Monocanalicular versus bicanalicular intubation in the treatment of congenital nasolacrimal duct obstruction

Abstract

BackgroundTo compare the success rate of monocanalicular intubation (MCI) compared with bicanalicular silicone intubation (BCI) in congenital nasolacrimal duct obstruction (CNLDO) in infants and toddlers.MethodsIn a prospective, nonrandomized, comparative study, MCI (n = 35 eyes) through the inferior canaliculus or BCI (n = 35 eyes) were performed under general anaesthesia in children aged 10 to 36 months with CNLDO. The tubes were removed 3–4 months after tube placement, and the children were followed up for 6 months after the removal of tubes. Therapeutic success was defined as the fluorescein dye disappearance test grade 0–1, corresponding with a complete resolution of previous symptoms. Partial success was defined as improvement with some residual symptoms.ResultsComplete and partial improvement was achieved in 31/35 (88.57%) in the BCI group and 34/35 (97.14%) in the MCI group. The difference between the two groups was not significant (p = 0.584). Complications occurred in both groups. Dislodgement of the tube and premature removal was observed in four BCI cases, and loss of the tube was observed twice in the MCI group. Canalicular slitting was observed in five eyes in the BCI group. Granuloma pyogenicum observed in 2 cases with MCI revealed a few weeks after the tube removal. Corneal erosion in the inferior medial quadrant was observed in one MCI eye and revealed in a few days after the local treatment without tube removal.ConclusionsBoth MCI and the BCI are effective methods for treating CNLDO. MCI has the advantage of a lower incidence of canalicular slit and easy placement.Electronic supplementary materialThe online version of this article (doi:10.1007/s00417-011-1700-2) contains supplementary material, which is available to authorized users.

Two-step retrograde closed stenting: a novel method for treating canalicular lacerations in Chinese patients

“…This procedure is traditionally followed with canalicular stenting; both procedures are performed concurrently in the operating room, where surgical registration and preparation by the nurses are needed. [1][2][3][4][5] The patients always waited for several hours, or even days, until a nurse, the operating room, and the experienced ophthalmologist were simultaneously available. Experienced ophthalmologists at a large hospital often treat more than one patient at a time, and it is particularly illogical to always ask them to wait for the uncertain emergent surgical schedule during their rest time.…”

“…[1][2][3][4] When evaluated for invasiveness, the nasal stenting is traditionally considered a more invasive technique because it is usually difficult to clamp the inserted antegrade suture crossing the inferior turbinate out of the inferior meatus, and it often needs to be assisted by an intranasal endoscope. 9,10 Sometimes, this process is time consuming.…”

“…2 Another goal is ensuring that the lacrimal punctum is returned to its previous physiological position without secondary eversion or slitting. 3 In situ canalicular anastomosis is also an important precondition for acquiring a normal eyelid position. 4 Although canalicular laceration management varies widely, it is generally agreed that an immediate anastomosis and stenting is necessary; the medial cut end may retreat and can be difficult to identify 24-48 h after injury because fibrin and granulation deposition occurs quickly.…”

Monocanalicular and bicanalicular silicone tube intubation results in patients with congenital nasolacrimal duct obstruction

“…[10][11][12] While bicanalicular intubation has been practiced since the 1970s, monocanalicular intubation did not start to become popular until the 1990s. [11] Both methods have their advantages and disadvantages.…”

“…[6,8,[10][11][12] In monocanalicular intubations, placement of the tube in the system can be sufficiently performed by entering only one punctum, where the tube is inserted from the upper and lower punctum in the ventricular intubation. [11,12] One of the most important advantages of the bicanalicular tube is that its surface is flatter [12][13][14] Monocanalicular tubes can cause abrasions or ulcers in the cornea, especially if they are placed in the upper canal and the collar side of the tube is larger. [14] Engel et al, [10] reported conjunctiva or corneal abrasion in 2% of 635 eyes where monocanalicular stapes were placed by upper canaliculus.…”