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

Abstract

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). 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 3-5years 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. 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 8.1weeks, while the mean length of follow-up starting from the removal of silicone stent to last follow-up was 61.0weeks. 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. 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.