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H. Tseng, M. Manning, Jr., J. Frankel; Laser Assisted Dacryoplasty with Monocanalicular Stenting: An Alternative to Dacryocystorhinostomy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1962.
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Incisional dacryocystorhinostomy (DCR) is currently the standard treatment for patients with nasolacrimal duct obstructions (NLDOs). While success rates of ≥90% are reported, disadvantages of DCR include cutaneous incision, scarring, and significant alteration of lacrimal system anatomy including disruption of medial canthal ligaments with consequent lacrimal pump dysfunction. Current DCR modifications include the use of endocanalicular laser in DCR and balloon dacryoplasty for incomplete NLDOs. This study investigates the success rate of laser–assisted dacryoplasty with monocanalicular stenting for treatment of acquired NLDOs.
In this retrospective case series, the authors examined 128 patients with incomplete NLDOs who underwent balloon dacryoplasty and complete NLDOs who underwent laser assisted balloon dacryoplasty in an antegrade fashion with MonostentTM monocanalicular stenting (Eaglevision). Exclusion criteria included history of facial trauma or dacryocystitis. For the remaining 118 cases, pre–operative evaluations included Jones testing, Technetium–99 dacryoscintography, and probing and irrigation. The patients were separated into incomplete and complete NLDOs groups and underwent dacryoplasty as follows: IV sedation and local anesthesia were administered. The superior and inferior puncta were dilated. An angiocatheter was then guided into the nasolacrimal duct. The balloon was inflated to 60mmHg for 90 sec. After deflating the balloon, the angiocatheter was removed. A monocanalicular stent was then inserted into the canalicular system and the punctal plug placed flush against the punctum. For those patients with complete obstruction, a holmium:Yag laser was threaded through the angiocatheter to treat the obstruction prior to monocanalicular stent placement.
Ninety–four systems (81%) experienced complete resolution or significant improvement in epiphora symptoms after surgery. Within this successful group, fifty–eight systems (81%) had had complete NLDOs and thirty–six systems (78%) had incomplete NLDOs. Twenty–four systems (19%) showed no improvement.
Laser assisted balloon dacryoplasty with monocanalicular stenting as a treatment for acquired NLDOs provides complete relief or substantial improvement in a significant percentage of patients. It should be considered an appropriate, less invasive treatment option for selected patients with NLDOs that have no history of facial trauma or dacryocystitis. Further investigation is warranted to determine the long–term success of this procedure.
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