Optimizing clinical outcomes for endoscopic lacrimal duct recanalization in patients with complete PANDO.

PURPOSE: The study aims to describe modifications and refinements in the technique and technology of Transcanalicular Endoscopic Lacrimal Duct Recanalization (TELDR) based on anatomical foundations to optimize its clinical outcomes in patients with complete Primary Acquired Nasolacrimal Duct Obstruction (PANDO). METHODS: The medical records of 115 patients who underwent TELDR procedures from January 2018 to July 2020 were reviewed retrospectively. Of the 115 patients, only those 35 patients with complete PANDO characterized by longstanding epiphora of 3-5 years duration, dense, diffuse fibrous tissue obstruction involving the sac, sac duct junction and the entire length of the nasolacrimal duct were included in the study. Parameters for success were analyzed based on patency on irrigation, functional endoscopic dye test, and improvement of epiphora. RESULTS: Forty-five cases from 35 patients with complete PANDO were included in the study. The mean length of time from the date of operation to silicone stent removal was 8.1 weeks, while the mean length of follow-up starting from the removal of silicone stent to last follow-up was 61.0 weeks. There were 95.6% anatomic patency on canalicular irrigation with saline and 95.6% functional patency based on functional endoscopic dye test. There was significant improvement of epiphora (p value of < 0.0001) post-operatively. CONCLUSION: The results of modified TELDR improved clinical outcomes and could be a definitive treatment in patients with complete PANDO with longstanding, dense, diffuse, fibrous tissue obstruction. Patients who experience reobstruction, may undergo a repeat of the recanalization approach.

Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies.

PURPOSE: Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction. METHODS: At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test. RESULTS: Among 14 patients included and after a mean follow-up of 19.5 months (range 13-51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported. CONCLUSION: Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.

A rare case of pemetrexed-induced diffuse punctal and canalicular stenosis: management by coronary balloon puncto-canaliculoplasty.

Several chemotherapeutic agents are known to induce lacrimal drainage stenosis and obstruction, resulting in epiphora. Pemetrexed is one such drug and is used in the management of mesotheliomas and non-small cell lung carcinomas. Pemetrexed inhibits folate metabolism at multiple levels. The present case is the second report of pemetrexed induced punctal and canalicular stenosis, but the first to document dacryoendoscopy findings and report balloon puncto-canaliculoplasty as a minimally-invasive treatment option.

Transcanalicular endoscopic dacryoplasty in patients with primary acquired nasolacrimal duct obstruction.

BACKGROUND: To investigate the lacrimal drainage system (LDS) from the punctum to the inferior meatus and the clinical outcomes of transcanalicular endoscopic dacryoplasty and silicone intubation through dacryoendoscopy in patients with primary acquired nasolacrimal duct obstruction (PANDO). METHODS: We conducted a retrospective chart review of 203 cases from 156 patients who underwent dacryoendoscopy (FT-203F; Fibertech Co., Tokyo, Japan) and sheath-guided silicone intubation for PANDO from December 2014 to March 2018. Clinical characteristics, tear meniscus height, irrigation test, dacryocystographic findings, and dacryoendoscopic findings related to clinical factors and surgical outcomes were evaluated. RESULTS: The study population consisted of 44 males and 119 females (mean age, 60.4 ± 13.6 years). The mean epiphora duration was 3.8 ± 4.8 years. Dacryoendoscopic findings revealed that the following factors were associated with LDS obstruction (% cases): mucus, 39.9%; fibrotic membrane, 19.2%; stones, 9.4%; granulation, 8.9%; and stenosis, 2.7%. The locations of obstruction were as follows (% cases): nasolacrimal duct, 35.7%; canaliculus, 33.0%; sac, 27.6%; and inferior meatus, 3.5%. The types of LDS obstruction were classified into two groups: secretory group (n = 118) that included mucus, stones, and granulation, and structural group (n = 85) associated with the membrane and stenosis; the pattern of them was divided into focal (n = 134) and diffuse (n = 76). The overall success rate was 86.2%. The success rate of the structural group (95.3%) was significantly higher than that of the secretory group (79.7%) (p = 0.001). All membranous obstruction cases at the inferior meatus were treated successfully, regardless of the irrigation test results. The success rate of the focal group (93.1%) was significantly higher than that of the diffuse group (74.0%) (p = 0.003). CONCLUSIONS: Dacryoendoscopic findings were informative regarding the clinical factors leading to LDS in PANDO patients. Mucus and stones in the lacrimal sac were common findings of functional lacrimal duct obstruction. Membranous obstruction and stenosis could be managed by recanalization under direct visualization. Transcanalicular endoscopic dacryoplasty and silicone intubation is considered to be a safe and effective procedure, sparing the patient from bony destruction in selected cases of PANDO.

Primary balloon dacryoplasty for nasolacrimal duct obstruction in adults: a systematic review.

Introduction: Acquired nasolacrimal duct obstruction (NLDO) is a major cause of epiphora. Balloon dacryoplasty (BD) is a minimally invasive procedure effectively used for congenital NLDO which has also been used in adults, instead of dacryocystorhinostomy (DCR), the current gold standard technique. The main objectives were to assess the results of BD with and without silicone tube insertion (STI) in NLDO in adults.Materiel and Method: A systematic review of literature was conducted on PubMed, SCOPUS and Cochrane databases. The articles were scanned to identify all studies that evaluated the outcomes of primary BD for NLDO in adults. The mean success rates were calculated and compared using the multiple comparisons Sidak's T-testResults: Sixty-seven articles were identified but only 13 publications matched the inclusion criteria. For partial NLDO, BD had a mean, success rate of 73.29% (64.86% with STI) with a mean follow-up of 16 months. For complete NLDO, BD had a success rate of 36.67% (52.50% with STI) with a mean follow-up of 15.5 months. Altogether the success rate of BD was significantly higher for partial NLDO compared to complete stenosis (p = 0,002).Conclusion: BD is significantly more successful for partial NLDO, without significant additional benefit from subsequent STI. The main complication would be the high recurrence rate. BD is not effective for complete NLDO with very low success rates. However, BD could be proposed for partial NLDO, as it is a safe procedure, with minimal invasiveness in comparison to DCR. Further prospective and controlled studies are required to confirm these encouraging results.

[Endonasal balloon dacryoplasty in partial and complete obstruction of dacryocystorhinostomy ostium]. / Endonazal'naya ballonnaya dakrioplastika pri chastichnom i polnom zarashchenii dakriostomy.

Despite the success of dacryocystorhinostomy (DCR) in the treatment of lacrimal drainage system (LDS) obliteration and the use of medical and surgical methods to prevent its recurrence, the number of relapses reaches 37%. The main etiological factor leading to this pathology is partial (stenosis) or complete obstruction of the ostium. PURPOSE: To study the effectiveness of endonasal balloon dacryoplasty in partial or complete obstruction of dacryocystorhinostomy ostium. MATERIAL AND METHODS: The study involved 122 patients (127 cases) with relapse after endonasal endoscopic dacryocystorhinostomy performed 6 months to 3 years ago to treat partial or complete obstruction of lacrimal sac neck. Patients of the 1st group (41 cases) underwent endonasal balloon dacryoplasty, patients of the 2nd group (42 cases) underwent endonasal balloon dacryoplasty with bicanalicular silicone stenting, patients of the 3rd group (44 cases) underwent revision endonasal endoscopic dacryocystorhinostomy with bicanalicular silicone stenting. RESULTS: After 12 months follow-up, positive results were observed in 85.7% of cases with ostium stenosis and 80.0% of cases with complete obstruction of the ostium among group 1 patients; in 86.4% of cases with ostium stenosis and 85.0% of cases with complete obstruction of the ostium among group 2 patients; and in 81.0% of cases with ostium stenosis and 82.6% of cases with complete obstruction of the ostium among group 3 patients. CONCLUSION: The obtained results give grounds to recommend inclusion of endonasal balloon dacryoplasty in the standards of treatment for patients with partial (stenosis) and complete obliteration of dacryocystorhinostomy ostium.

[Transcanalicular balloon dacryoplasty for the treatment of post-dacryocystorhinostomy recurrent stenoses]. / Transkanalikulyarnaya ballonnaya dakrioplastika ­ metod lecheniya retsidiva posle dakriotsistorinostomii.

PURPOSE: To compare the effectiveness of minimally invasive techniques used for the treatment of common canalicular (CC) ostium stenosis (or obliteration) in post-dacryocystorhinostomy (post-DCR) patients. MATERIAL AND METHODS: The study included 121 patients (127 cases), of which 61 patients (64 cases) had stenosis of the CC ostium and 60 patients (63 cases) had CC ostium obliteration. All stenoses and obliterations were recurrent and developed 6 months to 5 years after primary endonasal endoscopic DCR. Patients were divided into 3 groups. Group 1 included 20 patients (20 cases) with stenosis and 21 patients (22 cases) with CC ostium obliteration who underwent transcanalicular balloon dacryoplasty (DCP), group 2 - 20 patients (21 cases) with stenosis and 20 patients (21 cases) with CC ostium obliteration who underwent transcanalicular DCP and bicanalicular intubation, and group 3 - 21 patients (23 cases) with stenosis and 19 patients (20 cases) with CC ostium obliteration who received bicanalicular intubation alone. Results were evaluated 12 months after the intervention. RESULTS: The treatment was effective in as many as 80% and 68.2% of cases (respectively) in group 1, 76.2% and 66.7% of cases (respectively) in group 2, and 56.5% and 50% of cases (respectively) in group 3. CONCLUSION: The study proves transcanalicular DCP effective alone and shows no need in potentially complicated lacrimal ducts intubation.

Long-term outcomes of laser dacryoplasty combined with intubation using a new silicon tube in patients with lacrimal duct obstruction.

AIM: To determine the 15-year outcomes of laser dacryoplasty (LDP) in patients with lacrimal duct obstruction; and to evaluate LDP combined with intubation using a new silicone tube to treat complicated cases. METHODS: Patients with lacrimal duct obstruction and treated with LDP between April 2000 and April 2005 were investigated retrospectively. Totally 116 eyes with completed 15-year follow-up records were included in this study. For complicated cases (52 eyes of 52 patients), both LDP and intubation using a self-made silicon tube were performed. For patients with uncomplicated obstruction (64 eyes of 61 patients), only LDP was performed. Outcomes were assessed based on results of lacrimal irrigation and degree of symptoms during follow-up. RESULTS: At the follow-up time of 15y, 81 eyes achieved full success (69.8%); 21 eyes got improved (18.1%); and 14 eyes were considered failure (12.1%). The success rate was 71.2% (37/52 eyes) for complicated cases; and 68.8% (44/64 eyes) for uncomplicated cases. No statistically significant difference between two groups was observed (P=0.961). No postoperative complication was observed. CONCLUSION: LDP is a well-tolerated, simple, and effective procedure with satisfactory long-term outcomes in selected patients, which make it a good alternative to conventional dacryocystorhinostomy. In addition, intubation with the self-made mono-canalicular silicone tube facilitates the management of complicated cases with few complications.

Congenital Nasolacrimal Duct Obstruction Update Study (CUP Study): Report III. Analysis of Earlier Failed Probing without Endoscopy Guidance.

AIM: The purpose of this study was to report the profile and outcomes of children with an earlier failed probing that was performed without endoscopy guidance. METHODS: Retrospective interventional case study was performed on all the patients who were referred with a diagnosis of a single or multiple failed probing from Jan 2016 to June 2019 to a tertiary care Dacryology center. All the patients had a blind probing without an endoscopy assistance before referral. The parameters evaluated were patient demographics, number of earlier probings, prior operative notes, clinical presentation, findings of endoscopy guidance during the repeat procedure, simple vs complex CNLDO, types of complex CNLDO, management, complications and outcomes. RESULTS: One hundred eyes of 82 children had a failed probing experience without endoscopic guidance elsewhere. The mean age of the children was 55.7 months (range: 9-168 months). Of these, 63 eyes underwent repeat probing under endoscopic guidance, 35 eyes being simple CNLDO (35/63, 55.5%), and 28 eyes (28/63, 44.5%) being complex CNLDO. Among the complex subset, balloon dacryoplasty was performed for five cases and monoka-Crawford stents for eight cases under direct endoscopy visualization. Buried probes were managed successfully by standard protocols of probe exteriorization. The two cases of misdirected probes were re-directed under endoscopy guidance for appropriate recanalization and the single case of granuloma at the NLD opening was excised followed by intubation without any recurrence. CONCLUSION: Endoscopy guidance plays a crucial role in the management of CNLDO with an earlier failed probing.

Long-term outcomes of revision endoscopic dacryocystorhinostomy aided by 4-mm coronary balloon catheter dacryoplasty.

Our purpose was assess the long-term efficacy of 4-mm coronary balloon catheter dacryoplasty in revision endoscopic dacryocystorhinostomy (RevEnDCR). This retrospective interventional case-series was performed for patients who underwent RevEnDCR aided by a 4-mm coronary balloon catheter (CBC) dacryoplasty. The indications for the surgery were previously failed DCRs by external or endoscopic approach where the ostium showed near total cicatrization with or without the presence of organized granuloma threatening the internal common opening (ICO). The coronary balloon (4 × 10 mm, SPALNO, Cardiomac, Haryana, India) with the guidewire was used and a minimum of >12 months of follow-up was considered for analysis. Ten lacrimal systems of eight patients with mean age of 48.8 years underwent CBC-assisted revision endoscopic DCR. Of the 10 failed DCRs, 6 had a previous external approach DCR and 4 were endoscopic DCRs. Grossly stenosed ostium with near total cicatricial closure were noted in half of the patients (50%, 5/10) while the remaining half, in addition, showed organized granulomas threatening the ICO. The surgical technique using CBC was found to be minimally invasive, easy to perform with multiple advantages like uniform clearance of the area in front of ICO and more predictable lacrimal sac flaps. At a mean follow-up of 20 months, anatomical and functional success were achieved in 90% (9/10) of the eyes. We conclude that coronary balloon catheter-assisted revision endoscopic DCR is a minimally invasive and viable alternative in select group of patients of failed DCR with near total cicatrisation or organized granulomas threatening ICO.

Endoscopic endonasal balloon-dacryoplasty in failed dacryocystorhinostomy.

OBJECTIVE: Endoscopic endonasal balloon-assisted dacryoplasty is a minimally-invasive surgical procedure that can be used in recurrent epiphora, a common pathology in both adulthood and childhood. STUDY DESIGN/SETTINGS: We present a retrospective case series of eight patients who underwent trans-nasal balloon-assisted dacryoplasty after a failed external or endoscopic dacryocystorhinostomy, from March 2019 to January 2020, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. SUBJECTS AND METHODS: All patients underwent routine preoperative work-up including fluorescein test (Jones test I-II), probing and irrigation of the lacrimal pathway and nasal endoscopy. Because of the recurrent nature of the pathology, pre-operatory computed tomography scan or dacryocystography was not performed. The surgical procedure was based on enlargement of the stenotic neorhinostomy created by primary dacryocystorhinostomy through the use of a high-pressure balloon catheter. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. RESULTS: Anatomic and functional success was achieved in 100% of patients. Operative time ranged from 9 to 22 min (mean 16 min). No significant complications were reported. CONCLUSION: Our results indicate that trans-nasal balloon-assisted dacryoplasty can be considered as a safe and reliable surgical approach after a failed primary dacryocystorhinostomy. The shorter surgical time and reduced post-operative complication rates are the main advantages of this procedure.

Balloon catheter dilation as the primary treatment of congenital nasolacrimal duct obstruction.

PURPOSE: The aim of this study is to report the outcome of balloon catheter dilation as the primary treatment of congenital nasolacrimal duct obstruction in children of all ages. METHODS: A 10-year retrospective study of 148 children (270 eyes), aged 9 to 159 months (mean age: 29.6 ± 17.7 months), who previously had not undergone a nasolacrimal surgical procedure and who presented with clinical signs of nasolacrimal duct obstruction, was conducted. All children underwent balloon catheter dilation of the nasolacrimal duct. RESULTS: Treatment success, defined as complete resolution of nasolacrimal duct obstruction symptoms present at follow-up visits at 1 week and up to 6 months after surgery, was 87% (234 of 270 eyes). Partial success was defined as occasional tearing which was acceptable to parents and present in 3% (nine eyes). Only 10% of the children underwent a second procedure due to complete failure. In a sub-analysis by age groups-under 18 months, between 18 and 36 months, and above 36 months-complete resolution rates were 85%, 93%, and 77%, and partial success rates were 3%, 3%, and 4%, respectively. There was a statistically significant difference between the age groups (p = .007). CONCLUSION: In this large cohort of patients with nasolacrimal duct obstruction, balloon catheter dilation was successful as a primary treatment for congenital nasolacrimal duct obstruction, particularly under the age of 36 months.

Congenital nasolacrimal duct obstruction update study (CUP study): Paper II - Profile and outcomes of complex CNLDO and masquerades.

OBJECTIVE: To assess the profiles and outcomes of complex congenital nasolacrimal duct obstruction (C-CNLDO). METHODS: Retrospective interventional case-series was performed on patients diagnosed with C-CNLDO and managed at a tertiary care Dacryology Institute from Jan 2016 to June 2019. Complex CNLDO was diagnosed based on intraoperative findings during probing and are defined as entities where CNLDO is secondary to, or associated with complex embryonic entities like buried probe, mal-development or non-development of bony NLD, additional proximal lacrimal dysgenesis, atonic sac, or associated craniofacial syndromes and craniofacial dysostosis. The parameters studied include patient demographics, clinical presentation, types of C-CNLDO, management modalities, and outcomes. Success was defined as the subjective resolution of epiphora and discharge with objective measures of normal tear meniscus height and dye clearance on fluorescein dye disappearance test. For patients who underwent a dacryocystorhinostomy (DCR), a minimum follow-up of 1-year post-DCR was considered for outcome analysis. RESULTS: Of the 2714 cases of CNLDO managed during this period, 482 (17.75%) were diagnosed as complex CNLDO. C-CNLDO showed predilection to the male gender (60.3%, 291/482). A significant number of patients (40.2%, 194/482) presented beyond 36 months of age. The common subtypes of C-CNLDO were atonic sacs (33.8%, 163/482), buried probes (19.7%, 95/482), and associated proximal lacrimal drainage anomalies (11.2%, 54/482). Since C-CNLDO is usually confirmed during the initial endoscopy-guided probing, the managements varied based on the type of C-CNLDO. Silicone intubation and/or balloon dacryoplasty (BDCP), and/or additional minimally invasive procedures were added to the initial endoscopy-guided irrigation and probing based on the nature of C-CNLDO. The overall resolution rate with these non-bypass modalities was 72.6% (350/482). Although the success rates start dropping in C-CNLDO patients beyond 3-years of age, significant success rates with multi-modal (non-bypass) management were noted in age-groups 3-5 years (71.8%, 79/110) and encouraging results (38.5%, 27/70) in 5-10 years age group. The anatomical and functional outcomes in those who underwent endoscopic or external dacryocystorhinostomy with a follow-up beyond 1-year was 96.4% (55/57). CONCLUSION: The age at presentation is delayed in patients with C-CNLDO. Multi-modal endoscopy-guided management facilitates the identification of several sub-types of C-CNLDO, and achieves significantly high favourable outcomes in older children. C-CNLDO refractory to probing, intubation and BDCP demonstrates high success with external or endoscopic dacryocystorhinostomy.

The Use of Stents in Children with Nasolacrimal Duct Obstruction Requiring Surgical Intervention: A Systematic Review.

Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. It is managed conservatively in the first year of life, after which surgical treatment is classically based on a stepwise paradigm of probing, intubation, and dacryocystorhinostomy. This systematic review aims to present the current role of intubation in the management of children with NLDO requiring surgical intervention. A search for English-language articles from the electronic databases PubMed, SCOPUS, and the COCHRANE library was conducted over a period of five months in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. The following keywords were used to aid retrieval: stents, children, lacrimal intubation, endoscopic dacryocystorhinostomy, external dacryocystorhinostomy, NLDO, dacryocystitis, congenital, acquired. The primary outcome was defined as the success of the intervention, determined by resolution of symptoms and patency of the lacrimal anatomy confirmed by the fluorescein dye disappearance test or syringing. Secondary outcomes included the presence of complications. A total of 144 articles were identified; of these, 35 fulfilled the study criteria. The majority of the included studies involved lacrimal intubation alone, followed by intubation as an adjunctive procedure to balloon dacryoplasty and dacryocystorhinostomy. The overall success rate of these procedures ranged from 41.1% to 100%. Post-operative complications were reported in 65.7% of the included studies. Lacrimal intubation was most commonly performed as a primary procedure in children with NLDO, with high success rates. The main complication was stent dislodgement. There is lack of evidence regarding the benefit of intubation over probing as primary treatment of congenital NLDO. In the absence of high-quality evidence, the decision of whether to perform lacrimal intubation in children with NLDO requiring surgical intervention depends on clinical judgement and other low-level evidence, such as observational non-randomised trials.

[Microendoscopic minimally invasive techniques in lacrimal surgery]. / Mikroendoskopische, minimalinvasive Techniken in der Tränenwegschirurgie.

BACKGROUND: Lacrimation of the eye is a relatively common problem, the cause of which must be clarified by differential diagnostics. The most important symptom of a dysfunction of lacrimal drainage is epiphora. METHODS: Due to the enhancement and miniaturization of endoscopes, which were originally used in gastroduodenoscopy in the 1990s, it is possible to check the anatomical structure and visualize pathological changes of the lacrimal drainage system, which is only approximately 1 mm in diameter. As shown by the results, mechanical stenoses are often caused by recurrent chronic inflammation. A complete stenosis usually occurs only slowly due to dysregulation of the lacrimal unit. CONCLUSION: In contrast to the assumptions that were valid before the implementation of microendoscopy, complete stenoses are often only punctate and do not stretch over long distances. Shortly after the introduction of microendoscopic diagnostics minimally invasive therapy techniques, such as laser dacryoplasty (LDP) and microdrill dacryoplasty (MDP) were established. These procedures have enabled for the first time preservation of the entire physiology of the lacrimal drainage pump system despite surgical intervention after recanalization.

Dacryocystorhinostomy: History, evolution and future directions.

Dacryocystorhinostomy (DCR) is a procedure of choice for nasolacrimal duct obstruction and chronic dacryostenosis in the setting of patent canaliculi and a functional lacrimal pump. Two major approaches are utilized: external, via a transcutaneous incision and endonasal endoscopically guided. The surgery has a high success rate via both approaches. We review the history, evolution, current techniques, complications and future directions of DCR.

Surgical technique and preliminary results of transcanalicular endoscopic lacrimal duct recanalization and balloon dacryoplasty with silicone intubation in Filipino patients with complete nasolacrimal duct obstruction

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the surgical technique of transcanalicular endoscopic lacrimal duct recanalization (TELDR) with balloon dacryoplasty and silicone intubation in patients with complete nasolacrimal duct obstruction and assess their effectivity.</p> <p style="text-align: justify;"><strong>METHODS:</strong> Ten lacrimal systems from eight patients diagnosed with complete nasolacrimal duct obstruction (NLDO) underwent TELDR and balloon dacryoplasty with silicone intubation.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> All 10 lacrimal systems from eight patients who underwent TELDR and balloon dacryoplasty with silicone intubation had 100% anatomical and functional patency.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> TELDR and balloon dacryoplasty with silicone intubation represents an alternative, minimally invasive technique in the management of complete nasolacrimal duct obstruction.</p>

Comparison of Secondary Surgical Methods in Congenital Nasolacrimal Duct Obstruction after Failed Primary Probing

PURPOSE: Evaluate the surgical results and clinical value of monocanalicular stenting (Monaka(R))(FCI Ophthalmics, Marshfield Hills, MA, U.S.A) and balloon catheter dacryoplasty (DCP) using PTCA balloon (Stormer(R)) for congenital nasolacrimal duct (NLD) obstruction in children. METHODS: The authors performed monocanalicular stenting (Monaka(R)) and balloon catheter (Stormer(R)) DCP as a secondary treatment of 25 children (27 lacrimal systems) over 12 months of age who had undergone ineffective probing treatment. The patients were followed up over 3 months and the postoperative outcome was assessed by fluorescein dye test. RESULTS: Nine of eleven children (nine of eleven lacrimal systems, 81.8%) and seven of nine children (seven of nine lacrimal systems, 77.7%) showed objective and subjective improvement, respectively. CONCLUSIONS: Monocanalicular stenting and balloon dacryoplasty are excellent secondary treatments for congenital nasolacrimal duct obstruction after initial probing and irrigation surgery have been failed. Balloon dacryoplasty is a new procedure in improve the life-quality and reduce the complications rather than monocanalicular stenting.