Transcanalicular Trephination for Canalicular Block after Dacryocystorhinostomy

Vahdani, Kaveh; Rose, Geoffrey E.

doi:10.1016/j.ophtha.2019.05.017

Cited by 3 publications

(5 citation statements)

References 4 publications

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“…Anatomical success was reported in 88% of patients -complete in 63%, partial in 25% -and it was concluded that trephination may be useful as an adjunctive minimally invasive office procedure in almost twothirds of patients who develop either primary canalicular obstructions or secondary obstructions following DCR (Nathoo et al 2013). Canalicular trephination can be performed easily by means of a disposable 21-gauge trephine, with a revisional rate in 32% of cases, as recently described, highlighting the advantages of this repeatable technique with respect to the more expensive laser trephination (Vahdani & Rose 2019).…”

Section: Management Of Distal Canalicular Obstructions and Common Canalicular Obstructionsmentioning

confidence: 78%

“…• In distal canalicular obstructions bypass surgery should be advised, as a high proportion of these patients will not benefit from CDCR (Lee et al 2017, level IIB). Trephination and intubation is useful in case of recurrence of a membrane excised at primary surgery (Vahdani & Rose 2019, level IV).…”

Section: Discussionmentioning

confidence: 99%

“…Trephination and positioning of LacriJet -a single use injector handpiece into which a silicone tube is preloaded inside a metallic probe used for trephination -appears to be effective in patients with no previous history of discharge (Fig. 2), and no nasolacrimal duct obstruction associated to the canalicular block (Quaranta-Leoni et al 2020), and trephination and intubation is successful in patients with mid-canalicular block developed after DCR (Vahdani & Rose 2019).…”

Section: Management Of Mid-canalicular Obstructionsmentioning

confidence: 99%

“…Membranous medial canalicular occlusion is due to adherence of the valve of Rosenmuller deriving from chronic dacryocystitis, or to mucosal trauma during previous DCR, or to recurrence of a membrane excised at primary surgery (Vahdani & Rose 2019). Distal inferior canaliculus obstructions and common canalicular obstruction can be managed with canalicular trephination, with a reported success rate for a primary procedure of 92% (Sisler & Allarakhia 1990).…”

Section: Management Of Distal Canalicular Obstructions and Common Canalicular Obstructionsmentioning

confidence: 99%

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Proximal lacrimal obstructions: a review

Fiorino

Quaranta-Leoni

Quaranta‐Leoni

2021

Acta Ophthalmologica

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Purpose: The aims of the review are to summarize the aethiopathogenesis, management and outcomes of different treatments of proximal lacrimal obstructions. Methods: An electronic database (PubMed, MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on proximal lacrimal obstructions was performed. The articles were reviewed along with their relevant cross references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Results: Punctoplasty is as effective as punctal dilatation with monocanalicular or bicanalicular stent in case of punctal stenosis. Dacryocystorhinostomy with retrograde intubation is more effective in case of proximal canalicular obstructions than in case of mid-canalicular obstructions. Trephination and intubation is effective in both mid and distal canalicular obstructions in patients with no associated nasolacrimal duct obstruction. Canaliculodacryocystorhinostomy has a specific indication in case of proximal common canalicular obstruction. Bypass surgery is the preferred treatment if there is no residual patency, however surgical success may not match patient satisfaction. Conclusion: Optimal choice of surgical method depends on identification of the site of obstruction. Mini-invasive techniques should be avoided in cases that would only benefit from standard surgical treatment.

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Section: Management Of Distal Canalicular Obstructions and Common Canalicular Obstructionsmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Management Of Mid-canalicular Obstructionsmentioning

confidence: 99%

Section: Management Of Distal Canalicular Obstructions and Common Canalicular Obstructionsmentioning

confidence: 99%

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Proximal lacrimal obstructions: a review

Fiorino

Quaranta-Leoni

Quaranta‐Leoni

2021

Acta Ophthalmologica

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“…Trephination and positioning of LacriJet is effective in patients with no previous history of discharge, suggesting no presence of nasolacrimal duct obstruction prior to the canalicular block, or in patients with canalicular block developed after DCR (Vahdani & Rose 2019).…”

Section: Discussionmentioning

confidence: 99%

Management of proximal lacrimal obstructions: a rationale

Quaranta‐Leoni

Fiorino

Serricchio

et al. 2020

Acta Ophthalmologica

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Purpose To identify a rationale for correct surgical treatment of proximal lacrimal obstructions. Methods Retrospective review of 775 consecutive patients (974 eyes) with proximal lacrimal obstructions, operated on with customized surgery by a senior surgeon (FMQL) from January 2003 to December 2018. Results In case of punctal stenosis, punctoplasty was as effective as punctal dilatation with monocanalicular or bicanalicular stent (p > 0.05). In proximal canalicular obstructions, failure rate of dacrocystorhinostomy with retrograde intubation (R‐DCR) was significantly higher in case of false inferior passage creation than in case of no false passage creation (p = 0.02). In mid‐canalicular obstructions failure rate of R‐DCR was 41.3%, and bypass surgery with Jones tube at second stage was likely. Trephination and monocanalicular intubation, performed in selected cases, had a failure rate respectively of 16.6% and 21.7% in mid and distal canalicular obstructions. Canaliculodacryocystorhinostomy (CDCR) was successful in 77% of cases of proximal common canalicular obstruction. Bypass surgery is the treatment of choice in case of no residual patency, and rates of tube extrusion were significantly reduced with the use of StopLoss Jones tubes (SLJT) (1.7%) with respect to standard tubes (12%), (p = 0.04, Fisher’s exact test). Conclusion Patient history and accurate diagnosis of the site of obstruction are essential for a correct surgical choice. Less invasive techniques as trephination and intubation may be effective, but should be reserved to patients with no associated lower lacrimal obstruction. Further studies require specific randomized clinical trials, and a standardized protocol adopted by different clinical centres.

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