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David Silbert; Use of a self-retaining bicanalicular nasolacrimal stent for partial nasolacrimal obstruction in adults without need for general anesthesia.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4760.
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© ARVO (1962-2015); The Authors (2016-present)
Partial nasolacrimal duct (NLD) obstruction has been a challenging problem to treat short of placing crawford tubes under general anesthesia. We perform a retrospective observational study utilizing a bicanalicular self-retaining stent in adults without general anesthesia.
Kaneka Lacriflow stents were placed in the office under topical/local anesthetic or in conjunction with other eyelid surgery under conscious sedation. Ages of patients ranged from 33 to 90 years. Patients with epiphora due to punctal, canalicular or nasolacrimal stenosis were included. Irrigation was used to confirm the absense of complete obstruction. Local blocks to the infratrochlear nerve, eyelid and lidocaine gel infiltrated through the NLD were utilized. Stents were placed with a stylet to both upper and lower punctum. Stents were left in place for 3 months then removed. Improvement in epiphora was assessed one month later. An antibiotic steroid drop was used for 2 weeks after implantation and for 2 weeks following removal.
27 patient were included. 14 patients had bilateral surgery and 13 had unilateral. A total of 41 NLD were included in the study. In one patient the stent could not be passed down the NLD. Stent placement was succesful in 40/41 NLD (98%) with no patient complaining of excessive discomfort. In 27 eyes stents were placed under local anesthesia while 13 were performed under conscious sedation. 24 patients completed the full 4 months of follow-up while the rest are still in followup. 22/24 patients reported improvement in epiphora one month following removal of the stents (92%). 2 patients reported continued epiphora with stents in place, but improvement following removal. 1 patient had partial dislodgment of the stent, which was removed, replaced and then left in place for the full 3 months.
Epiphora due to partial nasolacrimal duct and canalicular obstruction has been challenging to treat. A hydrophilic polymer which makes it slippery in the NLD, a smaller intracanalicular diameter and a larger intraductal diameter allows the stent to pass easily and self retain. The Kaneka Lacriflow stent was able to be placed consistently without the need to enter the nose to recover or tie the stent. 92% of patients had significant improvement in epiphora without the need for a procedure under general anesthesia.
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