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Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
[Endoscopy of the Lacrimal Duct System in Children]
J Heichel1, T Bredehorn-Mayr1, H-G Struck1
1Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale.
Insights
Transcanalicular endoscopy offers new options for treating pediatric lacrimal duct obstructions and congenital anomalies. This minimally invasive approach successfully reconstructed lacrimal systems in three children, with no recurrences observed during follow-up.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Endoscopic Surgery
Background:
- Lacrimal duct pathologies are common in pediatric ophthalmology, often stemming from nasolacrimal duct obstruction or congenital anomalies.
- Complications can decrease healing chances with conservative treatment, necessitating surgical intervention.
- Transcanalicular endoscopy presents a minimally invasive surgical option for these conditions.
Observation:
- Three pediatric cases illustrate the use of transcanalicular endoscopy for lacrimal duct system pathologies.
- Case 1: An 8-week-old infant with an amniotocele causing recurrent inflammation.
- Case 2: A 5-year-old child with a congenital lacrimal fistula.
- Case 3: A 5-year-old child with severe chronic dacryocystitis and retained silicone tubes after prior surgeries.
Findings:
- Transcanalicular endoscopy successfully diagnosed and treated all three cases.
- A bullous Hasner's membrane was opened in Case 1.
- A lacrimal fistula communicating with the common canaliculus was identified and treated in Case 2.
- Retained silicone tube fragments were removed in Case 3.
- Post-operative silicone tubing and subsequent removal led to successful outcomes with no recurrences at extended follow-up.
Implications:
- Transcanalicular endoscopy provides valuable diagnostic and therapeutic options for specific pediatric lacrimal duct system indications.
- Its minimally invasive nature preserves topographic anatomy under direct visual control.
- This technique should be performed by experienced surgeons for optimal results in pediatric patients.
Background:
Pathologies of the lacrimal duct system show a frequent occurrence in paediatric ophthalmology. Mostly, the connection between the nasolacrimal duct and the nose fails to open but also combined diseases or congenital anomalies may be the reason. Because of complications, the chance for healing after a conservative therapeutic approach decreases and surgical intervention is necessary.
Patients And Methods:
The opportunity for transcanalicular endoscopy of the lacrimal duct system in children is shown by the presentation of three different case reports. Typical clinical findings are given and the use of dacryoendoscopy for diagnostic and therapeutic benefit is pointed out. Therefore, we present an 8-week-old child, suffering recurrent purulent inflammation due to an amniotocele (1), a 5-year-old child having a congenital lacrimal fistula (2) and another 5-year-old child with a severe chronic dacryocystitis of both eyes after several lacrimal duct surgeries showing remaining intrasaccal silicone tubes (3).
Results:
In all these cases transcanalicular endoscopy could be used successfully for reconstruction of the lacrimal duct systems. A bullous Hasner's membrane could be localized and opened (1). The lacrimal fistula was identified to communicate with the common canaliculus and combined stenosis of the canaliculus and saccus were treated (2). In the third case fragments of intrasaccal silicone tubes could be localised and the foreign bodies could be evacuated by transcanalicular surgery (3). The children with lacrimal fistula and the intrasaccal foreign bodies were treated with self-threading silicone tubing which was removed three months later. In the follow-up period (16 months in case 2, 22 months in case 3 and 38 months in case 1) recurrences of the lacrimal pathologies or clinical complaints were absent.
Conclusion:
Transcanalicular endoscopy of the lacrimal duct system should not be regarded as the means of choice but it does offer additional diagnostic and therapeutic options for special indications. A main advantage of this kind of surgery is its minimally invasive character. Under visual control, topographic anatomy can be preserved. Dacryoendoscopy in children should be done only by experienced surgeons.
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