Bicanalicular Silicone Intubation Research Articles

Bicanalicular silicone intubation versus probing for the treatment of congenital nasolacrimal duct obstruction in children older than 2 years

Background One of the most common conditions presenting to the oculoplastic clinic is congenital nasolacrimal duct obstruction (CNLDO), with an incidence of up to 20% in young children. Early probing as early as 18 months of age is usually associated with very good results. Conversely, the results of probing in older children and the need for intubation, either primary or secondary, are debatable in different studies. Purpose The aim of this study was to compare the outcome of probing versus primary intubation in children older than 2 years having CNLDO. Patients and methods This prospective cohort comparative study was carried out on 40 eyes of 36 children, aged 2–7 years of both sexes, with epiphora due to CNLDO. The eyes were divided into two groups: group A that included 20 eyes that underwent probing, and group B that included 20 eyes that underwent intubation in whom the tube was removed after 3 months. The enrolled children were subjected to local ophthalmological examination, eye lid examination, puncti evaluation, regurge test, nasal evaluation, lacrimal pathway evaluation, and computed tomography dacryocystography before the procedure and 3 months after the procedure. Results The intubation group (group B) was found to have a higher success rate (90%) compared to the probing group (group A) (80%), although the difference was statistically insignificant (P=0.661). On univariate regression analysis, age, contrast volume, and most dilated portion of the lacrimal sac before the procedure were significant predictors for the success rate (P<0.001). In addition, there was a significant relationship between the success rate and age, most dilated portion, and contrast volume after the procedure (P<0.001). Conclusion There was a high success rate for both probing and intubation in older children above 2 years suffering from CNLDO. Although intubation was found to have a higher success rate, the difference was statistically insignificant.

Does Bicanalicular Intubation Improve the Outcome of Endoscopic Dacryocystorhinostomy?

The aim of this study was to compare the success of endoscopic dacryocystorinostomy with and without bicanalicular intubation in the treatment of distal nasolacrimal duct obstruction. Methods: In a prospective, randomized, comparative study, endoscopic dacryocystorinostomy without bicanalicular silicone intubation (Group I) and endoscopic dacryocystorinostomy with intubation (Group II) were performed in patients with distal nasolacrimal duct obstructions. The tubes were removed 3 months after surgery in Group II, and the patients were followed up for 6 months after surgery. Therapeutic success was defined as the fluorescein dye disappearance test grade 0–1 corresponding with a complete resolution of symptoms. Results: Thirty patients, aged 23–86 years, were included in the study. The success rate was 13/15 (86.67%) in Group I and in 14/15 (93.33%) in Group II. The difference between the two groups was not statistically significant (p = 0.483). Most common complications were granulations that occurred in 1/15 (6.67%) patient in Group I and in 2/15 (13.33%) patients in Group II. Adhesions in rhinostomy with epiphora and persistent secretion were observed in 1/15 (6.67%) patient in Group II. Conclusions: Bicanalicular intubation does not significantly increase the success rate of EDCR in distal nasolacrimal obstruction in adults.

Comparison of Endoscopically Assisted Primary Probing and Bicanalicular Silicone Intubation for Congenital Nasolacrimal Duct Obstruction in Children Aged 4 to 7 Years.

To compare the clinical outcomes of primary nasolacrimal duct probing and primary bicanalicular intubations with endoscopic assistance for congenital nasolacrimal duct obstruction (CNLDO) in children aged 4 to 7 years. Forty-three eyes of 43 children (25 boys and 18 girls) with congenital epiphora who underwent primary unilateral probing and bicanalicular intubation were evaluated retrospectively. The tubes were removed 3 to 4 months after their placement, and the children were followed up for another 6 months after their removal. Treatment success was defined as the normal result of the fluorescein dye disappearance test and complete resolution of the lacrimal symptoms and signs of patients. The success rates were compared between the two groups (bicanalicular intubation vs probing). Type of CNLDO (membranous, incomplete complex, and complete complex) was determined with an endonasal endoscope. The mean age was 63.3 ± 11.1 months (range: 48 to 84 months) for the probing group and 64.4 ± 12.1 months (range: 48 to 84 months) for the bicanalicular intubation group (P = .915). The bicanalicular intubation group showed significantly greater treatment success (21 of 24, 87.5%) compared to the probing group (11 of 19, 57.9%; P = .038). Bicanalicular intubation provided higher treatment success among patients with complex CNLDO compared to probing (80.0% vs 11.1%, P = .002). There was no difference in mean age between the patients with successful and failed treatment in both groups (P = .631 and .137, respectively). Bicanalicular intubation was associated with a higher success rate than probing under nasal endoscopic visualization for the treatment of CNLDO in children aged 4 to 7 years. The type of CNLDO might be the primary factor for the treatment success. [J Pediatr Ophthalmol Strabismus. 2023;60(2):101-107.].

The Microbiological Profile of Bicanalicular Silicone Tubes Placed During External Dacryocystorhinostomy

Objectives:To identify microbiological growth on bicanalicular silicone tubes (BST) placed during dacryocystorhinostomy (DCR) surgery and to analyze the association between culture results and surgical outcomes and BST removal time.Materials and Methods:A total of 80 lacrimal drainage systems of 68 patients who had external DCR with bicanalicular silicone intubation were included the study. Twenty-five tubes (31.3%) were removed up to 8 weeks, 28 tubes (35.0%) were removed between 9 and 11 weeks, and the remaining 27 tubes (33.7%) were removed 12 weeks or more after surgery. The tubes were transferred to Stuart medium and sent for microbiologic examination. The disc diffusion method was used to determine antibiotic resistance.Results:Culture positivity was observed for 96.2% of the tubes. Among a total of 109 isolates, 63 were gram-positive bacteria (57.8%), 37 were gram-negative bacteria (34%), and 9 were fungi (8.2%). The most commonly isolated gram-positive and gram-negative bacteria were Staphylococcus aureus (66.6%) and Enterobacter spp. (29.7%), respectively. Penicillin, clindamycin, erythromycin, and tetracycline resistances were higher among gram-positive pathogens. Cephalothin, amoxicillin-clavulanic acid, and ampicillin resistances were higher among gram-negative pathogens. There was no significant difference in terms of the microbiological profile between the three groups of removed tubes. Haemophilus influenzae was isolated at a significantly higher rate in patients with surgical failure (p=0.04).Conclusion:Although a variety of agents were isolated from removed BST, gram-positive organisms were more frequent than gramnegatives and fungi. S. aureus and Enterobacter were the most common gram-positive and gram-negative isolates. Later BST removal was associated with the isolation of significantly more bacterial strains per tube. There was no correlation between multiple infections and surgical failure. H. influenzae was more common in failed DCR cases.

The results of Ritleng bicanalicular silicone intubation for congenital and adult partially acquired nasolacrimal duct obstruction.

OBJECTIVE:Our aim was to evaluate the long-term results of Ritleng bicanalicular silicone intubation for congenital and adult partially acquired nasolacrimal duct (NLD) obstruction.METHODS:We evaluated 28 eyes of the 26 patients treated with lacrimal intubation with the Ritleng method retrospectively. Patients were divided into two groups. Patients with congenital NLD obstruction (n: 16) constituted Group 1 and patients with adult partially acquired NLD obstruction (n: 10) constituted Group 2. The Ritleng probe was inserted from the canaliculus into the inferior meatus. Success was defined within two parameters: (1) Intubation of the silicone tube without complications and (2) recovery of the previous signs and symptoms and a normal fluorescein dye test.RESULTS:Mean of the patients’ ages was 2.4±1.6 years in Group 1 and 49±15 years in Group 2. The intubation was successful in all of the patients (100%) in Group 1, meanwhile in Group 2, false passage was observed in 2 patients (20%). Silicone tube was removed through the punctum in outpatient clinic conditions between 2 weeks and 3 months (mean: 2.1 months) in Group 1 and 4–6 months (mean: 5.2 months) in Group 2. Patients in Groups 1 and 2 were followed for 26±18.6–36±25 months, respectively. Previous signs and symptoms were recovered in 75% of the patients in Group 1 and the dye tests of these patients were normal. In Group 2, only two patient’s symptoms were resolved (20%). For the adult patients whose symptoms were not resolved, an external dacryocystorhinostomy operation was performed.CONCLUSION:The Ritleng lacrimal intubation system is an effective procedure for the treatment of congenital NLD obstruction for both short and long term. On the other hand, the effectiveness of the procedure is limited for the adult partially acquired NLD obstruction.

Adult encysted dacryocystocele: prevalence among patients with epiphora and its management with canaliculo-dacryocystorhinostomy

Purpose The aim of this study was to detect the prevalence of adult encysted dacryocystocele among patients with lacrimal passage obstruction and to evaluate its management by canaliculo-dacryocystorhinostomy (canaliculo-DCR).Patients and methods This is a prospective nonrandomized study that evaluated 381 adult patients who had acquired lacrimal passage obstruction. Of 47 patients who had encysted nonexpressible dacryocystocele, 48 eyes were included in this study. Dacryocystoceles were thoroughly evaluated before performing canaliculo-DCR with bicanalicular silicone intubation to address the two sites of lacrimal passage obstruction.Results Of 47 patients with nonexpressible dacryocystocele, 43 completed the postoperative follow-up period. The mean age of patients was 53.23±14.89 years. Approximately 88.4% of the patients lived in rural areas. Dacryocystoceles were in the right side in 62.8% of the patients. Females represented 83.7% of all patients, and 83.3% of them regularly applied traditional eye cosmetic (kohl) for a period ranging from 5 to 35 years. Canaliculo-DCR yielded 79% (34 out of 43 patients) success rate in the management of adult encysted dacryocystocele.Conclusion Adult acquired encysted nonexpressible dacryocystocele represented 12.6% of cases with lacrimal passage obstruction. Overall, 79% of the patients responded well to canaliculo-DCR procedure.

Transcanalicular Multidiode Laser Versus External Dacryocystorhinostomy in the Treatment of Acquired Nasolacrimal Duct Obstruction.

Objectives:This study was a comparison of the outcomes of transcanalicular multidiode laser dacryocystorhinostomy (TCLDCR) and external dacryocystorhinostomy (EXDCR) treatment for patients with acquired nasolacrimal duct obstruction.Methods:Thirty-one consecutive patients who underwent TCLDCR (TCLDCR group) and 68 consecutive patients who underwent EXDCR (EXDCR group) due to acquired nasolacrimal duct obstruction were enrolled in the study. Follow-up visits were performed on the first day, and at the first week, first month, third month, sixth month, and every six months thereafter. Surgical success was defined as achievement of a patent osteotomy and a successful bicanalicular silicone intubation during the procedure. Anatomical success was defined by observation of a patent osteotomy on lacrimal irrigation, regardless of epiphora. The surgery time and intra- and postoperative complications were noted for each patient.Results:The TCLDCR group had a significantly shorter mean surgery time (27.9±5.5 minutes) compared with the EXDCR group (58.5±12.0 minutes) (p<0.001). However, the mean anatomical and functional rates of TCLDCR (58.0% and 54.8%, respectively) were significantly lower than those of the EXDCR group (94.1% and 91.1%, respectively) (both p<0.001). Two patients had “cheese wiring” damage of the lower canaliculus and 1 patient in the TCLDCR group had a full-thickness skin defect in the medial canthal region. No serious intra- or postoperative complication occurred in the EXDCR group.Conclusion:Although a TCLDCR procedure decreased the surgical time, it had a significantly lower success rate in the treatment of acquired nasolacrimal duct obstruction compared to EXDCR. The decision of the type of surgery should be made based on the cosmetic and success expectations of the patients and the presence of systemic problems.

Recanalisation by Probing with a Bicanalicular Silicone Tube (Oggel Silicone Intubation) in Patients with Acquired Lacrimal Stenosis

Recanalisation and bicanalicular splinting with silicone tube is one therapeutic option for acquired lacrimal duct stenosis, and restenosis is frequently achieved. The aim was to determine the therapeutic success of Oggel silicone intubation after lacrimal syringing and probing. We also analysed other characteristics of the complaint and compared the therapeutic success with published results. Therapeutic success was defined as subjective absence of complaints. Other complaint features - directly after explantation of the Oggel tube, one month after explantation and one year after explantation - were retrospectively collected by a patient questionnaire, and a questionnaire for the attending ophthalmologist. These were completed with information from the patient's file. We included 82 procedures performed at the Dept. of Ophthalmology, University of Ulm, between 2006 and 2015. Statistical testing of the impact of risk factors on therapeutic success was performed, using logistic regression analysis and the Mann-Whitney U test. Subgroups were compared using Pearson-Chi-square and Fisher's exact tests and a Kaplan-Meier analysis was also performed. Therapeutic success could be documented in 80.8% of patients after explantation of the Oggel tube, in 61.6% of patients after one month and in 42.5% of patients at one year (n = 82). There were no significant differences between the subgroups of stenosis localisation, or the patients' age or sex. There was also no significant influence of the patient's age, the preoperative duration of complaints or risk factors predisposing for lacrimal duct stenosis. For the observation period of one year, the Kaplan-Meier analysis gave a probability of complaint-freeness of 52.2% for the patient group, as well as a mean duration of the complaint-free period of 34.2weeks. The results allow a prognostic assessment of the therapeutic success in the absence of significant differences in the subgroups. The therapeutic success of bicanalicular silicone intubation with the Oggel tube was in the lower third of comparable studies. The results conform to the observation that there is a progressive decline of therapeutic success. The comparison of the literature turned out to be methodically more difficult due to differences in study characteristics. Standardisation would make sense for future studies.

Bicanalicular Silicone Intubation for the Management of Punctal Stenosis and Obstruction in Patients With Allergic Conjunctivitis.

To evaluate the use of bicanalicular silicone intubation for the management of punctal stenosis and obstruction in patients with allergic conjunctivitis. A retrospective interventional case series of patients with acquired epiphora due to stenotic or obstructed puncta as a result of allergic conjunctivitis was performed. Punctal dilation and bicanalicular silicone intubation were performed in all patients. Munk Scale for grading of epiphora along with grading of fluorescein dye disappearance test was used to evaluate the functional improvement. Grading of punctal stenosis using Kashkouli's grading system was applied to evaluate the anatomical improvement. Patients having canalicular or nasolacrimal duct obstruction, punctal stenosis, and obstruction due to other causes were excluded. Fifty-one patients met the inclusion criteria with male-female ratio of 1:1.55 and an average age of 46 years at presentation. High patient tolerances without complications with the use of tubes were reported. Significant improvement 6 months after tube removal in comparison to preoperative period was found with anatomical and functional success rate of 91.83% and 87.75%, respectively. Two patients had a recurrence of the punctal stenosis many months after stent removal because of the early tube prolapse and exacerbation of the allergic conjunctivitis. Bicanalicular silicone intubation seems to be a well-tolerated and effective tool in the management of acquired punctal stenosis or obstruction secondary to allergic conjunctivitis. Bicanalicular silicone intubation appears to be a good option as patients with allergic conjunctivitis typically present with bilateral involvement of both puncti.

Early bi-canalicular silicone stent intubation in failed DCR with endoscopic visualization: a combined approach

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic dacryosystitis is a common condition affecting the eye and presenting to ENT surgeons and ophthalmologists, and treated with DCR (dacryocystorhinostomy). In few cases there can be recurrence of symptoms following DCR surgery which can be treated with bi-canalicular silicone intubation. The aim of this study is to assess the effectiveness of an early bi-canalicular silicone intubation in patients with failed DCR using endoscopic visualisation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective observational study. Thirteen cases of DCR operated for chronic dacryocystitis at St John’s Medical College Hospital were reviewed between January 2014 and February 2017. Endoscopic DCR was done for five patients and external DCR for eight patients, number of males were 5 (38%) and females were 8 (62%). Age: 9–73 years (avg: 40.5 years). &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Nine patients had complete resolution of symptoms following the primary DCR (4 following external DCR and 5 following endonasal endoscopic DCR). Four patients had failed DCR with persistence of watering three months following primary DCR surgery. Re-DCR with bi - canalicular silicon stent intubation was done in failed cases. Postoperative follow up of all the four patients showed complete resolution of symptoms.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Failed DCR surgeries can be effectively intubated using bi–canlicular silicon tubes in the early postoperative period following DCR surgery. Silicone tube intubation is the most safe and cost effective method. Endoscopic visualization gives an added advantage of localizing the cause for a failed DCR.&lt;/p&gt;

A NEW METHOD OF SILICONE INTUBATION OF THE LACRIMAL PATHWAYS

The method of bicanalicular silicone intubation of tear ducts is widely used as a stage of external and endonasal dacryocystorhinostomy, as well as during recanalization of the tear duct. The introduction of a silicone stent is the most common way to prevent rhinostoma closure. Its purpose is to maintain the permeability of the tubules or anastomoses during the healing period and can improve the results of surgical treatment if used correctly. Typically, pre-packaged kits consisting of silicone tubes attached to metal probes are used for the drainage implantation procedure. The disadvantages of using such kits are their high cost, insufficient length of metal probes when using them after dacryocystorhinostomy, and invasiveness of the procedure in the absence of visual inspection. The aim of our work was to develop a new method of silicone intubation of tear ducts, devoid of the described shortcomings. Material and methods. Silicone tubes 200 mm long were used as the lacrimal intubation kit. A line was antegradely conducted along the probe, which was then removed from the nasal cavity with a hook by endoscopic control. The procedure was repeated with the paired tear duct. Then the silicone tube was tied by both ends of the fishing line and passed to the free ends of it from the nose into the nasal cavity, where they were riveted and clipped. Results and discussion. In all cases, the drainage was performed as described. As in the case of other modifications of the drainage, holding the tube into the tear-nasal canal required more effort and more skill as compared to draining of the formed anastomosis. In all cases, the effectiveness of the method of holding the tube in the lacrimal duct depended on the severity of the obstruction. Conclusions. The method developed by us for carrying out a silicone tube into the lacrimal duct is effective, simple and does not require the use of complex technologies for the manufacture of an intubation kit.

Transcanalicular laser dacryocystorhinostomy for acquired nasolacrimal duct obstruction: an audit of 104 patients

PurposeExternal dacryocystorhinostomy (DCR) is considered as the gold standard in the treatment of acquired nasolacrimal duct obstruction. However, many advances have been made towards the development of modern minimally invasive therapies. These new techniques were proven less harmful to the patients’ skin and medial palpebral structures with their palpebral-canalicular pump mechanism. Options include endonasal and transcanalicular procedures. Here, we report on our 2-year experience with the surgical technique, results and complications of transcanalicular laser-assisted DCR.MethodsThis is a retrospective study. A total of 104 patients with acquired nasolacrimal duct obstruction underwent transcanalicular laser-assisted DCR combined with bicanalicular silicon intubation. We then analyzed intra-/post-operative complications and subjective and objective success rates. The institutional ethics committee ruled that approval was not necessary. The trial was registered with the German Clinical Trials Register (DRKS00012879).ResultsTranscanalicular laser-assisted DCR in combination with bicanalicular silicon intubation could be performed surgically successfully in 101 patients (97%). In three cases (3%) using the superior canalicular approach, positioning of the laser instrument at the anteroinferior rim of the middle turbinate failed. Complications included thermal injury to the canaliculus (one), canalicular infection (two) and silicon tube prolapse (ten). Functional success (resolution of preoperative symptoms) was achieved in 80 cases (77%), functional failure occured in 24 cases with all patients reporting persisting epiphora, 15 reporting failure to irrigate the nasolacrimal duct and 15 requiring secondary external DCR.ConclusionsLaser-assisted DCR shows promising results with few complications. It seems well suited as a second-step procedure after failed recanalization and before external DCR.

Meta-analysis of randomized controlled trials in dacryocystorhinostomy with and without silicone intubation

ObjectiveTo determine the effect of bicanalicular silicone intubation (SI) on dacryocystorhinostomy (DCR) success rate in adult primary acquired nasolacrimal duct obstruction. DesignMeta-analysis of randomized controlled trials (RCTs). MethodsPubMed, Embase, Cochrane CENTRAL, Ovid Medline, Google Scholar, and grey literature search was performed from inception to June 2017. All prospective DCR trials with randomization of SI were considered. Cases with non-SI or adjunctive mitomycin were excluded. Where possible we analysed only 1 eye from each subject. Random effects meta-analysis was performed. ResultsWe retrieved 1142 articles and after filtering there were 14 RCTs with a total of 1311 DCR cases. There were 444 external DCRs and pooled estimate showed risk ratio (RR) was 1.08 (95% confidence interval [CI] 1.01–1.15). There were 867 predominantly endonasal DCR with RR 1.04 (95% CI 0.99–1.09). When all DCR modalities were combined the RR was 1.05 (95% CI 1.01–1.09). ConclusionsOverall, there was a 5% statistically significant improvement in DCR success rate with SI, but more endonasal DCR RCTs are required.

Evaluation of intraoperative mitomycin C in surgical management of adult lacrimal sac mucocele

Purpose The purpose of this study was to evaluate the effectiveness of intraoperative mitomycin C (MMC) with canaliculodacryocystorhinostomy (DCR) and bicanalicular silicone intubation for the management of adult lacrimal sac mucocele. Patients and methods In a 3-year period, 30 eyes of 28 adult patients with acquired lacrimal sac mucocele were enrolled in the study after thorough evaluation and if required computed tomography imaging was taken. All patients had at least 8 mm of patent proximal canaliculi. Under general anesthesia, all patients underwent canaliculo-DCR with bicanalicular silicone intubation and intraoperative MMC 0.2 mg/ml solution applied for 5 min to the lacrimal passages. All patients were followed up for at least 12 months postoperatively. Results The mean age of the patients was 48.90±12.28 years and 78.6% of the cases were women. After a follow-up period of an average of 16 months, 93.3% of the patients reported successful results (disappearance of epiphora and lacrimal sac swelling and patent lacrimal passages) and only 6.7% presented with recurrent epiphora and obstructed lacrimal passages. No case of recurrent lacrimal sac mucocele was reported. Conclusions Canaliculo-DCR with bicanalicular silicone intubation and intraoperative MMC yielded satisfactory results in 93.3% of adult patients with acquired lacrimal sac mucocele.

Transcanalicular Laser-Assisted Dacryocystorhinostomy With Endonasal Augmentation in Primary Nasolacrimal Duct Obstruction: Our Experience.

To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up. A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley's nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of follow up, at 1 year. A successful outcome was defined in terms of ostium patency at the end of 1 year. The results were analyzed at the end of a follow up of 1 year, using various statistical tests (p < 0.05). The mean age of the patients was 35.3 ± 15.89 years, with 23 male and 37 female patients, the 2 groups having a similar male:female ratio. An overall success rate of 90% was achieved at the end of 1 year with no statistically significant difference between the groups. Postoperative complications like tube displacement and punctal, canalicular injury were more in the intubated group. The average osteotomy size was 8.06 ± 5.4 mm at the end of 1 year. Transcanalicular laser-assisted dacryocysto rhinostomy, with endonasal augmentation, is a scarless, effective, daycare procedure, for treatment of primary acquired nasolacrimal duct obstruction with no additional advantage offered by silicone intubation.

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction.

Today's gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.

Study of microbial growth on silicone tubes after transcanalicular laser-assisted dacryocystorhinostomy and correlation with patency.

Intubation in primary transcanalicular laser assisted dacryocystorhinostomy (TCLADCR) is performed to increase the success rates. However, the associated inflammation and infection can have adverse effects. To study the microbial infection and drug susceptibility of extubated silicone tubes and final anatomical patency in patients undergoing TCLADCR. A non-randomised prospective interventional study was conducted in a tertiary care eye centre. The study included twenty consecutive adult patients with primary nasolacrimal duct obstruction. They underwent TCLADCR with bicanalicular silicone intubation. The stents were removed at 2 months and subjected to culture sensitivity, followed by administration of appropriate antimicrobial agents. Main outcome measures studied were the microbial spectrum on the cultured tubes, their sensitivity profile and its correlation with final anatomical patency. A positive culture was obtained in 100% cases, comprising of normal commensals and pathogenic organisms. Of the total 24 isolates, 16 (66.6%) Gram positive bacteria (75% Staphylococcus aureus) and 8 (33.3%) Gram negative bacteria (commonest E.coli) were found, with 4 tubes having more than one isolate. No fungal growth was seen. Ninety percent success rate was achieved at one year following appropriate antimicrobial therapy except in 2 patients with gram negative isolates who had failed to take the prescribed antibiotics following sensitivity reports. There was no correlation between multiple infections and success rate. However, by using the Fisher exact test, a positive correlation was obtained between appropriate antibiotic treatment and the final anatomical patency (p less than 0.05). Silicone intubation predisposes to microbial growth, which if neglected, can lead to failure of TCLADCR.

Treatment of Acute Purulent Dacryocystitis by Early Bicanalicular Silicone Intubation: Safety, Efficacy, and Outcomes

ABSTRACTPurpose: To evaluate the safety, efficacy, and outcomes of early bicanalicular silicone intubation in the treatment of acute purulent dacryocystitis. Methods: This prospective interventional case series focused on acute purulent dacryocystitis from February 2010 to March 2014. Of the 21 cases, 16 cases were treated at the Fujian Provincial Hospital, and five cases were treated at the Lianjiang Hospital. Bicanalicular silicone intubation was inserted in the original lacrimal duct within 10 days after abscess decompression by pus aspiration method and systemic antibiotic application. Data collection included demographic profiles, perioperative and postoperative complications, and revision surgery. Resolution of signs and symptoms of acute purulent dacryocystitis, as well as successful anatomical patency assessed by irrigation, was evaluated. Follow-up times were more than 12 months, and ranged from 14 to 63 months.Results: All patients showed remarkable improvement of pain and swelling within 48 hours. Resolution of the erythema and edema was observed within one week after bicanalicular silicone intubation combined with topical antibiotic lavage. No intraoperative and postoperative complications were observed. After initial bicanalicular silicone intubation, anatomical success was observed in 66.7% (14/21) of the patients. Of the remaining seven patients who presented with severe reflux in irrigation, two patients chose re-intubation and five patients underwent standard external dacryocystorhinostomy. All patients had anatomical success at last follow-up. Conclusion: Early bicanalicular silicone intubation appears to be a safe, effective, and simple procedure, which offers a reasonable option in the treatment of acute purulent dacryocystitis, especially for those developing and underdeveloped areas.

Endonasal Dacryocystorhinostomy (DCR) with Transcanalicular Endoillumination (TCE) of the Saccus Lacrimalis

Endonasal dacryocystorhinostomy (DCR) has been established as a standard procedure of lacrimal surgery, since it causes much less tissue damage than ab externo procedures. Diffiulties in visualization of the target area has been a limitation to the transnasal approach. An improvement of the classical endonasal DCR was achieved by the introduction of a transcanalicular endoillumination (TCE) of the lacrimal sac using a 23-Gauge vitreoretinal light probe, which can easily be intubated into the cannaliculi and advanced into the the lacrimal sac. Illumination of the lacrimal sac guides the endonasal approach and facilitates the creation of a lacrimal bypass. In our standard procedure a bicanalicular silicone intubation through the osteotomy is finally placed. Due to the introduction of TCE of the lacrimal sac, the surgical procedure of endonasal DCR became less traumatic and needed a significantly reduced operating time.

Management of acquired punctal stenosis in trachomatous patients using single versus double silicone tube insertion (a pilot study)

Objective This study compares the effect of double versus single bicanalicular silicone tube in reducing tear meniscus and degree of tolerance to their presence in patients with punctal stenosis. Materials and methods The interventional case series included 30 eyes of 15 patients with acquired epiphora with bilateral visible stenotic puncti defined by inability to insert a 26-G cannula into the punctum without dilation. Under general anaesthesia, punctal dilation and bicanalicular silicone intubation were performed: one on the right side and two on the left side. Tear meniscus height was evaluated using a slit-lamp scoring system (Z-IV) at 1 week, 1 month, 6 months (when tubes were removed) and 12 months. Patients' satisfaction was evaluated by another scoring system (from 1 to 5) in addition to punctal shape and complications. Results All patients had trachoma associated with punctal stenosis. Tear meniscus was reduced compared with the preoperative status at every follow-up in both groups, especially at 1 and 6 months in favour of the double intubation group ( P Conclusion Double bicanalicular silicone intubation is as well tolerated as single tubes and could be considered in the management of acquired punctal stenosis, especially in patients with trachoma, mostly because of punctum overstretch with more potential space for tear drainage. Further studies are required to evaluate retaining of the stent to prevent recurrence following tube removal.