Factors Affecting the Long-term Outcome of Silicone Tube Intubation in Patients With Nasolacrimal Duct Obstruction

Jong-Seo Park; Sung-Woo Ha; Helen Lew

doi:10.3341/jkos.2011.52.2.129

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Park, Ha, and Lew: Factors Affecting the Long-term Outcome of Silicone Tube Intubation in Patients With Nasolacrimal Duct Obstruction

Original Article

J Korean Ophthalmol Soc 2011;52(2):129-135.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.2.129

Factors Affecting the Long-term Outcome of Silicone Tube Intubation in Patients With Nasolacrimal Duct Obstruction

Jong-Seo Park, MD, Sung-Woo Ha, MD, Helen Lew, MD

Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Address reprint requests to Helen Lew, MD Department of Ophthalmology, Bundang CHA Medical Center, CHA University #351 Yatap-dong, Bundang-gu, Seongnam 463-712, Korea Tel: 82-31-780-5330, Fax: 82-31-780-5333, E-mail: eye@cha.ac.kr

Received 19 May 201014 September 2010 Accepted 12 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate factors affecting the outcome of silicone tube intubation in patients with nasolacrimal duct obstruction.

Methods

A retrospective study of the outcome of silicone tube intubation performed from August 2001 to August 2009 in 98 patients (132 eyes) with nasolacrimal duct obstruction was conducted. Improvement was defined as the disappearance of epiphora after silicone tube intubation and success was defined as maintenance of improvement by the time of the final patient followup. Recurrence was also defined as appearance of epiphora after silicone tube extubation.

Results

The success rate was 76.5% (101 eyes), failure rate was 8.3% (11 eyes), and recurrence rate was 15.2% (20 eyes). Preoperative canaliculus irrigation test was significantly correlated with symptomatic improvement and recurrence after silicone tube intubation (p = 0.003 and 0.045, respectively). The mean time that patients experienced recurrence was 43.7 months after silicone tube intubation, according to Kaplan-Meier survival analysis.

Conclusions

Preoperative canaliculus irrigation test is a simple and effective tool to estimate the outcome of silicone tube intubation. This outcome should be considered in the stage of planning treatment in nasolacrimal duct obstruction patients.

Keywords: Canaliculus irrigation test, Silicone tube intubation

References

1. Keith CG. Intubation of the lacrimal passages. Am J Ophthalmol. 1968; 65:70–4.

2. Beigi B, O'Keefe M. Results of Crawford tube intubation in children. Acta Ophthalmol (Copenh). 1993; 71:405–7.

3. Connell PP, Fulcher TP, Chacko E, et al. Long term follow up of nasolacrimal intubation in adults. Br J Ophthalmol. 2006; 90:435–6.

4. Shah A, Tekriwal AK, Drummond PM, Woodruff G. Long-term results of closed nasolacrimal intubation in adults. Eur J Ophthalmol. 2007; 17:490–3.

5. Lee SH, Kim SD, Kim JD. Silicone intubation for nasolacrimal duct obstruction in adult. J Korean Ophthalmol Soc. 1997; 38:185–9.

6. Lee HS, Hwang WS, Byun YJ. Clinical results of silicone intubation for nasolacrimal duct obstruction in adult. J Korean Ophthalmol Soc. 1997; 38:1926–30.

7. Kwon YH, Lee YJ. Long-term results of silicone tube intubation in incomplete nasolacrimal duct obstruction. J Korean Ophthalmol Soc. 2008; 49:190–4.

8. Munk PL, Lin DT, Morris DC. Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology. 1990; 177:687–90.

9. Sohn HY, Hur J, Chung EH, Won IG. Clinical observation on silicone intubation in obstruction of lacrimal drainage system. J Korean Ophthalmol Soc. 1990; 31:135–40.

10. Kim HD, Jeong SK. Silicone tube intubation in acquired nasolacrimal duct obstruction. J Korean Ophthalmol Soc. 2000; 41:327–31.

11. Park HJ, Hwang WS. Clinical results of silicone intubation for epiphora patients. J Korean Ophthalmol Soc. 2000; 41:2327–31.

12. Kim CH, Lew H, Yun YS. Correspondence among the canaliculus irrigation test, dacryocystography and Jones test in the epiphora patients. J Korean Ophthalmol Soc. 2007; 48:1017–22.

13. Saleh GM, Gauba V, Tsangaris P, Tharmaseelan K. Digital sub-traction dacryocystography and syringing in the management of epiphora. Orbit. 2007; 26:249–53.

14. Soll DB. Silicone intubation:an alternative to dacryocystorhinostomy. Ophthalmology. 1978; 85:1259–66.

15. Angrist RC, Dortzbach RK. Silicone intubation for partial and total nasolacrimal duct obstruction in adults. Ophthal Plast Reconstr Surg. 1985; 1:51–4.

16. Huh D, Son MG, Kim YD. Silicone intubation for functional nasolacrimal duct obstruction. J Korean Ophthalmol Soc. 2000; 41:2303–7.

17. Beigi B, Uddin JM, McMullan TF, Linardos E. Inaccuracy of diagnosis in a cohort of patients on the waiting list for dacryocystorhinostomy when the diagnosis was made by only syringing the lacrimal system. Eur J Ophthalmol. 2007; 17:485–9.

18. Jeong HW, Cho NC, Ahn M. Result of silicone tube intubation in patients with epiphora who showing normal finding in dacryocystography. J Korean Ophthalmol Soc. 2008; 49:706–12.

Figure 1.

Kaplan-Meier survival plot for long term success after silicone tube intubation. Arrow suggests minimum follow up period (36 months) for the 50% success rate after silicone tube intubation.

Table 1.

Demographic features

Factors
Age (yr)	53.8 ± 12.8
Sex
Male	29 (29.6%)
Female	69 (70.4%)
Laterality
OD	66 (50.0%)
OS	66 (50.0%)
Duration of symptom (yr)	3.6 ± 4.4
Follow up duration (mon)	12.8 ± 12.2
Time of extubation (mon)	5.4 ± 1.7
Improvement	121 eye (91.7%)
Success^∗ rate	101 eye (76.6%)
Recurrence^† rate	20 eye (15.1%)
Failure	11 (8.3%)

^∗ Success was defined as resolution of epiphora and ‘pass’ at the canaliculus irrigation test at the final followup point;

^† Recurrence was defined as occurrence of epiphora after slilicone tube extubation.

Table 2.

Characteristics in patients with improvement after silicone tube intubation

Factors	Improvement^∗ (n = 121)	Failure (n = 11)	p-value
Sex			0.079^†
Male	35 (28.9%)	6 (54.5%)
Female	86 (71.1%)	5 (45.5%)
Age (yr)	53.7 ± 12.2	56.2 ± 18.0	0.605^‡
Laterality			0.753^†
OD	60 (49.6%)	6 (54.5%)
OS	61 (50.4%)	5 (45.5%)
Trephination	13 (10.7%)	1 (9.1%)	0.865^†
Duration of symptom (yr)	3.9 ± 4.8	2.3 ± 2.1	0.054^‡

^∗ Improvement was defined as resolution of epiphora and ‘pass’ at the canaliculus irrigation test after silicone tube intubation;

^† Pearson chi-square test;

^‡ Independent t-test.

Table 3.

Improvement or failure and success or recurrence after silicone tube intubation according to preoperative dacryocysto-graphic findings

Degree of obstruction	Improvement (Success/Recurrence) n = 121 (101/20)	Failure (n = 11)	p-value
Complete obstruction	11 (10/1)	3	0.017^∗ (0.445^∗)
Partial obstruction	105 (86/19)	6
Normal	5 (5/0)	2
Total	121 (101/20)	11

Level of obstruction	Improvement (Success/Recurrence) (n = 121) (101/20)	Failure (n = 11)	p-value
Lacrimal sac	16 (15/1)	2	0.232^∗ (0.218^∗)
Upper nasolacrimal duct	57 (49/8)	6
Lower nasolacrimal duct	48 (37/11)	3
Total	121 (101/20)	11

^∗ Pearson chi-square test.

Table 4.

Improvement or failure and success tion test or recurrence after silicone tube intuba tion according to preope erative canaliculus irriga-

Canaliculus irrigation test	Improvement (Success/Recurrence) n = 121 (101/20)	Failure (n = 11)	p-value
Not passed with regurgitation	31 (22/9)	8	0.003^∗ (0.045^∗)
Partial passed with regurgitation	51 (44/7)	3
Well passed without regurgitation	39 (35/4)	0

^∗ Pearson chi-square test.

Table 5.

Clinical factors in the patients with success group compared with recurrence group after silicone tube intubation

Factors	Success (n = 101)	Recurrence (n = 20)	p-value
Sex			0.672^∗
Male	30 (29.7%)	5 (25.0%)
Female	71 (70.3%)	15 (75.0%)
Age (yr, mean ± SD)	52.8 ± 12.2	55.9 ± 12.1	0.295^†
Laterality			0.348^∗
OD	52 (51.5%)	8 (40.0%)
OS	49 (48.5%)	12 (60.0%)
Trephination	10 (9.9%)	3 (15.0%)	0.501^∗
Duration of symptom (yr, mean ± SD)	3.7 ± 4.5	4.5 ± 6.1	0.488^†
Follow up duration (mon, mean ± SD)	13.1 ± 13.2	13.6 ± 9.1	0.844^†
Time of extubation (mon, mean ± SD)	5.5 ± 1.6	4.8 ± 1.7	0.069^†

^∗ Pearson chi-square test;

^† Independent t-test.

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