Endoscopic dacryocystorhinostomy with silicone, polypropylene, and T-tube stents; randomized controlled trial of efficacy and safety.

OBJECTIVE: To compare the efficacy and safety of endoscopic dacryocystorhinostomy (En-DCR) with different stent materials for lacrimal sac intubation in primary nasolacrimal ductal obstructions. STUDY DESIGN: Randomized controlled study with three parallel groups. Level of evidence is 1b. METHODS: A total of 91 patients (five bilateral) with primary nasolacrimal duct obstruction (NLDO) at a tertiary referral center scheduled for En-DCR were to allocated into three stent groups with a sealed envelope and were randomized into three treatments: silicone, Prolene (polypropylene), and otologic T-tube. Ophthalmology and otolaryngology clinics evaluated the patients preoperatively and postoperatively with endoscopes, lacrimal system syringing, and dacryocystography. The success of the stents was evaluated 12 months after surgery with symptom relief and ostial patency. Complications were also noted. RESULTS: The overall success rate of the En-DCR in the stent groups was 78.1% (75/96); specifically, 87.5% (28/32) with silicone, 84.4% (27/32) with Prolene, and 62.5% (20/32) with T-tube. The efficacy of the procedures with the T-tube was significantly lower than that of the Prolene and silicone (p = .031, χ(2) test). There were no significant differences between the silicone and Prolene (p = .718, χ(2) test). Prolene was found to be related with orbital complications. Spontaneous loss is a particular complication of otologic T-tube and highly portends to failure. CONCLUSIONS: The results of our study suggest that efficacy, defined as anatomic and functional success, is equally high for silicone and Prolene stents and lower for otologic T-tube in En-DCR.

The effect of dacryocystorhinostomy on mucociliary function.

OBJECTIVE: External dacryocystorhinostomy is suspected to cause mucociliary dysfunction by affecting ciliary activity and quality of the mucus. We hypothesized that patients who undergo endoscopic dacryocystorhinostomy may also experience mucociliary dysfunction. We evaluated the effects of surgery on mucociliary clearance time in patients who underwent endoscopic dacryocstorhinostomy and external dacryocstorhinostomy. STUDY DESIGN: A prospective controlled study. SUBJECTS AND METHODS: Forty-four patients were studied: 22 had undergone one-sided endoscopic surgery and 22 had undergone one-sided external surgery for nasolacrimal duct obstruction. Nonoperated sides of the both groups were remained as controls. The saccharin test was used to evaluate the mucociliary clearance time of the both sides. RESULTS: Dacryocystorhinostomy, results in prolonged mucociliary clearance times either endoscopic or external approach is performed (P < 0.001, paired t test). There was no significant difference between the mucociliary clearance times after endoscopic and external dacryocystorhinostomy (P = 0.22, Student's t test). CONCLUSION: Dacryocystorhinostomy impairs mucociliary function independent of the type of surgery.