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Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
Management of Pediatric Traumatic Nasolacrimal Duct Obstruction and Predictors for Surgical Outcomes
Lunhao Li1,2, Leilei Zhang1,2, Yimin Li1,2
1Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine.
Insights
Pediatric post-traumatic nasolacrimal duct obstruction (TNLDO) is often caused by sac-duct junction issues. Surgical success is predicted by factors like orbital fractures and lacrimal sac displacement.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Oculoplastics
Background:
- Pediatric nasolacrimal duct obstruction (NLDO) can result from trauma.
- Understanding clinical features and surgical outcomes is crucial for effective treatment.
Purpose of the Study:
- To evaluate clinical features, surgical treatments, and outcomes of pediatric post-traumatic NLDO.
- To identify predictors of surgical success or failure in these cases.
Main Methods:
- Retrospective chart review of pediatric patients (<18 years) with traumatic NLDO over 11 years.
- Analysis of clinical data, including surgical procedures (external and endoscopic dacryocystorhinostomy).
- Binary logistic regression used to develop a predictive model for surgical failure.
Main Results:
- 83 eyes from 80 patients were analyzed; 71.1% had lacrimal sac displacement, 79.5% had medial canthus deformities.
- Anatomical and functional success rate was 83.1% after a mean follow-up of 28 months.
- Orbital rim fractures, scarring, lacrimal sac displacement, and nearby fracture fragments predicted surgical failure.
Conclusions:
- The sac-duct junction is the most common obstruction site in pediatric post-traumatic NLDO.
- Lacrimal sac displacement and bony fragments near the sac are significant failure predictors.
- Medial canthal deformities can be concurrently treated with favorable outcomes.
Purpose:
The purpose of this study was to evaluate the clinical features, surgical treatments, and outcomes of pediatric post-traumatic nasolacrimal duct obstructions and predictors for surgical outcomes.
Methods:
A retrospective chart review was performed of patients under the age of 18 years with the diagnosis of traumatic nasolacrimal duct obstructions during an 11-year period from a tertiary referral center. The clinical data were reviewed and analyzed. A binary logistic regression was performed to establish a predictive model for surgical failure after treatment.
Results:
Eighty-three eyes of 80 consecutive patients were included in the study. Anterior displacement of the lacrimal sac was noted in 71.1% (59/83) cases. Medial canthus deformities were observed in 79.5% (63/83) cases. External dacryocystorhinostomy and endoscopic dacryocystorhinostomy were performed on 65 and 18 cases, respectively. At a mean follow-up of 28 months following stent removal, anatomical and functional success rate was noted in 83.1% (69/83). The presence of orbital fractures involving the rim, gross skin scaring, lacrimal sac displacement, and fracture fragments in the vicinity of the lacrimal sac were found to be significant predictors for surgical failure. The area under the raw current curves of the predictive model was 0.888.
Conclusion:
This large series of post-traumatic pediatric nasolacrimal duct obstructions showed that sac-duct junction was the most common site of obstruction and anterior displacement of the lacrimal sac and bony fragments in the lacrimal sac area were significant predictors of failures. Medial canthal deformities can be addressed simultaneously with good outcomes.
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