Nasolacrimal Stenting: Toward Improving Outcomes with a Simple Modification of the Song Stent

Abstract

The purpose of this study was to evaluate, in a prospective, single-center study, the effectiveness of Song's polyurethane stents, modified "in-house," in the percutaneous management of epiphora. Patients (n = 170; age range 18-83, mean = 64; 50 male, 120 female) with severe epiphora had the modified stents inserted (183 eyes/195 stents) to treat unilateral/bilateral and complete/partial obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 119 cases (61%) and chronic dacryocystitis in 76 (39%). The set designed by Song was used in all patients but modified by us such that the extreme end is cone-shaped. The original technique was slightly modified by us and the procedure was conducted on an outpatient basis. The initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 180 eyes and partial in 3. On follow-up (mean = 18 months; range: 2 days to 24 months), 165 of 195 stents (85%) remained patent. Primary patency rates at follow-up were 86%, 84%, 84%, and 79% in the first 6 months, second and third 6 months, and the present (24 months), respectively. Stents became obstructed in 30 patients, but all but 2 were easily withdrawn and 20 of these patients remained asymptomatic for a mean of 14 months (secondary patency of 67%). Following stent removal, the withdrawn stent was replaced with a new stent in the same intervention on 14 occasions. In another six cases, patency was re-established without the need of a second stent. The procedure is simple and safe, both in stent insertion as well as in mechanical de-blocking and withdrawal when occluded. Success was >80 % in the short term (1-year follow-up). Stenting failure does not preclude other treatment because with the modification that we had introduced, the extreme end of the stent becomes more accessible to mechanical de-blocking, withdrawal, and relocation. The levels of primary and secondary patencies are promising and warrant more extensive investigation.

Treatment of lacrimal stenoses obstructions with interventional radiology: immediate and 5-year follow-up results

“…This view is supported by reports [14] that stents modified in their extreme end (mushroom tip) had 79% patency rates at 24 months [15]. Therefore minimising interaction between the head of the stent and the lacrimal sac is thought to better preserve normal lacrimal dynamics and consequently ensure longer stent survival.…”

“…The procedure can be repeated after removal of the obstructed stent under fluoroscopy or nasal fiberoptic endoscopy. The patency rate for the entire follow-up period was 68.4% (52 cases) compared with 87% for DCR [15].…”

“…Questa teoria viene supportata da studi [15] che hanno segnalato che stent modificati nella estremità oculare garantiscono una durata della pervietà di 79% a 24 mesi [14]. Pertanto possiamo ritenere che quanto meno lo stent interagisce con il sacco tanto maggiore è la conservazione della normale dinamica lacrimale e di conseguenza la durata dello stent nella sua funzione.…”

Implante de ducto nasolacrimal de poliuretano: relato de caso

“…Semelhante ao nosso caso, um estudo mostra a colocação de 195 implantes de poliuretano modificados e em 3 pacientes houve migração. Um deles engoliu o implante e os outros dois relataram a saída pela cavidade nasal após assoar o nariz (17) . Resultados mostram que há vantagens sob o modelo tradicional.…”

“…Resultados mostram que há vantagens sob o modelo tradicional. Há menor taxa de obstrução (15% versus 33%), possibilidade de desobstrução in situ, e diminuição significativa da inflamação do saco lacrimal antes observada (17)(18) . No Brasil, ainda não se utiliza o implante de ducto nasolacrimal, sendo este o primeiro caso descrito.…”