Journal List > J Korean Ophthalmol Soc > v.59(6) > 1096571

Lee, Chung, and Lew: Clinical Efficacy of Lacrimal Endoscopy Assisted Silicone Tube Intubation in Patients with Nasolacrimal Duct Obstruction

Abstract

Purpose

We evaluated the clinical efficacy of lacrimal endoscopy-assisted silicone tube intubation in patients with a nasolacri-mal duct obstruction.

Methods

We conducted a retrospective chart review of 86 eyes of 67 patients who underwent lacrimal endoscopy (RUIDO fiber-scope; Fibertechco, Tokyo, Japan)-assisted silicone tube intubation from December 2014 to March 2017. We compared clinical characteristics, irrigation test results, and dacryocystographic and lacrimal endoscopic findings, and analyzed factors related to surgical success.

Results

In total, 86 eyes of 67 patients underwent lacrimal endoscopy-assisted silicone tube intubation. The success rate was 87.2%. There was a significantly lower preoperative tear meniscus height (420.5 ± 198.1 μ m vs. 639.0 ± 224.3 μ m, p < 0.001). In the surgically successful group, narrowing was frequently observed (29.0% vs. 0%, p = 0.030). Dacryolith findings were associated with surgical failure (10% vs. 29%, p = 0.043).

Conclusions

Lacrimal endoscopy-assisted silicone tube intubation is considered an effective and successful operative procedure and enables the observation of real-time findings inside the lacrimal drainage passage for the treatment of pathological lesions. Narrowing observed during lacrimal endoscopy indicated successful treatment as opposed to dacryolith findings, which were associated with a failed outcome.

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Figure 1.
Lacrimal endoscopy (RUIDO Fiberscope, FiberTech Co., Tokyo, Japan). Lacrimal endoscopy is, which bent type tip, 0.9 mm in diameter, allowing the procedure while observing the nasolacrimal pathway.
jkos-59-582f1.tif
Figure 2.
Representative photographs of lacrimal endoscopy. (A) Stone. (B) Mucus. (C) Granulation. (D) Narrowing. (E) Edema.(F) Fibrosis.
jkos-59-582f2.tif
Figure 3.
Lacrimal endoscopic findings according to clinical outcomes. (A) 75 cases with success (B) 11cases with failure.
jkos-59-582f3.tif
Table 1.
Demographics of patients and related factors with surgical success after lacrimal endoscopy assisted silicone tube intubation
  Success (n = 75, 87.2%) Failure (n = 11, 12.7%) Total (n = 86) p-value
Age (years) 60.1 ± 13.7 63.6 ± 13.5 60.5 ± 13.6 0.057
Duration (months) 42.0 ± 45.7 66.3 ± 108.3 45.1 ± 56.0 0.325
Preoperative Munk 4.5 ± 0.7 4.9 ± 0.3 4.6 ± 0.7 0.146
Postoperative Munk 0.3 ± 0.5 3.3 ± 1.7 0.7 ± 1.2 <0.001
Preoperative TMH (μ m) 420.5 ± 198.1 639.0 ± 224.3 448.4 ± 212.5 <0.001
Postoperative TMH (μ m) 218.9 ± 73.4 489.8 ± 156.2 253.0 ± 125.0 <0.001
Irrigation test (n, %)       0.089
 Well passed 31 (41) 2 (18) 33 (38)  
 Partially passed 25 (33) 5 (45) 30 (35)  
 Not passed 19 (25) 4 (36) 23 (27)  
Dacryocystography (n, %)       0.198
 Narrowing 40 (53) 4 (36) 44 (51)  
 Beaded 7 (9) 2 (18) 9 (10)  
 Complete obstruction 9 (12) 4 (36) 13 (15)  
 2nd dilation 7 (9) 1 (9) 8 (9)  

Values are presented as mean ± SD or n (%) unless otherwise indicated. p < 0.05, Mann-Whitney test.

TMH = tear meniscus height.

Table 2.
Lacrimal endoscopic findings according to clinical outcomes
  Stone Mucus Granulation Narrowing Edema Fibrosis
Success 8 (10) 32 (38) 12 (14) 24 (29) 1 (1) 7 (8)
Failure 4 (29) 5 (36) 3 (21) 0 (0) 0 (0) 2 (14)
p-value 0.043* 1.000 0.397 0.030* 1.000 0.323

Values are presented as n (%) unless otherwise indicated.

* p < 0.05, Fisher's exact test.

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