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Yoann Soldermann, Olivier Galatoire, jacomet pierre vincent; Efficacy and tolerance of balloon dacryocystoplasty in partial primary acquired nasolacrimal duct obstruction. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4759.
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© ARVO (1962-2015); The Authors (2016-present)
The main cause of tearing in adult is Primary Acquired Nasolacrimal Duct Obstruction. Stenosis is first partial, related to an inflammatory mucosal remodeling. The objective of this study is to evaluate the efficacy and the safety of antegrade balloon dacryocystoplasty in adults with a partial PANDO.
This is a prospective and a single center study. 35 nasolacrimal ducts of 24 patients, unresponsive to medical treatment, were included between February 2011 to August 2014. The patients with other causes of tearing, including dry eye and eyelid malposition, were excluded. All included patients passed a dacryoscanner before treatment. The anterograde dilatation using a balloon catheter (Ophtacath®, FCI, Paris) was performed in operating room under general anesthesia. A 9 atmospheres expansion during 90 sec on the first mark and during 60 seconds on the second mark treated all the nasolacrimal duct. The endpoint was the Munk’s tearing score at 1, 3, 6, 12 and 24 months. A complete success was defined as a Munk’s score of 0 or 1.On the other hand, a retrospective analysis was performed on 29 nasolacrimal ducts of 19 patients treated with a silicone intubation for tearing due to a partial stenosis between 2007 and 2013.
The average age of our patients was 65 ± 2 years. The mean duration of tearing before treatment was 3 ± 0.5 years. 77% of patients were women. The procedure were achieved in 100% of cases. 30 tearing improved with this procedure : 86% of cases (30/35). Complete success was effective for 20 nasolacrimal ducts : 57% of cases (20/35). The mean follow-up was 17 ± 3 months. No recurrence of tearing was observed during the monitoring period. 4 postoperative complications were recorded (11.8%): 1 orbital emphysema, 2 periorbital hematomas and 1 epistaxis. With silicone intubation, tearing improved in 37.9% of cases and a complete resolution was found in 27.6% of cases. The mean follow-up was 29 ± 3 months in this group. It was noted 3 postoperative complications (10%) with this technique.
Antegrade balloon dacryocystoplasty is an effective, non-invasive technique for treatment of partial PANDO in adults. This technique seems to be better than silicone intubation in this indication. Nevertheless, further prospective and comparative studies are needed to consolidate this promising results.
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