Endoscopic Lacrimal Silicone Tube Intubation in Patients with Primary Acquired Nasolacrimal Duct Obstruction: A Retrospective Study

Abstract

Background: A lacrimal endoscope is the only instrument that can be used to observe the luminal side of the lacrimal duct. Lacrimal tube intubation (LTI) surgery using a lacrimal endoscope is less invasive than a dacryocystorhinostomy. However, in LTI surgery for PANDO, the risk factors for poor outcomes although it remains unclear. This study aimed to determine the outcomes and risk factors of primary acquired nasolacrimal duct obstruction (PANDO) treated with LTI. Methods: This retrospective study was performed at Saitama Medical University Hospital. We enrolled 102 patients (75 females; mean age 72.1±9.0) who were diagnosed with unilateral PANDO and underwent LTI surgery using lacrimal endoscope between August 2016 and January 2020. Preoperatively, the lacrimal pathways were washed with a normal saline solution and samples obtained were cultured. The obstruction sites in the lacrimal pathway were determined endoscopically. Eight weeks after LTI, samples obtained from a piece of the removed lacrimal tube were cultured. We identified the bacterial cultures observed before and after the surgery. We examined risk factors for re-occlusion in patients with PANDO during the first 6 months after surgery. Results: Ninety-four (92.2%) sides successfully passed the lacrimal syringing test 6 months after surgery. In univariate and multivariate analyses, the risk factors for lacrimal duct re-occlusion were diabetes mellitus (p=0.02, 0.04, respectively) and the presence of granulomatous changes on endoscopy (p<0.001, 0.02, respectively). All 11 patients with PANDO and diabetes mellitus had positive lacrimal tube culture results. Conclusion: LTI failure was more common in patients with diabetic complications or when granulation was observed on lacrimal duct endoscopy.