Treating Epiphora in Adults With the Wilhelm Plastic Nasolacrimal Stent: Mid-Term Results of a Prospective Study
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The objective of the present study was to evaluate, in a prospective, single-center study, the effectiveness of the Wilhelm-type stent used in interventional radiology for the management of epiphora. Patients (n = 104; mean age 64 [range 25–88]; 33 male and 71 female) with severe epiphora had the stents inserted (135 stents in 115 eyes) to treat obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 83 cases, chronic dacryocystitis in 31, cases and postsurgical status in 1 case. The overall technical success rate of stent placement was near 94%. Resolution of epiphora was complete in 105 cases and partial in 3 cases. During a mean 13-month follow-up (range 1 week to 28 months), the median duration of primary patency was 11 months, and the percentage of patency at 6 months was 60.8%, at 1 year was 39.6%, and at 2 years was 25%. Stents malfunctioned in 54 cases, and all were easily withdrawn except in 1 case. Of these 27 cases, patency recovered spontaneously in 9 and by way of a second stent in 18. Secondary patency was 50%. Factors presdisposing to lower primary patency are inflammatory etiology and location of the obstruction. The benefit of stent deployment is clear with respect to the resolution of epiphora in candidate patients for percutaneous treatment. Technical and/or design improvements would be welcomed.
KeywordsLacrimal system treatment Lacrimal duct and sac obstruction Interventional procedures Stent Prostheses
We thank the team of doctors and nurses of the Interventional Radiology Unit of the Hospital Virgen de la Salud (Toledo, Spain) as well as the ophthalmologists and nursing personnel of the outpatient clinics of the Hospital Virgen del Prado (Talavera-España, Spain) and the Hospital de Toledo (Spain). Editorial assistance was given Peter R. Turner of t-SciMed (Reus, Spain).
- 12.Lanciego C, Toledano N, De Miguel S et al (2003) Resolution of epiphora with nasolacrimal stents: results of long-term follow-up in a multicenter prospective study. J Vasc Intervent Radiol 14:1417–1425Google Scholar
- 14.Wilhelm KE, Loeffler K, Urbach H et al (2002) Complete tear duct obstruction: Treatment with lacrimal polyurethane stent implantation [abstract]. Cardiovasc Intervent Radiol Soc Europe 25(Suppl 2 CIRSE):S149Google Scholar
- 26.Chiambaretta F, Modif R, Gerbaud L et al (2003) Stenting of lacrimal canal obstructions: a cost efficiency analysis [abstract 35.6.3]. Cardiovasc Intervent Radiol Soc Europe 1(Suppl CIRSE):63Google Scholar
- 28.Yazici Z, Yazici B, Parlak M et al (2002) Treatment of nasolacrimal duct obstruction with polyurethane stent placement: long-term results. Am J Radiol 179:491–494Google Scholar
- 34.Lanciego C, García García L (2008) Nasolacrimal duct interventions. In: Mauro MA, Murphy KPJ, Thomson KR, Venbrux AC, Zollikofer CL (eds) Image-guided interventions. Elsevier, Philadelphia, PA, pp 697–699Google Scholar
- 35.Ferrer-Puchol M, Esteban-Hernandez E, Jornet-Frayos J et al (2009) Treatment of lacrimal duct obstruction with a Tear-Leader stent. Arch Soc Esp Oftalmol 84:515–522Google Scholar
- 36.Becker BB (2001) Recanalization of the obstructed nasolacrimal duct system [editorial]. J Vasc Intervent Radiol 12:69–7699Google Scholar