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Choi and Lee: Comparison of Success Rates after Silicone Tube Intubation with or without Lacrimal Endoscopy for Epiphora
Original Article

J Korean Ophthalmol Soc 2018;59(11):1001-1008.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.11.1001

Comparison of Success Rates after Silicone Tube Intubation with or without Lacrimal Endoscopy for Epiphora

Min Gyu Choi, MD, Jeong Kyu Lee, MD, PhD

Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea

Address reprint requests to Jeong Kyu Lee, MD, PhD Department of Ophthalmology, Chung-Ang University Hospital, #102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: 82-2-6299-1666, Fax: 82-2-825-1666 E-mail: lk1246@cau.ac.kr

Received 26 July 2018       Revised 20 August 2018       Accepted 21 October 2018

Copyright © 2018 Korean Ophthalmological Society

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 compare the success rates between silicone tube intubation using a lacrimal endoscope and using a conventional nasal endoscope alone in adult patients suffering from epiphora.

Methods

We conducted a retrospective chart review of 80 eyes of 55 patients who underwent silicone tube intubation from January 2014 to June 2017. Patients were preoperatively diagnosed with syringing and dacryocystography. The silicone tube was removed 3 months after surgery and success rates were evaluated at 4 and 12 months. Success rates were analyzed by dividing the patients into two groups, according to lacrimal endoscope use.

Results

A lacrimal endoscope was used in 40 eyes. In the group using a lacrimal endoscope, preoperative diagnoses were partial obstruction in 26 eyes and complete obstruction in 14 eyes. In the group without lacrimal endoscope use, preoperative diagnoses were partial obstruction in 35 eyes and complete obstruction in 5 eyes (p = 0.018). The success rates at 4 and 12 months after surgery in the two groups (with and without lacrimal endoscope use) were 87.5% and 80.0% and 72.0% and 62.1% (p = 0.546 and p = 0.565), respectively. The success rates of patients with partial obstruction in the two groups were 92.3% and 82.9% at 4 months and 71.4% and 69.2% at 12 months (p = 0.448 and p = 1.000), respectively. The success rates of patients with complete obstruction in the two groups were 78.6% and 60.0% at 4 months and 72.7% and 33.3% at 12 months (p = 0.570 and p = 0.505), respectively. Site differences, the degree of obstruction, and lacrimal endoscope use had a significant impact on the success rate at 4 and 12 months (p = 0.001 and p = 0.022, respectively).

Conclusions

Although silicone tube intubation using a lacrimal endoscope cannot guarantee a significant success rate, it is possible to observe the anatomical structure of the nasolacrimal pathway in real time, such that the appropriate diagnosis and treatment can be performed simultaneously. Because patients diagnosed as having a complete obstruction had a good success rate, we can extend indication of silicone tube intubation as a less invasive approach.

Keywords: Lacrimal endoscope, Nasal endoscope, Nasolacrimal duct obstruction, Silicone tube intubation

References

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Figure 1.
Intraoperative photographs of silicone tube intubation using lacrimal endoscope with nasal endoscope. (A) The schematic diagram of lacrimal endoscope (RUIDO fiberscope, Fibertechco., Tokyo, Japan): probe, bent type 0.9 mm diameter and peripheral apparatus including monitor, recording and imaging system. (B, C) Insertion. (D) Examination of nasolacrimal pathway while as-sisting irrigation thorough water channel.
jkos-59-1001f1.tif
Figure 2.
Bar graphs showing the success rates of silicone tube intubation with or without lacrimal endoscope on 4 and 12 months since intubation. (A) Patients preoperatively diagnosed as nasolacrimal duct stenosis (or partial obstruction). There were no statistically significant differences between the two groups (p = 0.448, p = 1.000, respectively). (B) Patients preoperatively diagnosed as nasolacrimal duct obstruction. There were no statistically significant differences between the two groups (p = 0.570, p = 0.505, respectively). LE = lacrimal endoscope; M = months. * Fisher's exact test.
jkos-59-1001f2.tif
Figure 3.
Bar graphs showing the success rates on (A) 4 months and (B) 12 months after silicone tube intubation with or without lacrimal endoscope according to the site of stenosis or obstruction in dacryocystography. In group with lacrimal endoscope use (black hatch pattern), there were no significant differences in the success rate (p = 0.147, p = 0.644, respectively). However, there were significant differences in group without lacrimal endoscope use (white dot pattern) (p = 0.003, p = 0.018). When considering both lacrimal endoscope use and the site of stenosis or obstruction, there were significant differences in the success rate (p = 0.001, p = 0.022). LE = lacrimal endoscope; NLD = nasolacrimal duct. * Fisher's exact test.
jkos-59-1001f3.tif
Table 1.
Baseline characteristics of the patients (80 eyes)
  With lacrimal endoscope Without lacrimal endoscope p-value
Sex     0.586*
 Male 7/40 (17.5) 10/40 (25.0)  
 Female 33/40 (82.5) 30/40 (75.0)  
Age (years) 64.6 ± 13.6 59.0 ± 14.1 0.073†
Duration of symptoms (months) 36.1 ± 45.6 34.2 ± 54.5 0.864†
Duration of intubation (months) 3.5 ± 1.4 3.2 ± 1.2 0.311†
Follow up periods (months) 12.7 ± 5.9 11.4 ± 8.9 0.461†

Values are presented as mean ± SD or number/total (%) unless otherwise indicated.

* Chi-square test

† Independent t-test.

Table 2.
Comparison of preoperative diagnosis
Preoperative diagnosis With lacrimal endoscope Without lacrimal endoscope Total
Stenosis 26 (65.0) 35 (87.5)  
 Canalicular 7 (17.5) 6 (15.0) 13 (16.2)
 Nasolacrimal duct 16 (40.0) 25 (62.5) 41 (51.2)
 Canalicular + Nasolacrimal duct 3 (7.5) 4 (10.0) 7 (8.8)
Obstruction 14 (35.0) 5 (12.5)  
 Canalicular 5 (12.5) 2 (5.0) 7 (8.8)
 Nasolacrimal duct 9 (22.5) 3 (7.5) 12 (15.0)
Total p-value 40 40 800.018*

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

* Chi-square test.

Table 3.
Success rates with or without lacrimal endoscope use on 4 and 12 months after intubation
  With lacrimal endoscope Without lacrimal endoscope p-value*
Success rate (4 months after intubation) 35/40 (87.5) 32/40 (80.0) 0.546
Success rate (12 months after intubation) 18/25 (72.0) 18/29 (62.1) 0.565

Values are presented as number/total (%) unless otherwise indicated.

* Chi-square test.

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