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Jamie Dietze, Donny Suh; Patient factors predicting higher rate of failure in pediatric surgical correction of nasolacrimal duct obstruction. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4299. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Nasolacrimal duct obstruction is a common pediatric problem. Some children must undergo a surgical option to achieve symptom resolution and of those, some require additional surgical intervention, exposing them to more potential risk. We hypothesized that there may be common patient factors that may help to predict whether a child is at higher risk for surgical failure. We performed a retrospective, observational case-control clinical study looking at patient factors present prior to surgical intervention and their correlation with the necessity of multiple surgical interventions.
Patients aged 2 months-13 years old were identified by a pediatric ophthalmologist as having nasolacrimal duct obstruction necessitating surgical correction based on symptom history refractory to conservative management. Patients were split into two categories based on need of multiple surgical intervention(n’=46) vs single surgery(n=140) in Group A. Group B split only the patients who underwent probing and irrigation as the initial surgical intervention (n=105, n’=46). Group C split only the patients who underwent balloon dilation as the initial surgical intervention (n=30, n’=15). Patient factors, based on electronic medical record, that may predispose patients to an unsuccessful initial procedure were compared via odds ratio analysis. Patients were assessed on failure vs success rates based on the resolution of symptoms 6 months post-op.
Patient factors that had statistically significant increased odds were Trisomy 21 (p=0.019), prior diagnosis of allergic rhinitis/seasonal allergies(p=0.031), history of a URI within a month(p=0.012), and a prior diagnosis of OSA(p=0.04). When patients were stratified out into groups based on initial surgical intervention type, Trisomy 21 patients no longer had a significant odds ratio for repeat surgical intervention when a balloon dilation procedure was the initial intervention.
Our study suggests that patients who have the presence of Trisomy 21 or a history of recent URI may be correlated with a higher risk of failure with just a probing and irrigation surgery. Patients with Trisomy 21 may benefit from an initial balloon dilation procedure due to a similar risk profile as those without Trisomy 21. Patients with recent URI may benefit from the postponement of surgery until symptom treatment or resolution.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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