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M. Su, G.J. Ko, D.M. Najjar, E.H. Bedrossian, Jr., O.M. Zwick, A.D. Abel; Angiocatheter–Assisted Canaliculoplasty for Canalicular Stenosis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3788.
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© ARVO (1962-2015); The Authors (2016-present)
A novel approach for treatment of canalicular stenosis using an angiocatheter in patients with severe canalicular stenosis that cannot be overcome by standard probing at time of dacryocystorhinostomy (DCR).
Three patients from Temple University Hospital & Wilmington Hospital with canalicular stenosis and epiphora were enrolled. This technique is used while performing DCR with silicone tube intubation. The Guibor tube is used because it lacks the olive tip and advances easily through an 18 gauge angiocatheter.
After creating a DCR opening at the lacrimal sac, the angiocatheter is inserted into the punctum and directed through the canaliculus until stenosis is reached. The catheter is advanced through the scar until the needle is identified in the lacrimal sac. The angiocatheter needle is withdrawn, leaving the sleeve.
The metal probe of the Guibor tube is inserted through the sleeve and advanced until visualized in the middle meatus. The end of the metal probe is retrieved through the naris. The angiocatheter sleeve is withdrawn, leaving the tube in place.
If both canaliculi are stenotic, the metal hub of the catheter sleeve is cut and used for both canaliculi. Only with the hub removed can the catheter sleeve be easily cut, after placement of the second end of the Guibor tube. Timing for tube removal was tailored to the amount of pre–existing stenosis and likelihood for restenosis.
Patient #1: positive canalicular irrigation & only three episodes of epiphora per day at one year. Patient #2: positive canalicular irrigation & only one to two episodes of epiphora per day at 18 months. Patient #3: positive canalicular irrigation & rare episodes of epiphora at one year.
The standard for canalicular stenosis remains conjunctivodacryocystorhinostomy (CDCR) with Jones tubes. However, tube maintenance is challenging. Moreover, in many cases prior to DCR, the surgeon does not know the amount of canalicular stenosis. In addition, standard lacrimal probing often fails to release strictures. The authors' technique is simple and advantageous, adding a widely available instrument to the armamentarium when standard techniques fail. The angiocatheter provides a needle to penetrate strictures easily. It also allows excellent control with re–approximation of normal canalicular anatomy.
This alternative to CDCR has been used in three patients. All patients had irrigable canaliculi and fewer episodes of epiphora. While results are encouraging, more patients are needed to assess the success of this technique.
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