Silicone Tube Insertion Research Articles

A Comparative Study of Surgical Outcome in Endoscopic Endonasal Dacrocystorhinostomy with and without Stenting

Introduction To remove tears from people’s eyes’ – is one of the greatest challenges of lacrimal surgery. Epiphora is defined as watering eye due to inadequate drainage of normally produced tears. Dacryocystitis is the inflammation of the lacrimal drainage system which presents as acute dacryocystitis or a much commonly as chronic dacryocystitis. Other common causes of ephiphora are blepharitis, conjunctivitis, trichiasis, punctal eversion and foreign bodies. The conventional treatment for watering eyes due to Naso Lacrimal Duct (NLD) is the procedure of external dacryocystorhinostomy (DCR) which has its own limitations and disadvantages. With the introduction of high resolution endoscopes for paranasal sinuses, endoscopic endonasal DCR (EnDCR) is gaining popularity. The main advantages of the endoscopic technique are minimal morbidity, less intraoperative bleed, shorter operative time, preservation of pump function of orbicularis occuli muscle, presaccal fibers and medial canthal tendon and avoidance of cutaneous scar. In EnDCR the most common cause for failure of surgery is closure of rhinostoma and to prevent this silicone tube insertion is the most preferred method. It has also been claimed that silicone tubing would improve surgical results. But studies also indicate that silicone tubing itself results in certain problems like, foreign body sensation, increased granulation tissue leading to failure, prolapse of tube leading to injury to cornea, nasal migration of tube, fistula formation, pharyngitis and associated sinusitis & recurrent nose bleed. The present study was undertaken to compare the surgical results of endoscopic endonasal DCR with and without silicone stent. Aims & Objectives To compare the success rates of endonasal dacryocystorhinostomy and evaluate the presence of post-operative changes and their effect on the outcome of the surgery in endoscopic dacryocystorhinostomy with and without stenting. Material & Methods This Prospective randomized comparative study was carried out amongst the patients attending department of ENT and referred cases from ophthalmology department for chronic nasolacrimal duct obstruction, both as inpatients and outpatients with complaint of chronic epiphora. 50 patients divided into two groups of 25 each fulfilling inclusion and exclusion criteria were included using convenient sampling. Participants were divided into two groups of 25 each based on randomization technique. Group 1 includes patients undergoing EnDCR with stenting and Group 2 includes patients undergoing EnDCR without stenting. Patients were assessed for post-operative complications like granulations, size of the neo ostium and patency of the neo ostium were assessed on nasal endoscopy. Data was entered in MS Excel work sheet. Data was analyzed using appropriate statistical methods. Result This study had Female predominance in both the groups. No predominance for any side was observed. No major intra operative complications were observed. Duration of surgery was more in Group I which was statistically significant. Post-operative complications are seen more in group without stenting (64.0%) than in group with stenting (56%) with no statistical difference between the two groups. Granulations had no effect on the outcome of the. On subjective assessment of symptoms 92% of patients in group I and 88% of patients in group II showed improvement of symptoms post operatively. No statistical difference had been found between the results of both the groups. On objective assessment of size of the neo ostium, no statistical difference was seen between the two groups. The size of the neo ostium had no effect on the outcome of the surgery. On objective assessment of patency of the neo ostium was observed in 92% of patients in group I and 88% patients in group II with no statistical difference between the two groups. Conclusion As success rates of the surgery with stenting and without stenting are comparable and

Dacryoendoscopic Findings of Patients with Lacrimal Drainage Obstruction Associated with Cancer Treatment.

To compare the diagnosis and treatment outcome of lacrimal drainage obstruction of patients who underwent systemic chemotherapy (CTx) or radioactive iodine treatment (RAI) by using dacryoendoscopy and at the same time performing dacryoendoscopy-guided silicone tube insertion (STI) to treat epiphora. From July 2017 to December 2020, the medical records of 11 patients (16 eyes) were diagnosed with lacrimal drainage obstruction after CTx or RAI and underwent dacryoendoscopy-guided STI were reviewed retrospectively. We tried to count the number of obstructive sites in total patients using slit-lamp examination and dacryoendoscopic findings. A total of 11 patients, 16 eyes, were enrolled in this study. The onset of epiphora in the CTx group (3.0 ± 4.0 months) was significantly shorter than that in the RAI group (52.6 ± 36.5 months, p = 0.001). There were total 32 obstructive sites including 28 obstructive sites of dacryoendoscopic findings and four sites of punctual stenosis in total 16 cases. Using dacryoendoscopy, granulation findings was dominant in RAI patients (p = 0.038) and mucus finding was frequent mostly in lacrimal sac and canaliculus. In the CTx group, mucosal edema finding was dominant (p = 0.038) and fibrotic membrane finding was frequent in all levels of lacrimal drainage system. Regarding the obstructive location, lacrimal sac was the most frequently obstructed site in the two groups (p = 0.038). The onset of epiphora in the CTx group was significantly earlier than in the RAI group. In the CTx group, mucosal edema finding was frequent in all levels of lacrimal drainage system. In the RAI group, granulation finding was frequent mostly in lacrimal sac and canaliculus. Since the clinical outcome was satisfactory, intervention with dacryoendoscopy-guided STI could be a treatment of choice in patients with epiphora after CTx or RAI.

Outcome of monocanalicular intubation for complex congenital nasolacrimal duct obstruction: the role of age.

Objective: Complex congenital nasolacrimal duct obstruction (CNLDO) is caused by pathologies other than the typical incomplete perforation of the thin membrane in the distal end of the nasolacrimal duct (NLD). Our purpose was to determine the success of silicone tube insertion for such complex CNLDO cases.Methods: Children who met the defined criteria for complex CNLDO and underwent monocanalicular silicone tube insertion between April 2016 and December 2020 were included. The tube was retained for 6-8 weeks and the final outcome was measured 3-4 months after tube removal. If the patients were totally symptom free, the outcome was recorded as complete success. Acceptable outcome was defined as Munk score ≤ 1 (requiring less than twice daily dabbing) and others were classified as failed.Results: Initially, 147 eyes of 132 patients underwent NLD intubation. However, after exclusion of the 11 cases with spontaneous tube extrusion (7.48%), 136 eyes of 121 patients entered the final analysis. The mean age was 23.9 ± 13.0 months (range 8-73 months). The outcome was complete success in 100 eyes (73.5%), acceptable in 16 (11.8%), and failure in 20 eyes (14.7%). The differences in the outcome of the procedure for the eyes based on history of previous probing and age was not statistically significant.Conclusions: NLD intubation with monocanalicular stent is effective in the resolution of complex CNLDO in 85% of cases. This procedure is associated with infrequent complications, like tube loss. The success is not negatively affected by older age and previously failed probing history.Abbreviations: CNLDO = congenital nasolacrimal duct obstruction, NLD = nasolacrimal duct

Possibility of Pseudo-Obstruction in Lacrimal Canalicular Obstruction Diagnosed with Dacryocystography

Introduction: Endoscopic dacryocystorhinostomy (DCR) is the treatment of choice for patients with lacrimal drainage system obstruction. Dacryocystography (DCG) is one of the most common preoperative studies and considered as a useful test demonstrating the anatomy of lacrimal drainage systems. Objective: This study was designed to evaluate the diagnostic efficacy of DCG for canalicular obstruction and to compare surgical outcomes between true-obstruction versus pseudo-obstruction diagnosed with DCG. Methods: A retrospective study was performed on 45 consecutive patients with lacrimal canalicular obstruction who had underwent endoscopic DCR with silicone tube insertion from January 2009 to December 2014 at a single tertiary hospital. A review of medical records included demographic data, preoperative symptoms and signs, results of intraoperative canalicular probing, and surgical outcomes including the postoperative symptom improvement and endoscopic finding. Results: Of 45 patients, 34 patients (75.6%) had true-canalicular obstructions and 11 patients (24.4%) had pseudo-canalicular obstructions. The success rate of endoscopic DCR was 50% (17 of 34) in cases with true-canalicular obstruction while 90.9% (10 of 11) in pseudo-canalicular obstruction (p value <0.05). No intraoperative or postoperative complications including sinusitis or synechia were found. Conclusions: About a quarter of lacrimal canalicular obstruction cases diagnosed with DCG seem to be pseudo-obstruction. The success rate of endoscopic DCR in pseudo-canalicular obstruction is similar to that of saccal and nasolacrimal ductal obstruction.

Changes in Eyelid Position Following Silicone Tube Insertion and Removal in Dacryocystorhinostomy.

The authors sought to assess the changes in eyelid position after silicone tube insertion and removal in endoscopic dacryocys-torhinostomy. The authors retrospectively reviewed 60 eyes of 48 consecutive patients who underwent endoscopic dacryocystorhinostomy operation at Korea University Guro Hospital, Seoul, Republic of Korea, between April 2019 and November 2019. All cases were evaluated to discern eyelid positioning, focusing on the marginal reflex distance 1, medial palpebral fissure, central palpebral fissure (PF-2), lateral palpebral fissure (PF-3), and medial canthal angle (MCA) before surgery and at 1 week and 1, 2, 3, and 4 months postoperatively. Twelve patients (25%) were operated on bilaterally and 36 patients (75%) were operated on unilaterally. The average patient age was 56.5years and 9 men (18.8%) and 39 women (81.3%) were included in this study. At 2 months postoperatively, all values of interest (marginal reflex distance 1, medial palpebral fissure, PF-2, PF-3, and MCA) had decreased significantly (p < 0.05, Friedman test), but the changes in PF-3 immediately after surgery were not significant (P = 0.062, Wilcoxon rank-sum test). From 2 to 3 months after surgery, all 5 indicators of interest increased significantly. After silicone tube removal, whereas there was no statistically significant difference in medial palpebral fissure, PF-3, and marginal reflex distance 1 values; the changes in PF-2 and MCA values as compared with before surgery was 0.47 mm (p = 0.02, Wilcoxon test) and 3.25° (p = 0.000, Wilcoxon test), respectively, which was significantly different. However, with these small gaps, it will be difficult to notice the changes in PF-2 and MCA values during clinical examination. Insertion of a silicone tube during endoscopic dacryo-cystorhinostomy leads to temporary deformation of the lid position. However, after silicone tube removal, all eyelids recovered to their original shape.

A novel technique for dacryocystorhinostomy tube insertion

Abstract OBJECTIVE. The purpose of this paper is to describe a simple and safer silicone tube insertion technique in endoscopic dacryocystorhinostomy. MATERIAL AND METHODS. In our technique, steel wire is inserted into a rigid suction tube (3 mm in diameter) immediately after the medial wall of the sac under endoscopic view. The duration of retrieving the wire from the sac and out of the nasal passage, the number of mucosal lacerations and bleeding were compared with conventional methods such as using retrieval device or forceps. RESULTS. The duration of retrieving the wire from the sac and out of the nasal passage and mucosal laceration were statistically reduced (P&lt;0.05) in this novel technique when compared with other methods. CONCLUSION. Sheltering the sharp end of the wire with a suction cannula is a safe and easy method without using any additional tools

IS IT NECESSARY TO INSERT A SILICONE TUBE AFTER ENDOSCOPIC ENDONASAL DACRYOCYSTORHINOSTOMY? AND FOR HOW LONG? A COMPARATIVE PROSPECTIVE STUDY

This study aimed to evaluate the necessity for silicone tube insertion following endonasal endoscopic dacryocystorhinostomy (DCR), and the optimal time for its removal. A prospective study was done at Al-sadr Teaching and Al-Shafaa General Hospitals in Basrah, Iraq on seventy two patients with nasolacrimal duct obstruction diagnosed and referred from ophthalmologist to ENT clinic. Preoperative assessment with investigations were done and all patients were subjected to endoscopic endonasal DCR. The patients were divided into three groups; the first group included those with long period stenting (silicone tube removed three months or more), the second group included those patients with short period stenting (tube removed 2-3 weeks after surgery), and the last group included those with no silicone tube stenting. The success rate and complications after surgery were studied in each group for more than one year. The 72 patients were; 63 females (87.5%) who affected more than males (9, 12.5%). the most common age group was 21-45 years. Left side of disease 41(56.9%) is more than right side 31(43.1%). Sixty eight operations (94.4%) out of 72 were primary surgery while four (5.6%) were revision surgery. Ancillary procedures were done also; 13 (18%) septal surgery and 3(4.1%) endoscopic sinus surgery. Success rate was more among short period stenting group 22 out of 24 (91.6%), then without stenting group 19 (82.6%) and those with long period stenting was only 20 from 25 (80%). In conclusion, no statistical significant difference (benefit) about the usage or not of the silicone tube and also about how long keeping the tube, but it is preferable to use silicone tube (for 2-3 weeks only) to improve success rate. Keywords: Silicone tube, Insertion, Endonasal, Endoscopic, Surgery

A histopathological study of lacrimal puncta in patients with primary punctal stenosis

We investigated the etiology of punctal stenosis based on the histopathological features of puncta and clinical correlations in punctal stenosis patients. A retrospective review was conducted of 69 cases from 38 patients who were diagnosed with punctal stenosis. Slit-lamp examination, the lacrimal irrigation test, dacryocystography, and spectral domain-optical coherence tomography were performed for the evaluation of punctal occlusions. For treatment, punctoplasty using a punch biopsy with or without silicone tube insertion and histopathological examinations were performed. The pathological features of the punctal membranes were classified into two types of epithelia: squamous (95.7%, 66/69) and columnar (4.3%, 3/69). The squamous epithelial specimens were divided into three groups: fibrous tissue (66.8%, 48/69), goblet cells (21.8%, 48/69), and keratinization (4.3%, 3/69). Most of the subepithelial pathology was fibrosis (82.6%, 57/69), and inflammation was noted in 17.4% (12/69) of the patients. Subepithelial fibrosis was the most common pathological feature in patients exhibiting stenosis with a squamous epithelium, while inflammation was more strongly correlated with patients with a columnar epithelium. However, there was no correlation between the histopathological findings and treatment outcomes. Our histopathological findings suggest that primary fibrosis of the stenotic punctum was caused by intrinsic inflammation of the puncta rather than spreading from the conjunctiva or eyelid. Punctoplasty was effective in treating punctal stenosis, regardless of the epithelial type.

Polysaccharide-based superhydrophilic coatings with antibacterial and anti-inflammatory agent-delivering capabilities for ophthalmic applications

Medical silicone tubes are generally used as implants for the treatment of nasolacrimal duct stenosis. However, side effects such as allergic reactions and bacterial infections have been reported following the silicone tube insertion, which cause surgical failure. These drawbacks can be overcome by modifying the silicone tube surface using a functional coating. Here, we report a biocompatible and superhydrophilic surface coating based on a polysaccharide multilayer nanofilm, which can load and release antibacterial and anti-inflammatory agents. The nanofilm is composed of carboxymethylcellulose (CMC) and chitosan (CHI), and fabricated by layer-by-layer (LbL) assembly. The LbL-assembled CMC/CHI multilayer films exhibited superhydrophilic properties, owing to the rough and porous structure obtained by a crosslinking process. The surface coated with the superhydrophilic CMC/CHI multilayer film initially exhibited antibacterial activity by preventing the adhesion of bacteria, followed by further enhanced antibacterial effects upon releasing the loaded antibacterial agent. In addition, inflammatory cytokine assays demonstrated the ability of the coating to deliver anti-inflammatory agents. The versatile nanocoating endows the surface with anti-adhesion and drug-delivery capabilities, with potential applications in the biomedical field. Therefore, we attempted to coat the nanofilm on the surface of an ophthalmic silicone tube to produce a multifunctional tube suitable for patient-specific treatment.

Comparison of the Efficacies of 0.94 mm and Double Silicone Tubes for Treatment of Canalicular Obstruction.

PurposeTo compare the clinical effects of the single wide-diameter bicanalicular silicone tube and the double bicanalicular silicone tube in endonasal dacryocystorhinostomy (DCR) with canalicular trephinization for canalicular obstruction.MethodsWe retrospectively reviewed the records of 121 patients with monocanalicular or common canalicular obstruction who had undergone endonasal DCR with random bicanalicular insertion of either double silicone tubes (insertion of two tubes into each canaliculus) or a single wide-diameter (0.94 mm) silicone tube. The tubes were removed at around 3 months after surgery.ResultsThis study included 79 eyes of 61 patients in the double-tube intubation group and 68 eyes of 60 patients in the single wide-diameter tube intubation group. Anatomical success, evaluated by syringing, was achieved in 72 of the 79 eyes (91.1%) in the double-tube intubation group and 60 of the 68 eyes (88.2%) in the single wide-diameter tube intubation group. Functional success was achieved in 65 of the 79 eyes (82.3%) in the double-tube intubation group and 61 of the 68 (89.7%) eyes in the single wide-diameter tube intubation group. There were no significant differences in the success rates of surgery between the two groups. One patient in the double-tube intubation group underwent conjunctivodacryocystorhinostomy (CDCR) and two in the wide-diameter tube intubation group underwent CDCR or reintubation to treat recurrence.ConclusionsIntubation using a single wide-diameter tube during endonasal DCR is as effective as double-tube intubation for the treatment of canalicular obstruction, with a lower rate of complications such as inflammation or patient discomfort.

Clinical Outcomes of Probing in Children with Congenital Nasolacrimal Duct Obstruction

Purpose: To determine the success rate of probing for the treatment of congenital nasolacrimal duct obstruction and to identify the clinical factors affecting the success rates. Methods: The records of probing procedures from January 2005 to January 2015 were reviewed. The present study included 200 eyes of 174 patients with congenital nasolacrimal duct obstruction. Successful probing was defined as complete resolution of epiphora 3 months after treatment. Success rates were compared between the 2 groups in terms of sex, age, laterality, and previous probing. Results: A total of 200 eyes of 174 children (109 eyes of 94 males and 91 eyes of 80 females; mean age, 7.51 ± 3.39 months) had undergone the probing procedure. The overall success rates of primary probing were 81.5%, with an 80.7% success rate in males (88 eyes of 109 eyes) and 82.5% in females (75 eyes of 91 eyes). Success rates were 83.5% for the 91 eyes in children aged 0 to 6 months, 80.0% for the 90 eyes in children 6 to 12 months, and 78.9% for the 19 eyes in children over 12 months. No statistical significances were found among age groups. The probability of treatment success was lower in bilateral disease (p < 0.05; 86.4-67.3%). Twenty-four of 37 eyes with unsuccessful primary probing underwent secondary probing, resulting in a 70.8% success rate. Silicone tube insertion was performed in 4 eyes repeatedly, however, the procedures were unsuccessful. The overall success rate was 90%. Conclusions: The success rates among various age groups were not statistically significant. The probability of treatment success was lower in bilateral cases. Probing is an effective first-line treatment in children diagnosed with nasolacrimal duct obstruction. Close observation and appropriate treatment should be considered in patients with bilateral disease. J Korean Ophthalmol Soc 2016;57(7):1031-1036

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

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

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.

The Outcome of Silicone Intubation and Tube Removal in External Dacryocystorhinostomy Patients with Distal Canalicular Obstruction

To evaluate the outcome of silicone intubation and tube removal in external dacryocystorhinostomy (DCR) patients with distal canalicular or common canalicular obstruction. Seventy-five eyes of 69 patients with distal or common canalicular obstruction who had undergone external DCR and silicone tube insertion were included in the study. Silicone tube was left in place at least for 3 months. Presence of epiphora was questioned and patency was assessed by irrigation at each control after tube removal. Mean patient age was 49.8±14.4 years (range 15-78) and mean follow-up after surgery was 13.2±4.2 months (range 6-25). After tube removal, 16 eyes (21.3%) presented with epiphora and occluded canalicular systems. Two eyes (2.7%) presented with epiphora which started just after tube removal and had a patent canalicular system. Fifty-seven eyes (76%) were free of symptoms and had patent canalicular systems and 3 of these eyes (4%) had epiphora while the tube was in place. Silicone intubation is indicated in patients with distal or common canalicular obstruction. The majority of patients with canalicular problems are relieved of epiphora after silicone tube removal. However, the tube itself may transiently occlude the canalicular system and cause epiphora in some patients, and in some it can aid tear flow even in the presence of a patent system.

Surgical Results of Endoscopic Dacryocystorhinostomy and Lacrimal Trephination in Distal or Common Canalicular Obstruction

ObjectivesTo evaluate the surgical outcomes of endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stenting in patients with distal or common canalicular obstructions.MethodsThe medical records of 29 patients (31 eyes) from January 2001 to December 2009 who underwent endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone tube insertion for the treatment of distal or common canalicular obstructions were retrospectively reviewed. The level of obstruction was confirmed by intraoperative probing. The outcome of the surgery was categorized as a complete success, partial success, or failure according to the functional and anatomic patency.ResultsThe average age of the patients was 52 years. The duration of silicone intubation ranged from 4 to 11 months with an average of 5.7±1.6 months. The follow-up period after stent removal ranged from 4 to 15 months with an average of 8.2±3.3 months. Complete success was achieved in 25 out of 31 eyes (80.6%), partial success in 4 out of 31 eyes (12.9%), and failure in 2 out of 31 eyes (6.5%).ConclusionEndoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stent intubation may be safe and considered as an initial treatment of patients with distal or common canalicular obstructions.

A Case of Treatment of Traumatic Recurrent Frontal Sinusitis with T-tube

The most common disease process involving the frontal sinus is infection secondary to inadequate drainage through the frontal recess. Obstruction of the frontal recess may result from rhinosinusitis, allergic rhinitis, nasal polyposis, tumor and traumatic injury. The principle treatments are not only ventilation and drainage but also removal of predisposing factors. If there is no response to conservative treatment, surgical treatment is considered. To prevent closure of the frontal recess, external approach, endoscopic approach, grafts, indwelling tubes and mucoperiosteal flaps have been used. Insertion of silicone tube in frontal recess is a simple and easy method of drainage through frontal recess. We report a case of traumatic recurrent frontal sinusitis which was treated by endoscopic sinus surgery with silicone T-tube insertion. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:50-3 Key WordsZZFrontal sinusitis·Tube.

Results of the Mixed Solution of Hyaluronate and Sodium Carboxymethylcellulose in Endonasal Dacryocystorhinostomy

Purpose: To evaluate the long-term results of the application of a mixed solution of hyaluronate and sodium carboxymethlycellulose (HACMC, Guardix-sol) intraoperatively in endonasal dacryocystorhinostomy (Endo-DCR). Methods: In this retrospective randomized controlled study, Endo-DCR and silicone tube intubation were performed on 83 eyes of 83 patients who were diagnosed with nasolacrimal duct obstruction. In group A (40 patients, 40 eyes), HACMC was applied to the osteotomy site in the nasal cavity after standard Endo DCR procedure. In group B (43 patients, 43 eyes), a standard Endo-DCR procedure was performed without HACMC. The results for the two groups were evaluated by asking patients about the tearing condition and examining the patency of irrigation, complications, and related treatment. Results: There were no statistically significant differences in age, sex, silicone tube insertion duration, or mean follow-up time between the two groups. The primary success rates of the group A and the group B were 87.5% (35/40) and 81.4% (35/43), respectively. The final success rates after the revisonal surgery were 92.5% (37/40) and 86.0% (37/43), respectively, and there were no statistically significant differences between the two groups (P=0.348, Fisher’s exact test). Conclusions: Applying HACMC to the nasal cavity will be useful in treating patients with poor prognosis, although the higher average primary success rate of patients receiving HACMC, as compared to those who did not, was not statistically significant.

Result of Silicone Tube Intubation in Patients with Epiphora Who Showing Normal Finding in Dacryocystography

Purpose: To Compare treatment results on silicone tube insertion according to the region and severity of resistance in lacrimal probing for functional nasolacrimal duct obstruction patients who complained of epiphora but are shown to be normal in lacrimal syringing and dacryocystography. Methods: A retrospective study was conducted with 40 subjects (42 eyes) who had silicone tube insertion because of functional nasolacrimal duct obstruction. A comparison was made of post-operational patient satisfaction by grading (0～3) according to the region and the severity of resistance and whether the resistance region was singular or multiple resistance regions were found on probing. Success was defined as a grade of more than one point. Results: Two eyes had no resistance regions, 28 eyes had one resistance region, and 12 eyes had more than two resistance regions on lacrimal probing. There was no statistical significance in the ranking of post-operative satisfaction among theses groups. There was also no difference among the groups for post-operative satisfaction according to obstruction site. Conclusions: Most functional nasolacrimal duct obstruction patients showed partial obstruction of the nasolacrimal duct on probing. Since functional nasolacrimal duct obstruction is not possible, we must treat patients for partial nasolacrimal duct obstruction, for wihch silicone tube insertion is thought to be effective.

Selective non‐intubation of a silicone tube in external dacryocystorhinostomy

To evaluate whether silicone tube insertion is always necessary in external dacryocystorhinostomy (DCR). During external DCR for primary nasolacrimal duct obstruction carried out between January 2001 and October 2004, silicone intubation was not performed selectively if the lacrimal sac was large and the nasal cavity was not severely narrowed. Of a total of 166 DCR cases in 153 patients, no silicone tube was placed in 74 eyes of 69 patients (44.6%). Anatomic patency of rhinostomy was achieved in all non-intubation group eyes. However, four (6.7%) of these 69 eyes showed persistent epiphora even with anatomic patency. Silicone tubing can be avoided in about 50% of cases of external DCR without detrimentally affecting the success rate. Cases in which intubation was avoided had a large lacrimal sac and a wide nasal cavity.

涙嚢鼻腔吻合術の検討

We reviewed 11 patients (7 women and 4 men) with acquired dacryostenosis who underwent a dacryo-cysto-rhinostomy (DCR) at Saiseikai Utsunomiya Hospital between May 2000 and April 2004. The etiology was considered chronic inflammation in six, trauma in two and complications of paranasal sinus surgery in two. In addition to lacrymal probing and irrigation, we investigated all patients by anterior rhinoscopy and CT. One patient showed pneumatization in the lacrymal sac on CT and dacryoatresia was confirmed with irrigation. We diagnosed the common canaliculi as the site of atresia, and this was confirmed intraoperatively. We treated 7 cases by traditional extenal DCR (EXT-DCR) and 4 by endonasal endoscopic DCR (EE-DCR). We treated one case of relapsed obstruction with EE-DCR but treated well with the same method. The EXT-DCR cases have not show any recurrence to date. There were two cases of stenosis at the common canaliculi and both were improved after EE-DCR with silicone tube insertion. With EE-DCR, the duration of surgery was shorter and there was no scar formation or facial deformity. We suggest that ENT doctors should pay more attention to diseases of the naso-lacrymal system and cooperate with ophthalmologist when designing treatment regimens.