A prospective outcome study of membranous and solid distal common canalicular obstructions

Abstract

Purpose To prospectively evaluate the surgical outcomes of membranous and solid distal common canalicular obstructions (CCOs) following endoscopic dacryocystorhinostomy (EnDCR) and lacrimal intubation combined with either membranotomy or trephination. Methods This was a prospective, nonrandomized, consecutive interventional case series. Inclusion criteria included patients undergoing EnDCR with evidence of a membranous block or more solid obstruction of the distal common canaliculus, treated with membranotomy or canalicular trephination. Complete CCO was confirmed pre-operatively using dacryocystography and dacryoscintigraphy. All patients received bicanalicular intubation for 3 months with a minimum follow-up of 12 months. Functional and anatomical success was assessed at 4 weeks, 3 months, and 12 months following surgery. Functional success was defined as subjective improvement of epiphora and anatomical success as the presence of a patent ostium and a positive dye test on nasal endoscopy. Results Twenty-nine patients were included in the study with a mean age of 58 years. Twentyone patients (72%) received a membranotomy and eight (28%) required trephination. At 12 months, the functional and anatomical success rate in the membranotomy group was 90% (19/21) and 100% (21/21), respectively, and in trephination group the functional and anatomical success rate was 63% (5/8). There were no intraoperative or lacrimal stent-related complications. Conclusions Identifying and excising distal CCOs in association with EnDCR and lacrimal intubation is associated with a high degree of functional (83%) and anatomical (90%) success. The success of membranous obstructions appear be superior to outcomes for solid obstructions of the distal common canaliculus that require trephination.

Soft stop on syringing and probing may have a high false-positive rate in diagnosing pre-sac obstruction

“…Firstly, common canalicular/lacrimal sac mucosal folds (CLS-MFs) have been shown to impact the internal canalicular orifice on endoscopy and falsely suggest an obstruction during probing [15,16]. These mucosal folds occur in roughly 60% of the population [11,[17][18][19][20]. Next, changes in angulation within the course of the canaliculi can lead to kinking and the impression of a false soft stop [19,21,22].…”

Long-term outcomes of lacrimal canalicular trephination with viscoelastic-assisted monocanalicular stenting for canalicular obstructions

“…Sisler's lacrimal trephine is now an established instrument for the recanalization procedure in patients having LCO at any level (proximal, distal, or common) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. The standard operating technique for this mechanical device is now established [1,2,8].…”

“…Its simple design and easy to use made Sisler's lacrimal trephine one of the most favorite instruments in the armamentarium of a dacryologist [1,5,8]. This trephine has attracted worldwide attention and has been used with success rates ranging from 52-92% [6][7][8][9][10][11][12][13][14][15]. This technique was described in one of the pioneering articles in 2014 in patients of idiopathic lower LCO with a satisfactory success rate (83.3%) over 8.6 months [8].…”

“…To the best of our knowledge, the long-term outcomes of this procedure have still not been reported. Moreover, most studies featuring Sisler's trephine have been conducted in post-DCR patients with or without nasal endoscopic guidance [9][10][11][12][13][14][15]. Hence, we planned to study the long-term outcomes of lacrimal canalicular trephination (LCT) with viscoelastic assisted monocanalicular stenting (VAMS) in patients with LCO.…”