| Goldstein
SM, Goldstein JB, Katowitz JA.
Children's Hospital of Philadelphia,
University of Pennsylvania School of Medicine, Philadelphia,
Pennsylvania, USA.
PURPOSE: To determine the success of monocanalicular
stenting and balloon
dacryoplasty as secondary treatment options for congenital
nasolacrimal duct
obstruction after failed probing surgery.
METHODS: An interventional case series of
consecutive secondary balloon dacryoplasty and monocanalicular
stenting for congenital nasolacrimal duct obstruction was
reviewed. These secondary treatments were used in cases in
which a bicanalicular stent would have been used in the past.
Seventy-seven nasolacrimal systems in children with epiphora
after probing and irrigation surgery were treated with a monocanalicular
stent or balloon dacryoplasty. The patients were then evaluated
at least 3 months after surgery or after stent removal by
using a dye disappearance test. Cases in which there was no
significant dye at 5 minutes were considered a success. Cases
with residual dye or history of persistent tearing were considered
failures.
RESULTS: The monocanalicular stent was used
in 35 nasolacrimal systems, whereas balloon dacryoplasty was
used in 42 nasolacrimal ducts. The mean age of
treatment was 25.2 months for the monocanalicular stent group
and 25.8 months
for the balloon group. Overall, 32 of 35 (91%) nasolacrimal
ducts responded to
monocanalicular stenting, whereas 36 of 42 (86%) responded
to balloon treatment.
When the patient group was further stratified by age, the
monocanalicular
stenting was 94% successful in children younger than age 2
years and 89%
successful for children older than 2 years. The balloon treatment
had a success
rate of 91% in the younger group and 79% in the older group.
Chi-square
statistical analysis showed no significant difference between
the two treatments
or on the basis of age stratification within each treatment
group.
CONCLUSIONS: Monocanalicular stenting and
balloon dacryoplasty are excellent secondary therapies for
congenital nasolacrimal duct obstruction after initial probing
and irrigation surgery has failed. These two treatment options
are now our
procedures of choice for secondary surgery.
Ophthal Plast Reconstr Surg. 2004 Sep;20(5):352-7.
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