[Balloon dacryocystoplasty: interventional radiological therapy of congenital dacryostenosis]
R Hünerbein1, F Grass, M Leber
1Institut für Diagnostische und Interventionelle Radiologie, Klinikum Kassel. huenerb@klinikum-kassel.de
Insights
Balloon dacryocystoplasty effectively treats congenital nasolacrimal duct obstruction in children. This minimally invasive procedure offers a high success rate with minimal complications, resolving epiphora and infections.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Medical Imaging
Background:
- Congenital nasolacrimal duct obstruction (CNLDO) presents with epiphora and recurrent infections.
- Conservative treatments like massage and eye drops often fail in complicated cases.
- Dacryocystography is essential for diagnosing the extent of obstruction.
Purpose of the Study:
- To evaluate the efficacy of balloon dacryocystoplasty for complicated CNLDO.
- To assess the safety and success rates of this minimally invasive intervention.
Main Methods:
- 46 children with persistent CNLDO underwent dacryocystography and balloon catheter dilatation.
- Antibiotic irrigation of the lacrimal sac was performed post-dilatation.
- A 2.5 mm balloon catheter was used, with procedures often done as out-patient.
Main Results:
- Dacryocystography revealed various obstructions, including Hasner valve occlusions.
- Balloon dilatation was successful in all cases with a mean radiation time of 2.1 minutes.
- A 98% cumulative clinical success rate was observed, with minimal complications.
Conclusions:
- Balloon catheter dilatation is a low-risk, highly successful treatment for complicated CNLDO.
- This technique provides a valuable alternative after conservative treatments fail.
- Effective management of CNLDO improves patient outcomes and reduces recurrent infections.
Purpose:
To evaluate the results of balloon dacryocystoplasty in the treatment of complicated development of connatal obstructed nasolacrimal duct system.
Materials And Methods:
Dacryocystography under general anaesthesia was performed on 46 children with epiphora from birth and recurrent infection of the nasolacrimal duct system. 54 nasolacrimal ducts (8 children bilaterally) were treated with balloon catheter dilatation and antibiotic irrigation of the nasolacrimal sac. In all cases previous conservative treatment with eye drops and superficial massage of the lacrimal sac had failed. 11 children without clinical improvement were irrigated before catheter dilatation by an ophthalmologist. The ages ranged from 6 weeks to 7.5 years (mean 23.5 months). 39 dilatations were carried out as an out-patient procedure. The clinical results were confirmed by a questionnaire filled in by the parents.
Results:
15 incomplete obstructions and 39 occlusions of the Hasner valve (n = 45) or of the nasolacrimal duct system (n = 9) were demonstrated with dacryocystography. Dilatation with a 2.5 mm ballon was successfully performed in all cases and the mean radiation time was 2.1 minutes. No relevant complications occurred. The mean follow up time was 18.4 months (3 - 41 months). 39 of 46 children showed no symptoms, 6 children seldomly experienced onset of epiphora. The symptoms did not improve in only one child. The cumulative clinical success rate is 98 %.
Conclusion:
Following diagnostic dacryocystography, balloon catheter dilatation is a low risk and very successful treatment of complicated connatal obstructed nasolacrimal duct system.
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