without surgery. Available treatment options are conservative therapy, including observation, lacrimal sac massage and antibiotics, and invasive therapy. Observation, combined with conservative options, seems to be the best option in infants aged <1 year. Meanwhile, in children aged >1 year, nasolacrimal probing successfully addresses most obstructions. However, the most favorable timing for probing remains controversial. To alleviate persistent epiphora and mucous drainage that is refractory to probing, repeat probing, silicone tube intubation, balloon catheter dilation or dacryocystorhinostomy can be considered as available treatment options. Our review aims to provide an update to CNDO management protocols.
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Abstract
Introduction: Congenital nasolacrimal duct obstruction is one of the most common causes of epiphora in newborns and the main cause of this condition is the persistence of Hasner membrane. Several treatment options are available, like conservative treatment, probing, irrigation, or more complex techniques. Objective: The objective of this paper is to discuss the efficiency of different treatment options addressing congenital nasolacrimal duct obstruction based on trials reported in literature. Methods: Clinical trials were identified on PubMed. The results were discussed regarding patient age, type of treatment and efficiency of the treatment. Results: 41 trials were reviewed. The rate of resolution according to different treatment options was the following: conservative treatment 14.2-96%, probing 78-100%, irrigation 33-100%, silicon tube intubation 62-100%, inferior turbinate fracture 54.7-97%, balloon dacryocystoplasty 77%, endoscopic intranasal surgery 92.72%, and dacryocystorhinostomy 88.2-93.33%. Conclusions: The first choice in uncomplicated cases should be a conservative treatment, which can be followed until the age of 1 year, while in complicated cases other solutions should be considered. Abbreviations: CNDO = Congenital nasolacrimal duct obstruction, DCR = Dacryocystorhinostomy, MCI = Monocanalicular intubation, BCI = Bicanalicular intubation
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Affiliation(s)
- Elena Avram
- Ophthalmology Department, Medlife Băneasa Hyperclinic, Bucharest, Romania
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Saleem AA, Siddiqui SN, Wakeel U, Asif M. Anisometropia and refractive status in children with unilateral congenital nasolacrimal duct obstruction. Taiwan J Ophthalmol 2018; 8:31-35. [PMID: 29675347 PMCID: PMC5890582 DOI: 10.4103/tjo.tjo_77_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: The objective of the study was to evaluate the refractive status and thereby assess anisometropia in children with unilateral congenital nasolacrimal duct obstruction (CNLDO). STUDY DESIGN: This study design was a descriptive cross-sectional study. PLACE AND DURATION: this study was conducted at the Department of Pediatric Ophthalmology and Strabismology, Al-Shifa Trust Eye Hospital, Rawalpindi; from August 2013 to July 2014. METHODOLOGY: This study assessed consecutive children with unilateral CNLDO. Cycloplegic refraction on all children with CNLDO was performed followed by appropriate intervention. Refractive errors of the affected and normal eyes were compared. RESULTS: One hundred and twenty-four children with a mean age of 29.69 ± 21.12 months (range, 2 months to 8 years) were studied. Based on spherical equivalent (SE), hypermetropia was more common in the affected eyes (P < 0.001). Anisometropia of >1.5 diopters (D) was present in n = 17 (13.7%). Interocular difference was significant for spherical error and SE (P < 0.001) but not cylindrical errors. CONCLUSION: Unilateral CNLDO is associated with statistically significant anisometropia, especially anisohypermetropia which has amblyogenic potential. It is vital to perform cycloplegic refraction routinely and counsel parents regarding prognosis and regular follow-ups.
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Affiliation(s)
- Adnan Aslam Saleem
- Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | | | - Umair Wakeel
- Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Muhammad Asif
- Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
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Honkura Y, Takanashi Y, Kawamoto-Hirano A, Abe H, Osanai H, Murakami G, Katori Y. Nasolacrimal duct opening to the inferior nasal meatus in human fetuses. Okajimas Folia Anat Jpn 2017; 94:101-108. [PMID: 29681587 DOI: 10.2535/ofaj.94.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this study is to describe the Hasner's membrane which is the main factor of congenital nasolacrimal duct obstruction. Hasner's membrane at the nasal end of the fetal nasolacrimal duct (NLD) is considered to rupture at and after birth. However, topographical anatomy around the membrane as well as a mechanism of rupture seems to be still obscure. We observed frontal or sagittal sections of 20 late-stage fetuses (28-33 weeks) and found the on-going rupture in 2 specimens. The present sections demonstrated that 1) the nasal dilation was not a simple ball-like structure but extended posteriorly and laterally; 2) dilation of the NLD consistently involved the lacrimal sac; 3) Hasner's membrane and ductal mucosal layer contained no macrophages and no or few arteries and nerves. The posterior extension of the NLD end ranged from 1-2 mm, while the lateral extension 3-5 mm although a site of the thinnest membrane varied in location between specimens. Moreover, the thickest NLD due to dilation was in the slightly orbital or upper side of the nasal end. Therefore, before surgical treatment of Hasner's membrane, evaluation using medical images seems to be necessary. Since the nasal epithelium on Hasner's membrane was most likely to destroy earlier than the NLD mucosal lining, observations of the membrane from the nasal cavity seemed helpful for diagnosis at which site would be broken and when.
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Affiliation(s)
- Yohei Honkura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
| | - Yoshitaka Takanashi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
| | - Ai Kawamoto-Hirano
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
| | - Hiroshi Abe
- Depatment of Anatomy, Akita University School of Medicine
| | | | - Gen Murakami
- Division of Internal Medicine, Iwamizawa Asuka Hospital
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
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Rajabi MT, Zavarzadeh N, Mahmoudi A, Johari MK, Hosseini SS, Abrishami Y, Rajabi MB. Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction. Int J Ophthalmol 2016; 9:1466-1470. [PMID: 27803865 DOI: 10.18240/ijo.2016.10.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/15/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing. METHODS This retrospective study was performed on 338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing. Intubation was performed under light sedation in operating room and the stent was left 3mo in place. Clinical outcome was investigated 3mo after tube removal. RESULTS Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation (P=0.00). In addition, Monoka intubation had better outcomes compared to Masterka technique (P=0.046). No difference was found between genders but the higher the age, the better the outcomes with bicanalicular technique rather than monocanalicular. CONCLUSION Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages. Also, based upon our clinical outcomes, Masterka intubation is not recommended in cases of failed probing.
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Affiliation(s)
| | - Najmeh Zavarzadeh
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Alireza Mahmoudi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | | | | | - Yalda Abrishami
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
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Hung CH, Chen YC, Lin SL, Chen WL. Nasolacrimal Duct Probing under Topical Anesthesia for Congenital Nasolacrimal Duct Obstruction in Taiwan. Pediatr Neonatol 2015; 56:402-7. [PMID: 26026949 DOI: 10.1016/j.pedneo.2015.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/30/2015] [Accepted: 04/09/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To report the success rates of office probing for congenital nasolacrimal duct obstruction (NLDO) among children of different age groups in Taiwan. METHODS In this single-center, retrospective study, 564 eyes of 477 patients under the age of 5 years diagnosed with congenital NLDO were treated in a stepwise manner between 2001 and 2013. For infants aged < 6 months, treatment with massage and observation was suggested, followed by deferred probing under topical anesthesia if symptoms persisted. However, in cases of severe infection, immediate probing was suggested. In children aged > 6 months, office probing was usually highly recommended. Those with probing failures received either a second probing or silicone intubation. Treatment success was defined as anatomic patency by immediate irrigation after probing and absence of epiphora or mucous discharge at the follow-up visit. RESULTS Primary probing was successful in 457 of 564 eyes (success rate: 81%). The success rate of primary probing was negatively correlated with increasing age: 90.1% (163/181), 79.6% (164/206), 76.8% (73/95), 73.5% (36/49), 75% (18/24), and 33% (3/9) for the age groups of 0 to <6 months, 6 to <12 months, 12 to <18 months, 18 to <24 months, 24 to <36 months, and 36-60 months, respectively (p < 0.001, Fisher's exact test). The second probing was successful in 52 of 81 eyes. In total, probing was successful in 509 of 564 eyes (success rate: 90.2%). CONCLUSION Office probing is safe and effective for treating congenital NLDO. The success rate of primary probing decreases significantly with age.
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Affiliation(s)
- Chih-Heng Hung
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
| | - Yi-Chun Chen
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
| | - Shun-Ling Lin
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan; Medical College, National Taiwan University, Taipei, Taiwan; Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wei-Lun Chen
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
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Andalib D, Mansoori H. A comparison between monocanalicular and pushed monocanalicular silicone intubation in the treatment of congenital nasolacrimal duct obstruction. Int J Ophthalmol 2014; 7:1039-42. [PMID: 25540762 DOI: 10.3980/j.issn.2222-3959.2014.06.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/09/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation (PMCI) of the nasolacrimal duct for congenital nasolacrimal duct obstruction (CNLDO). METHODS In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation (MCI) (n=28 eyes) or PMCI (n=25 eyes). All procedures were performed by 1 oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal. RESULTS The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25±10.08mo (range, 13-49mo) for MCI and 26.85±12.25mo (range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes (90.0%) in the MCI group compared with 10 of 20 eyes (50%) in the PMCI group (P=0.01). In the PMCI group, the tube loss (30%) was greater than the MCI group (5%), however the differences between the 2 groups proved to be not significant (P=0.91). CONCLUSION Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.
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Affiliation(s)
- Dima Andalib
- Strabismus and Oculoplastic Unit, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Abbasi St, Tabriz 5154645395, Iran
| | - Hossein Mansoori
- Strabismus and Oculoplastic Unit, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Abbasi St, Tabriz 5154645395, Iran
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Ali MJ, Kamal S, Gupta A, Ali MH, Naik MN. Simple vs complex congenital nasolacrimal duct obstructions: etiology, management and outcomes. Int Forum Allergy Rhinol 2014; 5:174-7. [PMID: 25367436 DOI: 10.1002/alr.21435] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to report the comparative clinical profiles and outcomes of simple and complex congenital nasolacrimal duct obstruction (CNLDO). METHODS The study was a retrospective chart review of all patients presenting with CNLDO from a single surgeon's (M.J.A.) database. All patients underwent irrigation and probing under nasal endoscopic guidance. A detailed lacrimal system evaluation was performed, intraoperative findings including nasal endoscopy were documented, and etiologies of complex CNLDO were noted. Outcome measures were comparative profiles, and anatomical success and functional success of the interventions. Statistical analyses were performed using the Shapiro-Wilk test, Fisher's exact test, and Wilcoxon rank sum test. RESULTS Ninety-five eyes of 81 patients with simple CNLDO and 100 eyes of 83 patients with complex CNLDO were compared. The mean age at presentation was 17.6 months in simple CNLDO and 45.6 months in complex cases (p < 0.001). Epiphora and discharge were the most common symptoms; 89.4% among simple cases and 92% in the complex group. The most common causes of complex CNLDO were bony obstructions (23%), craniofacial syndromes (12%), and buried probe (10%). At a mean follow-up of 5.85 months for simple CNLDO and 4.68 months for complex CNLDO, anatomical success and functional success was noted in 97.8% and 94.7%, respectively, in simple CNLDO, and in 58% and 51%, respectively, in complex CNDLO (p < 0.001). CONCLUSION Bony obstruction, craniofacial syndrome, and buried probe were the most common reasons for a complex CNLDO, noted commonly in older children, with irrigation and probing having much poorer outcomes when compared with simpler obstructions.
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Kakizaki H, Takahashi Y, Kinoshita S, Shiraki K, Iwaki M. The rate of symptomatic improvement of congenital nasolacrimal duct obstruction in Japanese infants treated with conservative management during the 1st year of age. Clin Ophthalmol 2011; 2:291-4. [PMID: 19668718 PMCID: PMC2693981 DOI: 10.2147/opth.s2582] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study aimed to examine the rate of symptomatic improvement of congenital nasolacrimal duct obstruction (CNLDO) in Japanese infants treated with conservative management within the 1st year of age. Thirty-five lacrimal ducts in 27 patients diagnosed with CNLDO were included in the study. During the observational period, lacrimal ducts were massaged. As well, antibiotic eye drops, to be administered 4 times a day, were sometimes prescribed for obvious conjunctivitis. Two lacrimal ducts in 2 patients were probed before the 1st year of age because of dacryocystitis or severe blepharitis; these patients were included in the unimproved group. Twenty-nine lacrimal ducts in 21 patients resolved during the period (82.9%); with 16 lacrimal ducts resolving before six months of age. Therefore, a comparatively high percentage of resolution for CNLDO (82.9%) following conservative management was shown before the 1st year of age in Japanese infants.
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Affiliation(s)
- Hirohiko Kakizaki
- Department of Ophthalmology, Aichi Medical University, Aichi, Japan.
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