Success Rate Of Probing Research Articles

Assessing the success rate of treatment in simple and complex congenital nasolacrimal duct obstruction: a systematic review and meta-analysis.

To assess and compare the success rate (SR) of probing and intubation in patients with congenital nasolacrimal duct obstruction (CNLDO). We conducted a literature search for identifying relevant studies published in English using PubMed, Google Scholar, Scopus, and Web of Science databases from the date of inception to Feb 2023. After extracting data, the SR was compared between the study groups: simple and complex CNLDO. To compare the treatment outcome, the mean difference of the SR was considered as the effect size. Random effects model or fixed effects model were performed for statistical inferences. A total of 21 studies were eligible to be analyzed. The pooled SR of treatment was 88% in simple, and 57% in complex CNLDO. Exerting intubation in increased the SR from 87% (SR of probing) to 92% in simple CNLDO which was not significant. However, compared to probing, intubation has a significantly higher SR in complex CNLDO (46 to 82%). While the SR of probing was significantly lower in complex CNLDO, the difference between the SR of intubation was not significant between groups. Although increasing the age does not have an adverse effect on the SR in simple CNDLO, it causes a significant decrease in the SR of complex group. This study revealed that even though the addition of NLD intubation does not provide significant benefits beyond probing alone for patients with simple CNLDO, in children with complex CNLDO, NLD intubation should be considered as a primary treatment due to its substantial increase in surgical success rates. Delaying the treatment would increase its success in patients with complex but not the simple CNLDO.

Efficacy of probing in congenital nasolacrimal duct obstruction in paediatric patients

Background: Congenital nasolacrimal duct obstruction (CNLDO) is the most common disorder leading to epiphora and is usually due to failure of canalization of the nasolacrimal duct (NLD) at its distal end Objectives: To study the efficacy of probing in congenital nasolacrimal duct obstruction in 2 to 4 years of children. Methodology: Probing was carried out through the punctum by using bowman’s probe which was available in various sizes from 0.7mm to size 1.1mm. Appropriately sized probe was directed vertically first then gently directed medially until bony feeling was encountered. Firm pressure was applied to probe, attempted to advance probe beyond obstruction in NLD. Left the probe for 1 minute in that position. After the procedure topical antibiotic eye drops were advised for 2 weeks. Results: The overall success rate of probing in 2 to 4 years age group was 63.8%. In total 50 patients with 57 eyes 7 were bilateral cases in that 3 (42.9%) were treated successfully. In 43 unilateral cases 30 (69.8%) were treated successfully. The success rate of probing in right eye (70.8%) and left eye (68.2%). Conclusion: Probing can be still viable option for children aged 2years and more with CNLDO.

Outcome of Primary Probing for Simple Membraneous Congenital Nasolacrimal Duct Obstruction in Children Older Than 4 Years.

To report outcomes of nasolacrimal duct (NLD) probing in children 4 years and older with simple membranous NLD obstruction. The records of all patients 4 years and older with congenital NLD obstruction who underwent surgery from 1997 to 2015 at Washington University School of Medicine were retrospectively reviewed. Of 47 patients reviewed, 18 (38.3%) were found to have simple membranous obstructions and were included in this study. Simple membranous obstruction was present at the distal duct and was relieved with passage of the probes in all patients. Children with canalicular or diffuse distal NLD stenosis (as defined by a tight, gritty feeling or multiple obstructions when passing the probe through the bony portion of the NLD), trisomy 21, lacrimal trauma, or craniofacial abnormalities were excluded. A successful outcome was determined by resolution of epiphora and periocular crusting. Eighteen patients with ages ranging from 4.1 to 10.6 years with simple membranous NLD obstruction were treated. Sixteen of 18 (88.9%) patients had good outcomes following NLD probing. Two patients had persistent symptoms that resolved following balloon dilation and stent placement. This study found that the success rate of probing in older patients with simple membranous NLD obstruction was comparable to that of younger patients. NLD probing alone is a good treatment option for older children with simple membranous NLD obstruction. Additional procedures such as balloon catheter dilation or stent placement may not be necessary at the time of initial probing. [J Pediatr Ophthalmol Strabismus. 2020;57(1):44-47.].

Transcanalicular endoscopic primary dacryoplasty for congenital nasolacrimal duct obstruction.

To examine the causes of congenital nasolacrimal duct obstruction (CNLDO) using dacryoendoscopy, and to evaluate the surgical outcomes of primary transcanalicular endoscopic dacryoplasty. The subjects of this study were a total of 56 eyes of 46 Japanese children aged one to five years old (mean, 29.1 ± 14.0 months old) with clinically diagnosed CNLDO. The blockage was visualized and probed using a dacryoendoscope (MD10 with a 20 G probe, Fiber Tech Co., Ltd., Japan) under general anesthesia. We used a self-retaining bicanalicular lacrimal stent (Lacrifast®, Kaneka Co., Ltd., Japan) for nasolacrimal duct intubation. In each case the obstruction was found to be caused by a single focal blockage at the distal end of the duct. A nasolacrimal dacryolith was observed in 5 eyes (9%) and successfully removed using the dacryoendoscope. The success rate of probing by subsequent nasolacrimal duct intubation was 100%. No complications were observed. We obtained a 100% success rate with primary transcanalicular endoscopic dacryoplasty for the treatment of CNLDO. Direct visualization inside the lacrimal passage allowed for precise probing, even in infants, leading to successful treatment of CNLDO without any complications.

Curative effects of probing alone and probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital duct obstruction of children from 3–12 months of age

Background: To investigate the 1-time success rate of probing alone and nasolacrimal duct probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital nasolacrimal duct obstruction (CNLDO) in young children. Methods: A retrospective case series was performed on 494 cases (647 eyes) of 3–12 month-old children with CNLDO between July 2014 and July 2015. Material obtained from the lacrimal sac was cultured to isolate infectious agents. Susceptibility testing was done. Children from 3–12 months of age who were found to be sensitive to Levofloxacin (n=493 eyes) were separated into two groups: 3–6 months of age (276 eyes) and 7–12 months of age (217 eyes). Each of the groups were then randomized into group A (138 eyes of 3–6 months of age; 102 eyes of 7–12 months of age) and group B (138 eyes of 3–6 months of age; 115 eyes of 7–12 months of age). Children in group A underwent nasolacrimal duct probing alone; those in group B underwent nasolacrimal duct probing plus nasolacrimal duct injection of levofloxacin and the efficacy of probing was evaluated. Results: The average detection rate of pathogenic bacteria in dacryocystitis was 75.1%, and Staphylococcus aureus was found to be the main pathogenic bacteria (42.59%, 106 cases). Among children from 7–12 months of age, the 1-time success rate of nasolacrimal duct probing alone was 88.24% and the 1-time success rate of probing combined with nasolacrimal duct injection of levofloxacin ophthalmic gel was 96.52% (statistical significance, P=0.02 Conclusions: Most pathogenic bacteria (96.81%) were sensitive to levofloxacin. Nasolacrimal duct probing combined with nasolacrimal duct injection of levofloxacin may improve the success rate of probing in children older than 6 months of age.

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

Comparison of the clinical effects and complications of two operation methods for lacrimal duct obstruction

Objective To compare the clinical efficacy and complications of probing of lacrimal passages combined with retrograde intubation of Y shape silicone tube with or without Ofloxacin eye gel on treating lacrimal duct obstruction. Methods Eighty eyes of 75 cases of lacrimal duct obstruction who underwent surgeries in our hospital from 2012 to 2013 were investigated retrospectively.The success rate and complications of two operation methods were compared. Results All the patients were followed up for 3 months. The success rate of probing of lacrimal passages combined with retrograde intubation of Y shape silicone tube and Ofloxacin eye gel was higher than that of Y shape silicone tube intubation only, and the difference was statistically significant (χ2=4.694 P=0.03). It also significantly reduced the complications. Conclusion The probing of lacrimal passages combined with retrograde intubation of Y shape silicone tube and Ofloxacin eye gel can significantly reduce the early operative complications, and improve the success rate. Key words: Obstruction, lacrimal duct; Stentl, lacrimal duct; Intubation retrograde; Ofloxacin eye gel

Prognostic value of metal–metal contact during nasolacrimal duct probing

ObjectiveTo evaluate the prognostic value of metal–metal contact during nasolacrimal duct (NLD) probing in patients with simple membranous versus complex congenital NLD obstructions (CNLDO). DesignRetrospective case series. ParticipantsInfants diagnosed with CNLDO. MethodsSeventy-nine eyes of 70 infants with CNLDO who underwent probing were recruited. Metal–metal contact was sought during probing in every patient. CNLDO was classified into simple membranous versus complex type of obstruction. Complete resolution of epiphora, increased tear meniscus, and mucous discharge were defined as successful outcome. ResultsThe mean age of patients at the time of probing was 21.0 ± 8.3 (range 1–42) months. Postoperative evaluations were performed in all patients between the first and second postoperative months. Overall success rate of probing was 84.9%. A higher success rate was obtained in membranous (89.7%) versus complex (54.5%) obstructions (p = 0.01). A metal–metal contact could be established in 62 (78.5%) eyes. Treatment success was achieved in 93.5% of cases in which metal–metal contact was detected versus 52.9% of cases without metal–metal contact (p < 0.001). Among cases with metal–metal contact, a trend toward successful outcomes was observed with membranous as compared with complex obstructions (96.4% vs 71.4%, p = 0.059). Logistic regression analysis revealed the presence of metal–metal touch (odds ratio [OR] 13.3, p = 0.001) and membranous type obstruction (OR 7.7, p = 0.019) as significant factors for a successful outcome. ConclusionsEstablishment of metal–metal contact is an important prognostic sign for surgical success in both the membranous and the complex type of CNLDO.

Treatment of congenital lacrimal duct obstruction: A prospective clinical cohort study

Pressurized probing and irrigation is the method of choice for congenital lacrimal duct obstruction after conservative therapeutic strategies have failed. The aim of this study was to evaluate age dependence and success rates of different therapeutic options. A prospective cohort study of children with congenital lacrimal duct obstruction was performed. All children treated during the period between May 2009 and June 2010 were included. Surgical success was defined as the absence of epiphora and mucous discharge for a postoperative follow-up of 3 months. Odds ratios (OR) and 95 % confidence intervals (CI) of different variables were estimated using logistic regression. A total of 111 children (137 eyes) underwent treatment for congenital lacrimal duct obstruction. The mean age of the children was 7.7 months (range 1-30 months). The success rate of probing under local anesthesia was 85.5 % (n = 100). Probing under general anesthesia without intubation of the lacrimal pathway was successful in 28.6 % (n = 2). Treatment under general anesthesia with intubation of the lacrimal pathway had a success rate of 94.2 %. If the primary treatment was complicated the OR was 1.9 (95 % CI: 0.7-5.1), for males the OR was 1.7 (95 % CI: 0.8-3.5) and in cases of a positive family history the OR was 1.5 (95 % CI: 0.7-3.3). With every increasing month of age the risk not to be treated successfully increased (OR: 1.3, 95 % CI: 1.2-1.5). Syringing under local anesthesia is an effective therapy. The highest success rates were found at the ages of 1-6 months. Therapy with additional silicone tube intubation was highly successful.

Success rates of endoscopic-assisted probing for congenital nasolacrimal duct obstruction in children

To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction at different ages, using nasal endoscopy. Fifty eyes of 38 consecutive children with congenital nasolacrimal duct obstruction underwent endoscopic nasolacrimal duct probing under general anaesthesia. Patients were followed up for at least three months. Probing success was defined as complete remission of symptoms and a normal fluorescein dye disappearance test result. The age range of patients was 17-109 months. The success rates of probing were: 100 per cent (29 out of 29) for cases of stenosis at the lower nasolacrimal duct, 100 per cent (7 out of 7) for functional epiphora cases and 92.86 per cent (13 out of 14) for nasolacrimal atresia cases. Overall, there was only one child for whom the probing treatment for nasolacrimal duct obstruction was not successful; this child had Down's syndrome and a more complex developmental abnormality of the nasolacrimal duct. Age and site of obstruction were not found to significantly affect the outcome of probing. Probing of the nasolacrimal system using an endoscopic approach allows direct visualisation of the nasolacrimal duct. This can facilitate diagnosis of the anomaly and significantly increase the procedure success rate.

Intraoperative Prognostic Factors for Probing Outcome in Children with Congenital Nasolacrimal Duct Obstruction

To evaluate the intraoperative prognostic factors for probing outcome in children with congenital nasolacrimal duct obstruction (CNLDO). In a prospective interventional study, 69 eyes of 60 children aged 12 to 24 months with CNLDO underwent probing and irrigation. All procedures were performed by a single oculoplastic surgeon. The nature of the obstruction was classified by the surgeon as simple or complex. The fluency of irrigation after probing was defined as easy or difficult. Treatment success was defined as no epiphora or mucus discharge at 3 months after probing. The mean age at the time of probing was 15.3±3.1 months (range, 12-23 months). Treatment success was achieved in 56 of 69 eyes (81.2%). There was a significant difference in success rate of probing in eyes with simple obstruction (87.8%) compared with complex obstruction (65%) (p=0.02). Also, there was a significant difference in success rate of probing in eyes with easy irrigation (100%) compared with difficult irrigation (53.6%) (p<0.001). Probing was more successful in eyes with simple obstruction or easy irrigation in children aged 12 to 24 months. The fluency of irrigation as an objective finding was a reliable intraoperative prognostic factor for probing success.

Impact of lacrimal obstruction type on the efficacy of probing for congenital nasolacrimal duct obstruction

To explore the impact of lacrimal obstruction type on the efficacy of lacrimal probing in the treatment of congenital nasolacrimal duct obstruction. We conducted a retrospective study in which 872 eyes of 741 children with congenital nasolacrimal duct obstruction underwent nasolacrimal duct probing under superficial anesthesia. Two types of obstructions were encountered during probing, i.e. simple and complex. They were divided into early (4 - 12 months) and late (1 - 4 years) groups based upon the age at the time of initial probing. Those refractory to the first probing underwent a second probing 4 weeks later. The main observation criterion was the success rate of probing. The success rate was 90.0% in early group versus 70.4% in late group (χ(2) = 38.527, P < 0.01). No significant difference existed in the cure rate of simple or complex obstruction between two groups (χ(2) simple = 0.054, P = 0.815, χ(2) complex = 1.705, P = 0.192). The proportion of simple obstruction was 94.4% in early group versus 62.2% in late group. Difference was statistically significant (χ(2) = 125.471, P < 0.01). The success rate of a second probing of simple obstruction was 61.9% in early group versus 68.2% in late group (χ(2) = 0.324, P = 0.569). The success rate of a second probing of complex obstruction was 19.2% in early group versus 5.7% in late group (Fisher's exact test, P = 0.125). For either group, the success rate of a second probing of simple obstruction was higher than that of complex obstruction (χ(2) early group = 16.100, P < 0.01; χ(2) late group = 25.186, P < 0.01). Unsuccessful probing may result from the selection of complex obstructions. Probing should remain the first-line treatment in children above 1 year of age. The success rate with a second probing was significantly lower in patients of complex obstruction. Other surgical interventions, such as silicone tube intubation or balloon dacryocystoplasty, should be recommended instead of repeated probing for the patients of complex obstruction if an initial probing fails.

Value of microbiology study in congenital nasolacrimal duct obstruction

PurposeEvaluation of the effect of different microorganisms on congenital nasolacrimal duct obstruction (CNLDO) tightness and whether probing or silastic intubation is likely to fail in a particular microorganism infection. MethodsThe culture and sensitivity results of lacrimal drainage system (LDS) discharge samples from patients with CNLDO were reviewed. Different microorganisms were correlated with the severity of nasolacrimal duct (NLD) obstruction observed during surgical intervention. The success rates of probing and silastic intubation as a primary procedure for each identifiable microorganism were documented. Statistical analysis was conducted to correlate the type of microorganism with the tightness of CNLDO and treatment failure. ResultsOut of 181 specimens, 22 had no growth (12.1%). LDS with positive culture had 76.6% successful probing (n=49) and 82.1% successful silastic intubation (n=78). Gram-positive and Gram-negative species were almost equally detected. The most prevalent organisms were Streptococcus pneumoniae and Hemophilus influenzae (48.1% and 39.2%, respectively). Tight CNLDO was more prevalent in Serratia marcescens (n=2; 100%) and Staphylococcus aureus (n=4; 33.3%) infections with a 7.75 Odds ratio [95% confidence interval (CI), 1.67–34.63]. Staphylococcus aureus had 37.5% successful probing; however, success was achieved in all cases with silastic intubation. Serratia marcescens infections had 100% successful silastic intubation. ConclusionMicrobiology study can predict tight CNLDO and helps in choosing the most successful treatment option. CNLDO with Staphylococcus infection and Serratia marcescens were likely to have tight NLD obstruction and silastic intubation had better outcomes.

Age-Based Comparison of Successful Probing in Nepalese Children with Nasolacrimal Duct Obstruction

Purpose: To compare the success rates of probing in Nepalese children younger than 2 years versus children older than 2 years with nasolacrimal duct obstruction (NLDO), and to identify factors associated with successful probing.Materials and Methods: Data was collected and analyzed retrospectively on children who underwent probing under general anesthesia for NLDO at Tilganga Eye Centre, Nepal, from May 2004 to October 2008. We compared successful probing rates in children less than or equal to 2 years old (group 1) versus children greater than 2 years old (group 2), and analyzed whether various clinical factors were associated with successful probing. Successful probing was defined as complete resolution of all clinical signs (discharge, epiphora or increased tear lake) at the outcome visit one month following surgery.Results: Data on 84 children (109 eyes) was reviewed. The mean age of children in group 1 and group 2 was 15.3 months and 37.3 months, respectively. The success rate of probing for the overall sample was 82.6% (90/109 eyes). The success rate in group 1 was 90.2% (55/61 eyes), and 72.9% (35/48 eyes) in group 2 (p=0.018). Increased age at time of probing (p=0.031) and duration of symptoms (p=0.027) were associated with decreased probing success.Conclusion: Early treatment of NLDO with probing, ideally prior to 2 years, is associated with better outcomes. Age appropriate intervention may reduce the incidence of complications from NLDO, which is highly prevalent in the low-lying areas of Nepal, including Kathmandu.

The Results of Late Probing in Congenital Nasolacrimal Duct Obstruction

Purpose: To evaluate the results of lacrimal probing in children at or older than 1 year of age with congenital nasolacrimal duct obstruction. Materials and Methods: Fifty eyes of 38 children (24 males, 14 females) with congenital epiphora who underwent nasolacrimal duct probing were evaluated in a prospective study. The age of the patients was between 12 and 101 months (mean: 33 months). Success of probing was defined as complete resolution of preoperative symptoms and signs. The mean follow-up was 8 months (3–28 months). Results: The success rate of probing was 88% (44/50 eyes). Residual epiphora was observed in 6 eyes of 4 patients (12%). Age of the patient, gender, the frequency of epiphora before probing and the unilaterality or bilaterality of epiphora did not correlate with the success of probing (p > 0.05). Conclusion: Nasolacrimal duct probing is advocated as a primary treatment in children younger than 9 years of age before proceeding to more complex treatment options. Unsuccessful probing may result from the selection of nonmembranous obstructions rather than the increased age of the patients.

Endoscopic-assisted probing for congenital nasolacrimal duct obstruction

To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction (CNLDO) at different ages using nasal endoscopy, and to identify the anatomical sites of blockage within the drainage system. A total of 87 eyes from 67 consecutive children with CNLDO underwent endoscopic nasolacrimal duct (NLD) probing under general anaesthetic. Patients who had had previous probings were excluded from the study. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test (FDDT). Cure was judged as complete or near-complete remission of symptoms and signs and a normal FDDT. The age range was 12-91 months (mean 32.3 months). The success rates of probing were: 100% (58/58) for atresia and stenosis at the lower NLD, 100% (13/13) for punctal stenosis, 55.6% (5/9) for functional epiphora, and 0% (0/7) for canalicular and upper NLD obstruction. Age was not found to significantly affect the outcome of probing, whereas site did. Obstruction at canalicular or upper NLD level became more common with increasing age. Probing of the nasolacrimal system using the endoscopic approach allows direct visualisation of the distal nasolacrimal duct, which facilitates diagnosis of the anomaly at this site. More complex proximal anomalies became increasingly prevalent in older children, which accounted for the poorer results with increasing age. Site of obstruction has a greater bearing on outcome than patient age.