Nonsurgically placed nasolacrimal stents for epiphora: long-term results and factors favoring stent patency.

ABSTRACT

PURPOSE: To evaluate long-term effectiveness of a polyurethane stent in lacrimal system treatment. MATERIALS AND METHODS: Fluoroscopically guided placement of a polyurethane lacrimal stent was evaluated in 727 obstructed lacrimal systems in 588 patients with a mean follow-up period of 77 weeks (range, 1-277 wk), from which the technical and initial success rates and long-term patency were calculated. The impact of factors affecting long-term patency, including symptom duration, previous probing, presence of pus or eye discharge, lesion multiplicity, and site of obstruction were evaluated. Changes in 295 patients' lacrimal sac configuration after stent removal were analyzed and classified into three categories contraction, widening, and no change. RESULTS: The overall technical success rate in this study was 95.9%, with a 90.8% initial clinical success rate. The median primary patency duration was 504.33 days plus minus 23.17; secondary median patency duration was 642.87 days plus minus 24.68. Most favorable factors such as symptom duration, previous probing, presence of pus, or eye discharge showed no significant difference; however, site of obstruction and lesion multiplicity influenced mean patency. Lesions below the junction and single lesions showed longer patency periods. Common canalicular obstruction after stent removal occurred in 50 (17%) lacrimal systems. Irregular sac configuration appeared in 171 (58%) lacrimal systems after stent removal. Sac configuration was the same in 185 (62.7%) lacrimal systems, contracted in 105 (35.6%), and widened in five (1.7%). In 151 eyes of 295, epiphora recurred 121.6 days (range, 1-1,182 d) after stent removal. CONCLUSION: Fluoroscopic lacrimal stent placement is a simple and safe outpatient procedure, but high recurrence and sac irregularities after stent removal are not encouraging.