Abstract
BackgroundThe dacryoendoscope is the only instrument that can observe the luminal side of the lacrimal passage with minimal invasiveness. It was developed to treat lacrimal passage obstructions by inserting a bicanalicular nasal stent with sheath-guided bicanalicular intubation (SG-BCI). The purpose of this study was to determine the outcomes of SG-BCI to treat lacrimal passage obstructions. In addition, to determine the effects of SG-BCI treatment on the quality of life.MethodsThis was a retrospective observational study of 128 patients (mean age 70.9 ± 11.0 years, range 28–93 years) diagnosed with a unilateral lacrimal passage obstruction. There were 73 patients with a nasolacrimal duct obstruction, 37 with a lacrimal canaliculus obstruction, 7 with a lacrimal punctum obstruction, and 11 with common lacrimal canaliculus and nasolacrimal duct obstructions. They were all treated with SG-BCI. The postoperative subjective outcomes were assessed by the answers to the Glasgow Benefit Inventory (GBI) questionnaire and to an ocular specific questionnaire on 6 symptoms including tearing, ocular discharges, swelling, pain, irritation, and blurred vision. The objective assessments were the surgical success rates and the patency at 6 months after the bicanalicular nasal stent was removed. The patients were divided into those with a pre-saccal obstruction, Group 1, and with a post-saccal obstruction, Group 2. The subjective and objective outcomes were compared between the two groups.ResultsOne hundred twenty-four sides (96.9%) had a successful probing and intubation of the lacrimal passage obstruction by SG-BCI. Of the 124 sides, 110 sides (88.7%) retained the patency after the stent was removed for at least 6 months. The GBI total, general subscale, social support, and physical health scores were + 37.1 ± 29.0, + 41.5 ± 30.0, + 28.0 ± 39.4, and + 24.1 ± 37.7, respectively, postoperatively. All of the 6 ocular specific symptom scores improved significantly postoperatively. The postoperative score of tearing improved in Group 1 (P < 0.0001), while the postoperative scores of all symptoms improved significantly in Group 2.ConclusionsThe relatively high surgical success rates and positive GBI scores, and improved ocular symptom scores indicate that SG-BCI is a good minimally invasive method to treat lacrimal passage obstructions.
Highlights
The dacryoendoscope is the only instrument that can observe the luminal side of the lacrimal passage with minimal invasiveness
The relatively high surgical success rates and positive Glasgow Benefit Inventory (GBI) scores, and improved ocular symptom scores indicate that sheath-guided bicanalicular intubation (SG-bicanalicular intubation (BCI)) is a good minimally invasive method to treat lacrimal passage obstructions
The obstructions have been treated by external dacryocystorhinostomy (EX-DCR) as first described by Toti in 1904, and this has been the gold standard treatment for a primary acquired nasolacrimal duct obstruction (PANDO) with success rates ranging from 90 to 99% [1, 2]
Summary
The dacryoendoscope is the only instrument that can observe the luminal side of the lacrimal passage with minimal invasiveness. It was developed to treat lacrimal passage obstructions by inserting a bicanalicular nasal stent with sheath-guided bicanalicular intubation (SG-BCI). The recent development of nasal endoscopic techniques and instruments have led to higher success rates for EN-DCR to treat PANDOs [2, 6,7,8]. The technique of bicanalicular intubation (BCI) to treat PANDOs was introduced as an alternative to DCR [9,10,11,12,13]. One of the reasons for the lower success rates might be because inserting the lacrimal stent is a blind technique without visual guidance. There has been only one report comparing the success rates for BCI of the blind insertion to dacryoendoscope-assisted intubation. Fujii et al reported that 87.8% of the nasolacrimal ducts that had dacryoendoscope-assisted intubation remained patent, while 71.4% of the nasolacrimal ducts that were intubated without a dacryoendoscope remained patent at 1 month after the stent was removed [21]
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