Tratamiento de la obstrucción congénita de la vía lagrimal mediante balón catéter, intubación monocanalicular y control endoscópico / Treatment of the congenital obstruction of the lachrymal route, by means of ball catheter, intubation monocanalicular and endoscopic control

Introducción y objetivo: La obstrucción lagrimal congénita constituye un motivo frecuente de consulta, siendo el control endoscópico de la fosa nasal a nivel del meato inferior el que permite llevar a cabo procedimientos quirúrgicos controlados. El objetivo de nuestro estudio es analizar el resultado obtenido en el tratamiento de la obstrucción congénita de la vía lagrimal mediante dilatación del conducto nasolagrimal con balón catéter e intubación monocanalicular con Monoka y control endoscópico en niños en los que habían fallado dos sondajes como tratamiento previo. Material y métodos: Entre octubre de 2004 y septiembre de 2008 se practica esta técnica en un estudio prospectivo en 36 pacientes con una edad entre 12 y 66 meses (media de 36,2 meses) con obstrucción nasolagrimal congénita en los que ha fallado el sondaje en dos ocasiones. Se incluye cuestionario con test de Munk y examen oftalmológico, incluyendo el test de desaparición de colorante a los 5min, efectuados en los controles a las 6 semanas, 3 meses, 6 meses y 12 meses en todos los casos. Se define éxito cuando se normalizaron todos los síntomas y signos (Munk 0) y en el test de desaparición de colorante hay ausencia de tinción residual (grado 0). Resultados: En el 91,66 % de los pacientes se obtuvieron buenos resultados y en el 8,33%, aceptables. Todos los casos (100%) mejoraron con respecto a los síntomas previos. No se precisó repetir el proceso ni practicar una dacriocistorrinostomía en ningún caso. Conclusiones: El tratamiento de la obstrucción congénita de la vía lagrimal mediante balón catéter, intubación monocanalicular y control endoscópico es una técnica quirúrgica segura, efectiva y poco agresiva para el tratamiento de la obstrucción lagrimal congénita con fracasos de 2 sondajes previos (AU)

Introduction and goals: Congenital lachrymal obstruction is a frequent motive of consultation. Endoscopic control in the inferior meatus of the nostril allows to realize surgical controlled procedures. The aim of the study is to analyze the result obtained in the treatment of congenital obstruction of the lachrymal duct by monocanalicular intubation with Monoka and endoscopic control in children who had failed two lachrymal system probings. Methods: Between October 2004 and September 2008 this technique was performed in a prospective study on 36 patients with congenital nasolacrimal obstruction who had failed two lachrymal system probings. The mean age was 36.2 months (range 12–66 months).Patients were followed at 6 weeks, 3 months and 6 months, with clinical evaluation by Munk's score and ophthalmologic exam using dye disappearance test. Success was defined as complete resolution of signs and symptoms (Munk 0) and no fluorescein remaining in dye disappearance test (grade 0). Results: The procedure was successful in 91.66% of the cases and acceptable in 8.33%.We have not found any complication or side effects, and not further procedures have been needed on any patient. Conclusions: Balloon dachryoplasty with monocanalicular intubation under endoscopic control is a safe, easy to perform and effective surgical technique for the treatment of congenital lachrymal obstruction with two previous failed lachrymal system probing (AU)

[Treatment of the congenital obstruction of the lachrymal duct, by means of balloon catheter, monocanalicular intubation, and endoscopic control]. / Tratamiento de la obstrucción congénita de la vía lagrimal mediante balón catéter, intubación monocanalicular y control endoscópico.

INTRODUCTION AND GOALS: Congenital lachrymal obstruction is a frequent motive of consultation. Endoscopic control in the inferior meatus of the nostril allows to realize surgical controlled procedures. The aim of the study is to analyze the result obtained in the treatment of congenital obstruction of the lachrymal duct by monocanalicular intubation with Monoka and endoscopic control in children who had failed two lachrymal system probings. METHODS: Between October 2004 and September 2008 this technique was performed in a prospective study on 36 patients with congenital nasolacrimal obstruction who had failed two lachrymal system probings. The mean age was 36.2 months (range 12-66 months). Patients were followed at 6 weeks, 3 months and 6 months, with clinical evaluation by Munk's score and ophthalmologic exam using dye disappearance test. Success was defined as complete resolution of signs and symptoms (Munk 0) and no fluorescein remaining in dye disappearance test (grade 0). RESULTS: The procedure was successful in 91.66% of the cases and acceptable in 8.33%. We have not found any complication or side effects, and not further procedures have been needed on any patient. CONCLUSIONS: Balloon dachryoplasty with monocanalicular intubation under endoscopic control is a safe, easy to perform and effective surgical technique for the treatment of congenital lachrymal obstruction with two previous failed lachrymal system probings.

[Conjunctivodacryocystorhinostomy with the assistance of diode laser. Endoscopic placement of Jones lacrimal tubes]. / Conjuntivodacriocistorrinostomía con láser diodo. Inserción endoscópica de tubos de Jones.

OBJECTIVE: To describe and assess a surgical technique for cases of complete bicanalicular lachrymal destruction by means of the endoscopic insertion use of the Jones tube with a diode laser to study functionality and complications. PATIENTS AND METHOD: A descriptive study of a case series with 24 consecutive patients with complete bicanalicular obstruction who underwent conjunctivodacryocystorhinostomy with diode laser. The surgery time, intra-operative and post-operative complications, long-term patency, and need for secondary revision were evaluated. RESULTS: Twenty-four consecutive patients were included in the study. All surgical procedures were successfully performed without significant complications. Average operating time was 15 minutes. The length of the tubes used ranged from 17 to 26 mm. Patients were evaluated at 24 hours, 3 weeks, 3 months, and 6 months and then every 6 months. The most frequent post-surgical complication was the downward migration of the tube towards the nasal fossa (37.5%). Secondary intervention was performed in 6 patients. Success was demonstrated using the fluoresceinic staining test under endoscopic monitoring and represented 37.5% after the initial surgery and 50% including revision surgery. CONCLUSIONS: Laser-guided endoscopic intubation is a speedy and accurate surgical procedure that is well-tolerated during the operation and leaves no scar on the skin surface. However, it is associated with a considerable number of post-surgical complications.

Conjuntivodacriocistorrinostomía con láser diodo. Inserción endoscópica de tubos de Jones / Conjunctivodacryocystorhinostomy with the assistance of diode laser. Endoscopic placement of jones lacrimal tubes

Objetivo: Describir y evaluar la cirugía en los casos de destrucción canalicular total, mediante la inserción endoscópica con láser diodo del tubo de Jones para estudiar la funcionalidad y las complicaciones. Pacientes y método: Se realiza un estudio descriptivo de una serie de casos consecutivos en 24 pacientes con obstrucción bicanalicular completa, a los que se practica una conjuntivodacriocistorrinostomía con láser diodo. Se valoró los tiempos quirúrgicos, las complicaciones operatorias y postoperatorias, la permeabilidad y la necesidad de reintervenciones. Resultados: Se incluyó a 24 pacientes en el estudio. La cirugía se llevo a cabo en todos los pacientes sin complicaciones. El tiempo quirúrgico medio fue de 15 min. Los tamaños de los tubos usados fueron de 17-26 mm. Se efectuaron controles a las 24 h, a las 3 semanas y a los 3 y 6 meses, seguidos de revisiones cada 6 meses. La complicación posquirúrgica más frecuente fue el desplazamiento inferior del tubo hacia la fosa nasal (37,5 %). Se precisó reintervención en 6 casos. Los éxitos demostrados mediante el test de tinción fluoresceínica con control endoscópico fueron un 37,5 % tras una primera intervención y un 50 % si se incluye una segunda reintervención. Conclusiones: La intubación endoscópica guiada con láser es una cirugía precisa, rápida, bien tolerada intraoperatoriamente y sin cicatriz cutánea, si bien va asociada a un importante número de complicaciones posquirúrgicas

Objective: To describe and assess a surgical technique for cases of complete bicanalicular lachrymal destruction by means of the endoscopic insertion use of the Junes tube with a diode laser to study functionality and complications. Patients and method: A descriptive study of a case series with 24 consecutive patients with complete bicanalicular obstruction who underwent conjunctivodacryocystorhinostomy with diode laser. The surgery time, intra-operative and post-operative complications, long-term patency, and need for secondary revision were evaluated. Results: Twenty-four consecutive patients were included in the study. All surgical procedures were successfully performed without significant complications. Average operating time was 15 minutes. The length of the tubes used ranged from 17 to 26 mm. Patients were evaluated at 24 hours, 3 weeks, 3 months, and 6 months and then every 6 months. The most frequent post-surgical complication was the downward migration of the tube towards the nasal fossa (37.5 %). Secondary intervention was performed in 6 patients. Success was demonstrated using the fluoresceinic staining test under endoscopic monitoring and represented 37.5 % after the initial surgery and 50 % including revision surgery. Conclusions: Laser-guided endoscopic intubation is a speedy and accurate surgical procedure that is well-tolerated during the operation and leaves no scar on the skin surface. However, it is associated with a considerable number of post-surgical complications