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Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
[Treatment of congenital lacrimal duct obstruction: A prospective clinical cohort study]
J Heichel1, F Bachner2, A Schmidt-Pokrzywniak3
1Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland. jens.heichel@uk-halle.de.
Insights
Pressurized probing and irrigation effectively treats congenital lacrimal duct obstruction. Success rates are highest for infants aged 1-6 months, with silicone tube intubation showing excellent outcomes.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Context:
- Congenital lacrimal duct obstruction (CLDO) is a common condition in infants.
- Pressurized probing and irrigation is a standard surgical intervention when conservative methods fail.
Purpose:
- To evaluate the age-dependency and success rates of different therapeutic options for CLDO.
- To analyze factors influencing treatment outcomes in pediatric patients.
Summary:
- A prospective cohort study included 111 children (137 eyes) treated for CLDO.
- Success rates varied: probing under local anesthesia (85.5%), general anesthesia without intubation (28.6%), and general anesthesia with silicone tube intubation (94.2%).
- Increasing age correlated with a higher risk of unsuccessful treatment (OR: 1.3).
Impact:
- Syringing under local anesthesia is an effective treatment for CLDO.
- Optimal treatment success is observed in infants between 1-6 months of age.
- Silicone tube intubation demonstrates high efficacy in managing CLDO.
Background:
Pressurized probing and irrigation is the method of choice for congenital lacrimal duct obstruction after conservative therapeutic strategies have failed. The aim of this study was to evaluate age dependence and success rates of different therapeutic options.
Material And Methods:
A prospective cohort study of children with congenital lacrimal duct obstruction was performed. All children treated during the period between May 2009 and June 2010 were included. Surgical success was defined as the absence of epiphora and mucous discharge for a postoperative follow-up of 3 months. Odds ratios (OR) and 95 % confidence intervals (CI) of different variables were estimated using logistic regression.
Results:
A total of 111 children (137 eyes) underwent treatment for congenital lacrimal duct obstruction. The mean age of the children was 7.7 months (range 1-30 months). The success rate of probing under local anesthesia was 85.5 % (n = 100). Probing under general anesthesia without intubation of the lacrimal pathway was successful in 28.6 % (n = 2). Treatment under general anesthesia with intubation of the lacrimal pathway had a success rate of 94.2 %. If the primary treatment was complicated the OR was 1.9 (95 % CI: 0.7-5.1), for males the OR was 1.7 (95 % CI: 0.8-3.5) and in cases of a positive family history the OR was 1.5 (95 % CI: 0.7-3.3). With every increasing month of age the risk not to be treated successfully increased (OR: 1.3, 95 % CI: 1.2-1.5).
Conclusion:
Syringing under local anesthesia is an effective therapy. The highest success rates were found at the ages of 1-6 months. Therapy with additional silicone tube intubation was highly successful.
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