Clinical Effectiveness of Balloon Dacryocystoplasty in Circumscribed Obstructions of the Nasolacrimal Duct

Abstract

Purpose: Balloon dacryocystoplasty (DCP) is known to have limited clinical success rates. In a previous publication, we tried to define subgroups that could benefit from interventional treatment of tear duct stenoses. The purpose of this study was to evaluate the clinical effectiveness of DCP performed with limited indication confined to patients with circumscribed stenosis or distal occlusion of the nasolacrimal duct (NLD). Patients and Methods: Twenty-nine patients with severe epiphora due to dacryocystographically proven postsaccal obstruction of the lacrimal draining system were treated by means of DCP and were available for a telephone interview after a median follow-up period of 40 months (5–75 months). A standardized questionnaire covered the individual history of epiphora before and after interventional treatment. All patients had circumscribed stenoses of the lower lacrimal sac or the NLD or presented with short-distance occlusions of the distal NLD. Patients with canalicular, high saccal or diffuse lesions as well as cases with active dacryocystitis, suspicion of dacryocystolithiasis or posttraumatic stenosis were excluded from DCP. Failures or recurrences with no major improvement compared with the initial status were taken as a study endpoint. Results: We dilated 21 partial and 8 complete obstructions and post-DCP control dacryocystograms showed a widening of the ductal lumen or improvement of flow. In 25 out of 29 patients, regression of clinical symptoms occurred during the first week after treatment, 4 cases remained unchanged. Ten out of 25 patients with initial improvement reported recurrence of severe epiphora after a median period of 5 months. Five patients of all treated patients (n = 29) received additional operative dacryocystorhinostomy (DCR) after failure of DCP or due to severe recurrences. One patient received DCR during the 1st week after DCP (n = 1). Four out of 25 patients with initial improvement underwent DCR. Overall, 15 of the 29 treated patients had durable improvement of epiphora by DCP alone. Conclusion: Even patients with circumscribed obstructions of the NLD and exclusion of factors potentially associated with poor outcome of tear duct stenosis after DCP balloon dilatation showed a limited clinical success and high recurrence rate. The main argument to continue DCP as first or second line treatment in selected patients with duct obstructions is its lack of invasiveness. Even patients with increased risk of general anesthesia can be treated and approximately half of the operations may be avoided.

Efficacy of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in treatment of acquired partial nasolacrimal duct obstruction in adults

“…In contrast our study focused only on partial obstructions and excluded complete obstructions, post-traumatic obstructions as well as canalicular stenosis and obstructions. The authors of the current study concur with Luchtenberg et al 13 that these excluded cases do not do well with balloon dilatation.…”

“…The quest on this front has been to look into the feasibility of using minimally invasive alternatives. With the advent of balloons, several studies have looked at the efficacy of using 3-mm balloon catheters in such cases 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. The 3 mm balloon has an outer diameter of 3 mm and length of 15 mm, and targets at dilating the distal and proximal portions of nasolacrimal duct.…”

“…However bicanalicular silicone intubation specifically for partial NLDO was found to have a success rate of 54% 5 . Balloon dacyroplasty is also rapidly gaining ground as a minimally invasive alternative for the treatment of partial nasolacrimal duct obstructions 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15. The purpose of the present study is to describe the efficacy and complications of 3 mm balloon catheters in managing acquired partial or incomplete NDLO in adults.…”

Minimally Invasive Strabismus Surgery for Rectus Muscle Posterior Fixation

“…Keyhole openings have replaced larger cuts in many surgical fields [1]. Eye surgeons also have developed several keyhole or otherwise minimally invasive procedures for lids [3], the lacrimal system [4], conjunctiva [5], cataracts [6], glaucoma [7] and vitreoretinal surgery [8]. …”

Endonasale mikroskopische Dakryozystorhinostomie mit Endoillumination und Intubation bei Patienten mit kombinierten Tränenwegspathologien oder Revisionen

“…Die endonasale DZR wird neben der externen DZR angewandt. Heutzutage stellen jedoch auch minimalinvasive Verfahren, wie Ballonkatheterdilatation [2], Laserdakryoplastik [3] und Mikrodrill [4], eine Alternative dar. Diese Operationsmethoden zeichnen sich durch geringe Invasivität aus, jedoch sind sie bei komplexeren Tränenwegsstenosen, z.…”