June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
A modified bicanalicular Crawford placement method for congenital nasolacrimal duct obstruction: reducing need for operative room removal
Author Affiliations & Notes
  • Ellen Elizabeth Ingram
    LSU Health New Orleans, New Orleans, Louisiana, United States
  • John P Thompson
    LSU Health New Orleans, New Orleans, Louisiana, United States
  • Elizabeth Bozner
    LSU Health New Orleans, New Orleans, Louisiana, United States
  • Armin Avdic
    LSU Health New Orleans, New Orleans, Louisiana, United States
  • Charles Reeder
    LSU Health New Orleans, New Orleans, Louisiana, United States
  • George Ellis
    Children's Hospital of New Orleans, New Orleans, Louisiana, United States
  • Austin Pharo
    LSU Health New Orleans, New Orleans, Louisiana, United States
  • Footnotes
    Commercial Relationships   Ellen Ingram None; John Thompson None; Elizabeth Bozner None; Armin Avdic None; Charles Reeder None; George Ellis None; Austin Pharo None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4061. doi:
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      Ellen Elizabeth Ingram, John P Thompson, Elizabeth Bozner, Armin Avdic, Charles Reeder, George Ellis, Austin Pharo; A modified bicanalicular Crawford placement method for congenital nasolacrimal duct obstruction: reducing need for operative room removal. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4061.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Bicanalicular stenting for congenital nasolacrimal duct obstruction (NLDO) often requires use of the operative room (OR) for removal. This study introduces a method for Crawford bicanalicular stent placement by looping the ends to themselves which are tied together with dissolvable sutures to ease in-office removal.

Methods : This is a single institution, retrospective study that evaluates outcomes of patients aged 5 or under who underwent bicanalicular stenting for congenital NLDO by a single surgeon between 2004 and 2020. It was IRB approved. Only primary surgeries were included in the analysis. Stenting could be accompanied by balloon dilatation and/or turbinate infracture. Age, sex, follow-up time, complications, type of intervention, extrusion, recurrence, and OR removal were recorded.

Results : This study included 56 eyes from 54 patients with a mean age of 19.0 ± 9.5 months (range, 8-50 months). In patients with bilateral procedures, only right eyes were analyzed unless there was a complication or recurrence in the left eye, in which case it was added. There was a 30.3% extrusion rate, a 5.4% rate of recurrence of disease, and a 3.6% rate of operative room removal. The average follow-up time was 25.1 ± 39.8 months (median, 4.1 months, range, 1-132 months). For patients with or without extrusion, there were no statistically significant differences between age, sex, laterality, type of intervention, follow-up time, or rate of recurrence. Each eye that had recurrence (3 total) or needed OR removal (2 total) underwent only bicanalicular stenting without accompanying procedures, although the difference in rates between procedures was also not statistically significant.

Conclusions : This method had a low recurrence and OR removal rate, with similar extrusion and complication rates to other bicanalicular stent and intubation methods for the treatment of congenital NLDO. This procedure can be particularly useful in uncooperative patients or when attempting to avoid increased operative time.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Figures 1-6: Illustration of the method of securing the stent ends by looping one around the other and securing with a square knot, followed by additional suture loops and an additional square knot.

Figures 1-6: Illustration of the method of securing the stent ends by looping one around the other and securing with a square knot, followed by additional suture loops and an additional square knot.

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