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Optimizing clinical outcomes for endoscopic lacrimal duct recanalization in patients with complete PANDO

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Abstract

Purpose

The study aims to describe modifications and refinements in the technique and technology of Transcanalicular Endoscopic Lacrimal Duct Recanalization (TELDR) based on anatomical foundations to optimize its clinical outcomes in patients with complete Primary Acquired Nasolacrimal Duct Obstruction (PANDO).

Methods

The medical records of 115 patients who underwent TELDR procedures from January 2018 to July 2020 were reviewed retrospectively. Of the 115 patients, only those 35 patients with complete PANDO characterized by longstanding epiphora of 3–5 years duration, dense, diffuse fibrous tissue obstruction involving the sac, sac duct junction and the entire length of the nasolacrimal duct were included in the study. Parameters for success were analyzed based on patency on irrigation, functional endoscopic dye test, and improvement of epiphora.

Results

Forty-five cases from 35 patients with complete PANDO were included in the study. The mean length of time from the date of operation to silicone stent removal was 8.1 weeks, while the mean length of follow-up starting from the removal of silicone stent to last follow-up was 61.0 weeks. There were 95.6% anatomic patency on canalicular irrigation with saline and 95.6% functional patency based on functional endoscopic dye test. There was significant improvement of epiphora (p value of < 0.0001) post-operatively.

Conclusion

The results of modified TELDR improved clinical outcomes and could be a definitive treatment in patients with complete PANDO with longstanding, dense, diffuse, fibrous tissue obstruction. Patients who experience reobstruction, may undergo a repeat of the recanalization approach.

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Data availability

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Acknowledgements

I am grateful to Mr. Raymark Salonga for his statistical analysis of our data, to Ann Carmeline Beronilla, M.D., Joy Katrina Bolusan R.N., and Nenita Sanchez, BSPsych for their technical assistance in the preparation of the article.

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The author received no financial support for the research, authorship and/or publication of this article.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Santo Tomas Hospital Eye Institute, University of Santo Tomas Hospital, University of Santo Tomas, Rm. 501, Doctors’ Clinics, 5th Floor, España Blvd, 1008, Sampaloc, Manila, Philippines

    Reynaldo M. Javate

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Correspondence to Reynaldo M. Javate.

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This study is in accordance with the guidelines of the Declaration of Helsinki of 1975, as revised in 2000 and submitted to the Research Ethics Committee of the University of Santo Tomas Hospital, Manila, Philippines (REC-2020-09-103-MD-FR).

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This is a retrospective study and only medical charts were reviewed.

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Informed consent was obtained by the author for publication of image in Figs. 3 and 4.

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Javate, R.M. Optimizing clinical outcomes for endoscopic lacrimal duct recanalization in patients with complete PANDO. Int Ophthalmol 43, 175–184 (2023). https://doi.org/10.1007/s10792-022-02414-2

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