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Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
Factors Associated With Nasolacrimal Duct Probing Failure Among Children in the Intelligent Research in Sight
Isdin Oke1,2, Tobias Elze2, Joan W Miller2
1Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Most young children undergoing nasolacrimal duct probing do not require repeat procedures. Factors like surgeon experience and balloon catheter dilation are linked to lower reoperation rates for pediatric nasolacrimal duct obstruction.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Nasolacrimal duct probing is a common procedure for congenital nasolacrimal duct obstruction in children.
- Understanding factors influencing the success of this intervention is crucial for optimizing treatment strategies and outcomes.
Purpose of the Study:
- To identify patient and procedural factors associated with the need for repeated nasolacrimal duct probing in young children.
- To inform clinical practice patterns and improve success rates for this common pediatric ophthalmic surgery.
Main Methods:
- Retrospective cohort study using the Intelligent Research in Sight (IRIS) Registry.
- Analysis of 19,357 children undergoing nasolacrimal duct probing before age 4.
- Kaplan-Meier and Cox proportional hazards regression models to assess reoperation risk.
Main Results:
- The cumulative incidence of repeated nasolacrimal duct probing within 2 years was 7.2%.
- Bilateral obstruction and office-based simple probing were associated with a higher risk of reoperation.
- Primary balloon catheter dilation and procedures by high-volume surgeons were associated with a lower risk of reoperation.
Conclusions:
- Most children undergoing nasolacrimal duct probing do not require repeat procedures.
- Surgeon experience, primary balloon catheter dilation, and procedures performed under anesthesia are associated with reduced reoperation risk.
- These findings can help refine surgical techniques and patient selection for nasolacrimal duct probing.
Importance:
Understanding the factors associated with nasolacrimal duct probing failure in young children may help inform practice patterns.
Objective:
To identify factors associated with repeated nasolacrimal duct probing in young children.
Design, Setting, And Participants:
This retrospective cohort study analyzed data from the Intelligent Research in Sight (IRIS) Registry for all children who underwent nasolacrimal duct probing before 4 years of age between January 1, 2013, and December 31, 2020.
Main Outcomes And Measures:
The Kaplan-Meier estimator was used to assess the cumulative incidence of a repeated procedure within 2 years of the initial procedure. Hazard ratios (HRs) derived from multivariable Cox proportional hazards regression models were used to evaluate the association between repeated probing and patient age, sex, race and ethnicity, geographic region, operative side, laterality of obstruction, type of initial procedure, and surgeon volume.
Results:
This study included 19 357 children (9823 [50.7%] male; mean [SD] age, 1.40 [0.74] years) undergoing nasolacrimal duct probing. The cumulative incidence of repeated nasolacrimal duct probing was 7.2% (95% CI, 6.8%-7.5%) within 2 years of the initial procedure. Among 1333 repeated procedures, the second procedure involved silicone intubation in 669 (50.2%) and balloon catheter dilation in 256 (19.2%). Among 12 008 children aged 1 year or younger, office-based simple probing was associated with a slightly higher probability of reoperation compared with facility-based simple probing (9.5% [95% CI, 8.2%-10.8%] vs 7.1% [95% CI, 6.5%-7.7%]; P < .001). In the multivariable model, a greater risk of repeated probing was associated with bilateral obstruction (HR, 1.48; 95% CI, 1.32-1.65; P < .001) and office-based simple probing (HR, 1.33; 95% CI, 1.13-1.55; P < .001), and a lower risk was associated with primary balloon catheter dilation (HR, 0.69; 95% CI, 0.56-0.85; P < .001) and procedures performed by high-volume surgeons (HR, 0.84; 95% CI, 0.73-0.97; P = .02). Age, sex, race and ethnicity, geographic region, and operative side were not associated with reoperation risk in the multivariable model.
Conclusions And Relevance:
In this cohort study, most children in the IRIS Registry undergoing nasolacrimal duct probing before 4 years of age did not require any additional intervention. Factors associated with lower risk of reoperation include surgeon experience, probing performed under anesthesia, and primary balloon catheter dilation.
