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Z. Wang, D. Chen; A Simple and Evolutional Approach Proven to Re-Canalize the Nasolacrimal Duct Obstruction. Invest. Ophthalmol. Vis. Sci. 2008;49(13):105.
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To evaluate the long-term performance of re-canalization of nasolacrimal duct obstruction (RC-NLDO), a simple and evolutional approach, in the treatment of the nasolacrimal duct obstruction (NLDO) and chronic dacryocystitis.
Long-term follow-up (up to 54 months) results between two groups of patients with RC-NLDO and external dacryocystorhinostomy (EX-DCR) were compared, and the histopathological examinations of RC-NLDO were performed in rhesus monkeys. One thousand and forty patients with 1147 eyes suffering from NLDO and chronic dacryocystitis were enrolled in this study. The RC-NLDO was performed in 1012 eyes as a study group, which was compared with 135 eyes underwent EX-DCR as a control group. Patients with surgical failures were offered a second surgery. Patient follow-up was evaluated by dye disappearance test, lacrimal irrigation and symptoms in all patients, and the digital subtraction dacryocystogram were performed in some patients. The RC-NLDO was performed in one eye of 12 animals and the other eyes were used as controls for pathological study. The animals were sacrificed immediately, 7 days, and 1-3 months after surgery for histopathological examination. The healing process and pathological changes of re-epithelization and infiltration of inflammatory cells were examined in nasolacrimal duct of rhesus monkey.
The clinical success rats were 93.1% in 1012 cases of RC-NLDO, and 91.11% in 135 cases of EX-DCR. The success rats for second surgery were achieved in 85.19% on RC-NLDO and 40.0% on EX-DCR. No major intra- or post-operative complications were observed in the RC-NLDO group. Mild postoperative bleeding occurred in 1 case (0.74%) and transient pain occurred in 8 cases (5.93%) in the EX-DCR group. The mean operative duration was 12.5 minutes for RC-NLDO while 40.3 minutes for EX-DCR (P<0.001). Pathological study in rhesus monkeys demonstrated that the RC-NLDO wounded epithelium in nasolacrimal duct healed completely within 1 month without granulation tissue formation.
Our findings demonstrated that this new approach of RC-NLDO was proven to re-canalize the obstructed nasolacrimal duct with a comparable success rate to EX-DCR, and it may be an optimal choice for recurrent patients with NLDO and chronic dacryocystitis.
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