Clinical Efficacy of Lacrimal Endoscopy Assisted Silicone Tube Intubation in Patients with Nasolacrimal Duct Obstruction

Sang Min Lee; Sok Joong Chung; Helen Lew

doi:10.3341/jkos.2018.59.6.582

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

Original Article

J Korean Ophthalmol Soc 2018;59(6):582-588.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.6.582

Clinical Efficacy of Lacrimal Endoscopy Assisted Silicone Tube Intubation in Patients with Nasolacrimal Duct Obstruction

Sang Min Lee, MD, Sok Joong Chung, MD, Helen Lew, MD, PhD

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

Address reprint requests to Helen Lew, MD, PhD Department of Ophthalmology, CHA Bundang Medical Center, #59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Tel: 82-31-780-5330, Fax: 82-31-780-5333 E-mail: eye@cha.ac.kr

Received 28 December 2017 Revised 1 April 2018 Accepted 27 May 2018

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

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.

Keywords: Lacrimal endoscopy, Nasolacrimal duct obstruction, Silicone tube intubation

References

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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.

Figure 2.

Representative photographs of lacrimal endoscopy. (A) Stone. (B) Mucus. (C) Granulation. (D) Narrowing. (E) Edema.(F) Fibrosis.

Figure 3.

Lacrimal endoscopic findings according to clinical outcomes. (A) 75 cases with success (B) 11cases with failure.

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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