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Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
Minimally-Invasive Surgical Approach to Congenital Dacryostenosis: Proposal for a New Protocol
Stefano Pensiero1, Laura Diplotti1, Gianluca Visalli2
1Department of Ophthalmology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
Insights
Probing is a highly effective treatment for congenital dacryostenosis in infants, with success rates unaffected by surgical timing. Early intervention is recommended to identify potential maldevelopments, and repeated probing is effective for unresponsive cases.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital dacryostenosis is a common infant ophthalmological condition with high spontaneous resolution.
- Lacrimal drainage system probing is the primary surgical approach for unresponsive cases, but optimal timing and treatment for persistent cases remain debated.
Purpose of the Study:
- To determine the optimal timing for probing in pediatric congenital dacryostenosis.
- To evaluate the efficacy of repeat probing and dacryointubation for cases unresponsive to initial surgery.
- To ascertain the epidemiology of lacrimal outflow maldevelopments.
Main Methods:
- A retrospective cohort study of 625 eyes from 457 patients (7-48 months) undergoing dacryostenosis surgery.
- Patients were stratified into four cohorts based on surgical timing.
- Data analysis employed Fisher's exact test.
Main Results:
- Primary probing demonstrated high success rates, with no significant variation across different surgical timing cohorts.
- Recurrences were observed in one-third of cases; two-thirds were successfully managed with secondary probing or dacryointubation, showing comparable efficacy.
- Dacryointubation resolved all cases unresponsive to a second surgical intervention.
Conclusions:
- Surgical probing for congenital dacryostenosis is highly effective, irrespective of timing.
- Early intervention is advised to detect maldevelopments requiring more intensive management.
- For primary probing failures without maldevelopments, repeated probing is a less invasive yet equally effective alternative to dacryointubation.
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.
