Monocanalicular Silicone Research Articles

Long-term outcomes of laser dacryoplasty combined with intubation using a new silicon tube in patients with lacrimal duct obstruction.

To determine the 15-year outcomes of laser dacryoplasty (LDP) in patients with lacrimal duct obstruction; and to evaluate LDP combined with intubation using a new silicone tube to treat complicated cases. Patients with lacrimal duct obstruction and treated with LDP between April 2000 and April 2005 were investigated retrospectively. Totally 116 eyes with completed 15-year follow-up records were included in this study. For complicated cases (52 eyes of 52 patients), both LDP and intubation using a self-made silicon tube were performed. For patients with uncomplicated obstruction (64 eyes of 61 patients), only LDP was performed. Outcomes were assessed based on results of lacrimal irrigation and degree of symptoms during follow-up. At the follow-up time of 15y, 81 eyes achieved full success (69.8%); 21 eyes got improved (18.1%); and 14 eyes were considered failure (12.1%). The success rate was 71.2% (37/52 eyes) for complicated cases; and 68.8% (44/64 eyes) for uncomplicated cases. No statistically significant difference between two groups was observed (P=0.961). No postoperative complication was observed. LDP is a well-tolerated, simple, and effective procedure with satisfactory long-term outcomes in selected patients, which make it a good alternative to conventional dacryocystorhinostomy. In addition, intubation with the self-made mono-canalicular silicone tube facilitates the management of complicated cases with few complications.

Trephination and silicone tube intubation in the treatment of canalicular obstruction.

To evaluate the efficacy of trephination and monocanalicular/bicanalicular silicone tube use depending on the number of affected canaliculi in patients with canalicular obstruction. This retrospective study included 46 eyes of 36 patients who underwent trephination and silicone tube intubation performed by a single experienced oculoplastic surgeon due to canalicular obstruction between 2005 and 2020. Monocanalicular silicone tube was applied to patients with one canalicular obstruction, and bicanalicular silicone tube was applied to those with the upper and lower canalicular involvement of the same eye. Canalicular obstructions were divided into groups according to their localization as proximal, middle, and distal. The silicone tubes were kept in place for at least 5months after the operation, and the follow-up duration of the patients was at least 12months. Twenty (55.6%) patients were female and 16 (44.4%) were male. The mean age was 15.82 ± 7.02years in the treatment success group and 28.87 ± 12.74years in the treatment failure group (p = 0.001). While 67.6% of the eyes in the treatment success group had monocanalicular obstruction (monocanalicular silicone tube applied), 66.7% of those in the treatment failure group had bicanalicular obstruction (bicanalicular silicone tube applied) (p = 0.049). The most common distal obstruction was seen in the treatment success group, and the least distal obstruction and the most proximal obstruction were observed in the treatment failure group (p < 0.001). The mean duration silicone tube stay was 9.37 ± 1.96months in the treatment success group and 7.25 ± 1.42months in the treatment failure group (p = 0.003). We consider that trephination with the use of a monocanalicular or bicanalicular silicone tube depending on the number of affected canaliculi can be the first choice of treatment in canalicular obstruction due to its high success rate, especially in distal obstruction.

Management of congenital nasolacrimal duct obstruction in down syndrome.

Congenital nasolacrimal duct obstruction (CNLDO) is common in Down Syndrome (DS), and more difficult to treat. Our purpose was to describe the management of CNLDO in paediatric patients with DS. Retrospective cohort study. Medical chart review of all DS patients diagnosed with CNLDO at the Division of Ophthalmology at the Children's Hospital of Philadelphia during a 12-year period (2009-2020). Main outcome measures included: Surgical interventions, primary probing outcome, rate of dacryocystorhinostomy (DCR) and/or conjunctivodacryocystorhinostomy (CDCR), and overall success. 126 patients (236 eyes) were included, mean age of 1.8 ± 2.1 years (range 0.1-11.3 y), 110 (87%) had bilateral CNLDO. Mean follow-up time was 41 months. 84 patients (67%) underwent at least one surgical intervention; the mean number of surgical interventions in this group was 1.8 ± 1.4 per patient (range, 1-6). The most common primary intervention was probing (n = 74, 88%), mostly (n = 57, 68%) with monocanalicular silicone intubation. Probing with silicone intubation had a higher success rate compared to probing alone (P = 0.002). Twenty (24% of 84) patients underwent DCR/CDCR during the follow-up period. Complete resolution was achieved in 123 patients (98%). CNLDO in Down syndrome is associated with high rates of bilateral obstructions and with less favourable surgical outcomes. Many patients ultimately require a more robust surgical intervention such as DCR or CDCR. The use of monocanalicular stent in initial probing was associated with a higher success rate, and would appear to be appropriate in all CNLDO-DS cases.

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

Pulled versus Pushed Monocanalicular Silicone Intubation in Adults with Lacrimal Drainage System Stenosis: A Comparative Case Series.

Purpose To compare the success rate and complications of pulled versus pushed monocanalicular intubation in adults with incomplete lacrimal drainage system obstruction (lacrimal drainage system stenosis). Methods Patients with lacrimal drainage system stenosis (Munk grade ≥3), including both nasolacrimal duct (NLD) stenosis and common canalicular stenosis, were recruited in this prospective comparative case series. Patients underwent probing and either Monoka (51 eyes) or Masterka (48 eyes) intubation under general or local anesthesia. Tubes were removed 4–14 weeks after the procedure. Six months after tube removal, Munk grades 0 and 1 were defined as a complete success, Munk grade 2 was defined as a partial success, and Munk grade ≥3 was defined as failure. All complications were recorded. Results Ninety-nine eyes from 89 patients with lacrimal drainage system stenosis who underwent either Monoka (51 eyes) or Masterka (48 eyes) intubation were included. The mean (SD) age of the patients was 55.4 (12) years in the Monoka group and 53.5 (12.9) in the Masterka group. Groups were matched on demographics. Masterka intubation could not be performed in one eye. Complete and partial successes were observed in 52.9% (27/51) and 17.6% (9/51) of eyes in the Monoka group and 42.6% (20/47) and 12.8% (6/47) of eyes in the Masterka group, respectively (p=0.29). There was a trend toward a higher total success rate in patients with NLD stenosis treated with Monoka 66.7% (26/39) than Masterka 45.5% (15/33) intubation (p=0.07). This trend also existed in patients with common canalicular stenosis (83.3% (10/12) vs. 76.6% (11/14), p=0.75). Age, sex, bilateral involvement, and duration of intubation did not have a significant impact on the success rate. Early tube loss, slit puncta, and temporary superficial punctate keratopathy were observed complications. Conclusion Intubation with the pulled monocanalicular silicone tube was associated with a slightly but not significantly higher success rate in adults with lacrimal drainage system stenosis. Patients with NLD stenosis may achieve better results with pulled silicone tubes.

The significance of primary monocanalicular silicone tube intubation in late surgical treatment in children

To evaluate the effect of monocanalicular silicone tube intubation outcomes as an initial surgical treatment in children older than 1 year old with primary nasolacrimal obstruction. Probing or monocanalicular silicone tube intubation was performed as primary surgical treatment on 12-48 months old children with primary nasolacrimal obstruction. Probing was performed on 53 eyes of 43 patients and silicone tube intubation on 45 eyes of 39 patients. Treatment was considered successful after improvement in patient complaints, the presence of normal tear meniscus, and normal results of fluorescein disappearance time test. Retrospective treatment success was compared between two groups according to age groups. Treatment success was 79.1% in the probing group and 92.3% in the silicone tube intubation group. The success of the treatment was evaluated separately in the groups of 12 to <24 months, 24 to <36 months, and 36 to <48 months, and although the success level of the silicone tube intubation group was consistently found to be higher, the difference was not statistically significant. Treatment success decreased statistically significantly in the probing group with increased age of the patients, especially after 24 months. There was no such statistically significant decrease in the silicone tube intubation group. The choice of monocanalicular silicone tube intubation for primary surgical treatment in children with primary nasolacrimal obstruction provides success without the need for repetitive surgical interventions, especially in children older than 24 months.

A novel monocanalicular silicone intubation technique for canalicular laceration repair

This study aimed to evaluate the clinical efficacy and reliability of a novel monocanalicular silicone intubation (nMCI) technique for canalicular laceration repair in a series of patients treated over a 3-year period. The case records of 86 patients (86 eyes) who had undergone nMCI-based surgical repair of canalicular lacerations were retrospectively reviewed. The silicone tube removal was planned for 3 months postoperatively. A minimal follow-up of 6 months was adopted for the final analysis. The primary outcome measures included anatomical patency on irrigation and relief from epiphora, which were assessed subjectively and objectively through a fluorescein dye disappearance test. A total of 86 patients (72 males and 14 females; mean age = 34 years) were included. The upper canaliculus was damaged in 13 cases, while the lower canaliculus was damaged in 73 cases. Successful stenting was achieved in all cases. The postoperative eyelid position was satisfactory in the majority of the patients. The mean period of stenting was 3 months, while the mean postoperative follow-up period was 6 months. There were no cases of premature stent extrusion. The functional drainage following stent removal was normal in 95% of the patients, while the syringing revealed full patency with no narrowing or reflux. The present results suggest that the nMCI technique presents an effective and atraumatic surgical approach for adult patients with canalicular lacerations. The main advantages of the technique are the simple insertion and the easy removal of the tube, which results in high anatomical and functional success rates and offers an effective alternative in the treatment of monocanalicular lacerations.

Imperméabilité lacrymonasale simple de l’enfant : comparaison entre une intubation monocanaliculaire « tirée » type Monoka versus intubation monocanaliculaire « poussée » type Masterka

The primary cause of congenital epiphora, congenital nasolacrymal duct obstruction (CNLDO) affects 5 to 20% of newborns. In children over 12 months, it is currently recommended to treat with primary probing and intubation of the nasolacrymal duct under general anesthesia. The purpose of this study is to compare "pulled" monocanalicular intubation (Monoka) versus "pushed" monocanalicular intubation (Masterka). This retrospective study included 73 children between 2014 and 2017 who presented with CNLDO with membranous (mucosal) obstruction. All procedures were performed under general anesthesia with endotracheal intubation. Children with CNLDO underwent either monocanalicular silicone intubation (Monoka) with classic nasal recovery or pushed monocanalicular intubation (Masterka) inserted via the canthus. Treatment success was defined as complete resolution of epiphora at two months after the procedure. Surgical outcomes were assessed in 53 eyes with Monoka and 20 eyes with Masterka intubation. The mean age at treatment was 25 months (range, 12-69 months) for the two groups. Treatment success was achieved in 19 of 20 eyes (95.0%) in the Masterka group compared with 50 of 53 eyes (94.0%) in the Monoka group. A tube loss occured in 14% of cases in both groups. In children over 12 months of age, the Masterka "pushed" monocanalicular intubation technique is an effective treatment for congenital nasolacrymal duct obstruction.

A Comparison between Pulled and Pushed Monocanalicular Silicone Intubation in Management of Congenital Nasolacrimal Duct Obstruction

Background: Congenital nasolacrimal duct obstruction (CNLDO) is usually caused by a membranous block at the valve of Hasner. Symptoms of CNLOD include epiphora, mucous discharge, or mucopurulent discharge. Many CNLDOs can resolve spontaneously by the first year of life. Children who ultimately have unsuccessful responses to canalization will undergo invasive procedures for CNLDO, including probing, silicone intubation, balloon dacryocystoplasty and dacryocystorhinostomy. There are two types of lacrimal intubation, monocanalicular and bicanalicular. Pushed monocanalicular stent is characterized by the probe guide actually placed inside the silicone tube, rather than attached at the end as in conventional ‘‘pulled’’ intubations stents. Aim of the work: was to compare the success rate of pulled monocanalicular (MCI) versus pushed monocanalicular silicone intubation (PMCI) of the nasolacrimal duct for congenital nasolacrimal duct obstruction. Patients and methods: In a prospective randomized clinical trial 67 eyes of 67 patients with CNLDO underwent either pulled monocanalicular silicone intubation (MCI) (=32 eyes) or PMCI ( =35 eyes). Cases were considered successful if reached grade 0 or 1 in fluorescein dye disappearance test -complete or partial resolution of symptoms - after two months after tube removal. Results: This study included only patients with simple obstruction at the level of the Hasner valve and diagnosed intraoperative during the initial probing thus, the surgical outcome was assessed in 30 eyes of 30 patients in the MCI groups. 15 eyes received MCI in the upper punctum and 15 eyes received MCI in the lower punctum. The other 30 eyes 30 patients did PMCI with Masterka tube. 15 eyes received PMCI in the upper punctum and 15 eyes received PMCI in the lower punctum. 33 females (55%) & 27 males (45%) with age ranged from 12 to 46 months with mean of 26 ± 11 months. Follow-up of the patients was done at 1 week, 1 month, 2 and 3 months post-operative. Tube removal was done 3 months post operatively in both types of tube. The overall success rate in the MCI intubation groups was 86.7%, whereas in the PMCI intubation groups was 80%. However, the difference in the success rates between the two groups was statistically insignificant (P= 0.4884) using Chi-square test. Conclusion: Results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.

A Comparison between Pulled and Pushed Monocanalicular Silicone Intubation in Management of Congenital Nasolacrimal Duct Obstruction

A Comparison between Pulled and Pushed Monocanalicular Silicone Intubation in Management of Congenital Nasolacrimal Duct Obstruction

Monocanalicular and bicanalicular silicone tube intubation results in patients with congenital nasolacrimal duct obstruction

Monocanalicular and bicanalicular silicone tube intubation results in patients with congenital nasolacrimal duct obstruction

Traumatic Canalicular Laceration Repair with a New Monocanalicular Silicone Tube.

This study evaluated the efficacy of a new pushed monocanalicular silicone tube in reconstructing traumatic canalicular laceration. This interventional case series enrolled 48 patients with a traumatic canalicular laceration. Patients with bicanalicular involvement were excluded. Canalicular repair was performed under an operating microscope and involved proximal end exploration of the canaliculus, stenting of the canaliculus with a 35-mm Masterka tube, and approximation of the lacerated canaliculi margins. After 6 months, anatomical and functional success rates were evaluated by diagnostic probing and by asking the patients (or their guardians) about tearing. The mean age of patients was 32.2 ± 21.2 years (1.5-75 years). Of the 48 patients included, 38 were males. Lower canaliculus was involved in 35 patients. Other ocular injuries were observed in 38 patients. The average interval between the surgery and Masterka removal was 12.2 ± 1.4 weeks (10-16 weeks). Early tube extrusion was observed in 3 patients. No significant complication was observed in this series. Anatomical and functional success rates were 87% and 100%, respectively. The results demonstrated that intubation of lacerated canaliculi with Masterka tube for canalicular repair was safe, effective, and simple with minimal complications.

Clinical Effectiveness of Monocanalicular Silicone Intubation for Congenital Nasolacrimal Duct Obstruction Under Nasal Endoscopic Visualization of the Terminal End of the Obstructed Nasolacrimal Duct.

To evaluate the cause of nasolacrimal duct obstruction through confirmation by nasal endoscopic findings of Hasner's valve and to report the success rate of monocanalicular silicone intubation (MCI) for the management of congenital nasolacrimal duct obstruction (CNLDO). Seventy-seven eyes of 56 patients with CNLDO underwent MCI under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct at the Korea University Ansan Hospital and Guro Hospital from October 2008 to March 2013. The following demographic information was analyzed: age, sex, endoscopic findings of Hasner's valve during operation, complications, and outcomes. The main outcome measures were disappearance of epiphora symptoms beginning the first 2 months after removal of the silicone tube. The silicone tube was removed under topical anesthesia in the office between 2 and 3 months, postoperatively. The mean (± SD) age of the study population was 29.8 (± 26.9) months (range: 6 months to 12 years). Under nasal endoscopic view, 45 ducts (58.4%) had a thin membranous obstruction or had a simple stenotic opening of Hasner's valve. Seven ducts (9.1%) had thick obstructing membranes with probe passage under the lateral nasal mucosa. Twenty-three ducts (29.9%) showed the probe tip protruding through balloon-like nasal mucosa. Two ducts (2.6%) appeared to have probe protrusion through a stretchable valve. The overall success rate was 89.6% (69/77). The incidence of tube prolapse and tube loss was 18.2% (14 eyes) and 13.0% (10 eyes), respectively. No other complications were observed. Monocanalicular silicone intubation under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct can be an effective procedure for the management of CNLDO.

A comparison between monocanalicular and pushed monocanalicular silicone intubation in the treatment of congenital nasolacrimal duct obstruction.

To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation (PMCI) of the nasolacrimal duct for congenital nasolacrimal duct obstruction (CNLDO). In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation (MCI) (n=28 eyes) or PMCI (n=25 eyes). All procedures were performed by 1 oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal. The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25±10.08mo (range, 13-49mo) for MCI and 26.85±12.25mo (range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes (90.0%) in the MCI group compared with 10 of 20 eyes (50%) in the PMCI group (P=0.01). In the PMCI group, the tube loss (30%) was greater than the MCI group (5%), however the differences between the 2 groups proved to be not significant (P=0.91). Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.

Early loss of monocanalicular silicone tubes in congenital nasolacrimal duct obstruction: Incidence, predictors, and effect on outcome

PurposeTo study predictors and implications on outcome of premature silicone tube-loss, a post-operative complication of monocanalicular intubation (MCI) performed for treatment of congenital nasolacrimal duct obstruction (CNLDO). MethodsWe conducted a retrospective analysis of cases of post-operative loss of monocanalicular silicone tubes occurring at one medical center from January 2007 to December 2013. ResultsDuring the study period monocanclicular silicone tubes were lost in 24/54 eyes (44%) of 19/46 children. Multivariate regression analysis identified bilateral intubation as an important predictor of early tube-loss (r=0.54, P=0.006). Seven of eight (88%) children who had both eyes intubated prematurely lost their tubes compared to 12/38 (32%) children who had unilateral intubation (P=0.005). Treatment success was lower in eyes with early tube-loss (17/24 eyes, 71%) compared to eyes with full tube retention (25/30 eyes, 83%), however this difference was not statistically significant (P=0.333). In our study, treatment outcome correlated with duration of intubation (r=0.51, P=0.002). Surgical success was achieved in 33/39 eyes (85%) in which the tubes were retained at least 2 months compared to 7/15 eyes (47%) with shorter period of intubation (P=0.012). ConclusionsSpontaneous tube-loss is a post-operative complication of monocanalicular silicone intubation that can occur more frequently than previously reported in certain populations. Tube-loss occurring soon after surgery is often associated with persistent symptoms and increased need of reoperation.

Silicone Intubation for Nasolacrimal Duct Stenosis in Adults

The purpose of this study was to compare the success rate of monocanalicular versus that of bicanalicular silicone intubations of the nasolacrimal duct for nasolacrimal duct stenosis (NLDS) in adults (patent nasolacrimal duct with resistance to positive-pressure irrigation). In a prospective randomized clinical trial, 52 eyes of 38 patients with NLDS underwent either monocanalicular silicone intubation (MCI) (n = 26 eyes) or bicanalicular silicon intubation (BCI) (n = 26 eyes). All procedures were performed by 1 oculoplastic surgeon. Tube removal was planned for 3 months postoperatively. Treatment success was defined as the complete resolution of epiphora or intermittent epiphora with normal dye disappearance test at 6 months after tube removal. The surgical outcome was assessed in 25 eyes with MCI and 21 eyes with BCI. The mean (SD) age of treatment was 52.7 (18.6) years for MCI and 49 (18.8) years for BCI. Treatment success was achieved in 19 of 25 eyes (76%) in the MCI group compared with 16 of 21 eyes (76.2%) in the BCI group. Differences between the 2 groups proved to be not significant (P = 0.9). The only complication was peripunctal pyogenic granuloma in 2 eyes with BCI. Both MCI and BCI were successful in a similar percentage of patients with NLDS. The main advantages of the former technique were simple insertion and easy removal of the tube.

Indikation und Technik der Tränenwegsintubation

There are several well established methods to correct congenital and acquired lacrimal canalicular stenosis. The primary goal of all these surgical methods is the reopening and recanalization of a functional lacrimal pathway. Intubation by bicanalicular or monocanalicular silicone tubes has been established as a means of enhancing the redevelopment of a smooth epithelial surface and keeping the recanalized tear ducts continuously open. The use after endocanalicular surgery is mostly undisputed and unequivocally advocated after trauma but the use after either endonasal or transcutaneous dacryocystorhinostomy is still controversial as there is no clear evidence that it produces superior results. There are several systems available to place monocanalicular or bicanalicular silicone tubes. The decision to place an intubation depends mainly on the level and the type of stenosis.

Endonasal Dacryocystorhinostomy in a Pediatric Patient With Ectrodactyly-ectodermal Dysplasia After Failure of External Dacryocystorhinostomy and as First Procedure

A 9-year-old patient affected by ectrodactyly-ectodermal dysplasia was referred to our clinic complaining of epiphora in both eyes. She had previous external dacryocystorhinostomy in her left eye. Ophthalmic examination revealed absence of the superior tear ducts and discharge in both eyes. Lacrimal irrigation through the inferior canaliculi revealed nasolacrimal duct obstruction on both sides. A bilateral endo-dacryocystorhinostomy was performed as a revision procedure in the left eye and as first procedure in the right eye. A monocanalicular silicone stent through the inferior tear duct was introduced on both sides at the end of the surgery. Follow up was 8 and 5 months for the left and the right eye, respectively. Epiphora was absent, and lacrimal irrigation showed a patent osteum at last follow-up. This case suggests that endo-dacryocystorhinostomy seems to be a safe and effective procedure, both as revision and as first procedure, even in children with ectrodactyly-ectodermal dysplasia.

Monocanalicular versus bicanalicular silicone intubation for congenital nasolacrimal duct obstruction

To compare the success rate of monocanalicular versus bicanalicular silicone intubation of the nasolacrimal duct for congenital nasolacrimal duct obstruction (CNLDO). In a prospective randomized clinical trial, 70 eyes of 57 children with CNLDO underwent either monocanalicular silicone intubation (MCI) (n = 35 eyes) or bicanalicular silicone intubation (BCI) (n = 35 eyes). All procedures were performed by 1 oculoplastic surgeon. Tube removal was planned for 3 months postoperatively. The results were assessed using a Munk score. Treatment success was defined as Munk score 0-1 at 3 months after tube removal. The surgical outcome was assessed in 29 eyes with MCI and 27 eyes with BCI. The mean age of treatment was 34.9 ± 12.7 months for MCI and 38.7 ± 18.6 months for BCI. Treatment success was achieved in 25 of 29 eyes (86.2%; 95% CI, 79%-96%) in the MCI group compared with 24 of 27 eyes (89%; 95% CI, 84%-94%) in the BCI group (RR = 0.96; 95% CI, 0.79-1.18). There were no corneal or canalicular complications in either group. MCI and BCI were successful in a similar percentage of children with CNLDO. The mainadvantage of the former technique was easy tube removal without sedation in the office.

Nonlaser Endoscopic Endonasal Dacryocystorhinostomy With Adjunctive Mitomycin C in Children

To determine the outcome and safety of pediatric endonasal dacryocystorhinostomy with the use of adjunctive mitomycin C. A prospective, nonrandomized and noncomparative interventional case series study was performed in 71 consecutive procedures. Sixty patients 16 years of age and younger underwent nonlaser endonasal dacryocystorhinostomy with the use of adjunctive mitomycin C. Eleven patients had a simultaneous bilateral procedure performed. All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac and surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was completely removed and a neurosurgical cottonoid soaked in mitomycin C at 0.5 mg/ml placed at the osteotomy site for 5 minutes. All patients underwent bicanalicular or monocanalicular silicone intubation. The main outcome measures were the resolution of epiphora, lacrimal discharge, and patency of the ostium confirmed either by endoscopic visualization and/or irrigation at 6 months or a normal dye disappearance test. Thirteen patients' (18%) final evaluation was via telephone survey. The mean follow-up was 12.3 months. Nonlaser endonasal dacryocystorhinostomy with adjunctive mitomycin C was successful in 67 cases (94.4%). African descent was strongly associated with a higher rate of obstruction (p < 0.001). Infection at the time of surgery (p = 0.051) and less than 3 months intubation (p = 0.059) were also borderline significant. Previous trauma, gender, age, and side operated had no influence on the final outcome. No significant complications were encountered. Nonlaser endonasal dacryocystorhinostomy with mitomycin C is a safe and successful procedure for the treatment of congenital nasolacrimal duct obstruction in children. It has the advantage of leaving no scar and of preserving the medial canthal structures. It can be successfully performed as a simultaneous bilateral procedure.