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Debates in Dacryology: The Intubation Dilemma!

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Principles and Practice of Lacrimal Surgery

Abstract

The use of stenting in dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO) in the absence of canalicular disease is controversial. There is no definitive evidence to support the routine use of intubation in DCR for PANDO. Advocates for stenting report an increased patency rate, due to presumed maintenance of canalicular and ostial patency. However, recent meta-analyses have not found a significant benefit from routine intubation. In addition, there are reports of complications with stents like granulomas, inflammation, punctal and canalicular cheese-wiring. This chapter will examine these aspects in the light of current literature.

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References

  1. Vicinanzo M, McGwin G, Long JA. The consequence of premature silicone stent loss after external dacryocystorhinostomy. Ophthalmology. 2008;115:1241–4.

    Article  PubMed  Google Scholar 

  2. Madge S, Selva D. Intubation in routine dacryocystorhinostomy: why we do what we do. Clin Exp Ophthalmol. 2009;37:620–3.

    Article  PubMed  Google Scholar 

  3. Madge S, Selva D, ANZSOPRS DCR Intubation Study Group. Canalicular intubation in routine dacryocystorhinostomy. Clin Exp Ophthalmol. 2009;37:533–44.

    Article  PubMed  Google Scholar 

  4. Griffiths J. Nasal catheter use in dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 1991;7:177–86.

    Article  CAS  PubMed  Google Scholar 

  5. Mäntynen J, Yoshitsugu M, Rautiainen M. Results of Dacryocystorhinostomy in 96 patients. Acta Otolaryngol Suppl. 1997;529:187–9.

    Article  PubMed  Google Scholar 

  6. Allen K, Berlin AJ. Dacryocystorhinostomy failure: association with nasolacrimal silicone intubation. Ophthalmic Surg. 1989;20:486–9.

    CAS  PubMed  Google Scholar 

  7. Anderson R, Edwards JJ. Indications, complications and results with silicone stents. Ophthalmology. 1979;86:1474–87.

    Article  CAS  PubMed  Google Scholar 

  8. Boboridis KG, Bunce C, Rose GE. Outcome of external dacryocystorhinostomy combined with membranectomy of a distal canalicular obstruction. Am J Ophthalmol. 2005;139:1051–5.

    Article  PubMed  Google Scholar 

  9. Smirnov G, Tuomilehto H, Terasvirta M, et al. Silicone tubing after endoscopic dacryocystorhinostomy: is it necessary? Am J Rhinol. 2006;20:600–2.

    Article  PubMed  Google Scholar 

  10. Zolli C, Shannon GM. Dacryocystorhinostomy: a review of 119 cases. Ophthalmic Surg. 1982;13:905–10.

    CAS  PubMed  Google Scholar 

  11. Mann B, Wormald PJ. Endoscopic assessment of the dacryocystorhinostomy ostium after endoscopic surgery. Laryngoscope. 2006;116:1172–4.

    Article  PubMed  Google Scholar 

  12. Chong K, Lai FHP, Ho M, et al. A randomized trial on silicone intubation in endoscopic mechanical dacryocystorhinostomy (SEND) for primary nasolacrimal duct obstruction (report). Ophthalmology. 2013;120:2139–45.

    Article  PubMed  Google Scholar 

  13. Allen K, Berlin AJ, Levine HL. Intranasal endoscopic analysis of dacryocystorhinostomy failure. Ophthal Plast Reconstr Surg. 1988;4:143–5.

    Article  CAS  PubMed  Google Scholar 

  14. Rosen N, Sharir M, Moverman DC, et al. Dacryocystorhinostomy with silicone tubes: evaluation of 253 cases. Ophthalmic Surg. 1989;20:115–9.

    CAS  PubMed  Google Scholar 

  15. Chan W, Selva D. Ostium shrinkage after endoscopic dacryocystorhinostomy. Ophthalmology. 2013;120:1693–6.

    Article  PubMed  Google Scholar 

  16. Linberg J, Anderson RL, Bumsted RM, et al. Study of intranasal ostium external dacryocystorhinostomy. Arch Ophthalmol. 1982;100:1758–62.

    Article  CAS  PubMed  Google Scholar 

  17. Older JJ. Routine use of a silicone stent in a dacryocystorhinostomy. Ophthalmic Surg. 1982;13:911–5.

    CAS  PubMed  Google Scholar 

  18. Pandya VB, Lee S, Benger R, et al. External dacryocystorhinostomy: assessing factors that influence outcome. Orbit. 2010;29:291–7.

    Article  PubMed  Google Scholar 

  19. Callejas C, Tewfik MA, Wormald PJ. Powered endoscopic dacryocystorhinostomy with selective stenting. Laryngoscope. 2010;120:1449–52.

    Article  PubMed  Google Scholar 

  20. Walland M, Rose GE. The effect of silicone intubation on failure and infection rates after dacryocystorhinostomy. Ophthalmic Surg. 1994;25:597–600.

    CAS  PubMed  Google Scholar 

  21. Rosser P. There is no use crying over spilt tears: the surgical management of primary acquired nasolacrimal duct obstruction. Aust N Z J Ophthalmol. 1999;27:95–100.

    Article  CAS  PubMed  Google Scholar 

  22. Choung H, Khwarg SI. Selective non-intubation of a silicone tube in external dacryocystorhinostomy. Acta Ophthalmol Scand. 2007;85:329–32.

    Article  PubMed  Google Scholar 

  23. Saeed B. Endoscopic DCR without stents: clinical guidelines and procedure. Eur arch Otorhinolaryngol. 2012;269:545–9.

    Article  PubMed  Google Scholar 

  24. Pittore B, Tan N, Salis G, et al. Endoscopic transnasal dacryocystorhinostomy without stenting: results in 64 consecutive procedures. Acta Otorhinolaryngol Ital. 2010;30:294–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Ananth L, Hosamani P, Chary G. Efficacy of endonasal dacryocystorhinostomy, using ‘cold steel’ instruments without stenting, in treatment of distal nasolacrimal duct obstruction. J Laryngol Otol. 2011;125:590–4.

    Article  CAS  PubMed  Google Scholar 

  26. Unlu H, Gunhan K, Baser EF, et al. Long-term results in endoscopic dacryocystorhinostomy: is intubation really required? Otolaryngol Head Neck Surg. 2009;140:589–95.

    Article  PubMed  Google Scholar 

  27. Smirnov G, Tuomilehto H, Teräsvirta M, et al. Silicone tubing is not necessary after primary endoscopic dacryocystorhinostomy: a prospective randomized study. Am J Rhinol. 2008;22:214–7.

    Article  PubMed  Google Scholar 

  28. Gu Z, Cao Z. Silicone intubation and endoscopic dacryocystorhinostomy: a meta-analysis. Head Neck Surg. 2010;39:710–3.

    Google Scholar 

  29. Unlu H, Aslan A, Toprak B, et al. Comparison of surgical outcomes in primary endoscopic dacryocystorhinostomy with and without silicone intubation. Ann Otol Rhinol Laryngol. 2002;111:704–9.

    Article  PubMed  Google Scholar 

  30. Feng YF, Cai JQ, Zhang JY, et al. A meta-analysis of primary dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol. 2011;46:521–7.

    Article  PubMed  Google Scholar 

  31. Cannon P, Chan WO, Selva D. Incidence of canalicular closure with endonasal dacryocystorhinostomy without intubation in primary nasolacrimal duct obstruction. Ophthalmology. 2013;120:1688–92.

    Article  PubMed  Google Scholar 

  32. Ali MJ, Psaltis AJ, Ali MH, et al. Endoscopic assessment of the dacryocystorhinostomy ostium after powered endoscopic surgery: behaviour beyond 4 weeks. Clin Exp Ophthalmol. 2015;43:152–5.

    Google Scholar 

  33. Murphy J, Ali MJ, Psaltis AJ. Biofilm quantification on nasolacrimal silastic stents after dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2015;31:396–400.

    Google Scholar 

  34. Ali MJ, Baig F, Lakshman M, et al. Scanning electron microscopic features of nasolacrimal silastic stents retained for prolong durations following dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2016;32:20–3.

    Google Scholar 

  35. Fayers T, Dolman PJ. Bicanalicular silicone stents in endonasal dacryocystorhinostomy: results of a randomized clinical trial. Ophthalmology. 2016;123:2255–9.

    Article  PubMed  Google Scholar 

  36. Malhotra R, Norris JH, Sagili S, et al. The learning curve in endoscopic dacryocystorhinostomy: outcomes in surgery performed by trainee oculoplastic surgeons. Orbit. 2015;34:314–9.

    Article  PubMed  Google Scholar 

  37. Ali MJ, Psaltis AJ, Murphy J, et al. Outcomes of primary powered endoscopic dacryocystorhinostomy: comparison between experienced versus less experienced surgeons. Am J Rhinol Allergy. 2014;28:514–6.

    Google Scholar 

  38. Kamal S, Ali MJ, Nair AG. Outcomes of endoscopic dacryocystorhinostomy: experience of a fellowship trainee at a tertiary care center. Ind J Ophthalmol. 2016;64:648–53.

    Google Scholar 

  39. Longari F, Dehgani Mobaraki P. Endoscopic dacryocystorhinostomy with and without silicone intubation: 4 years retrospective study. Eur Arch Otorhinolaryngol. 2016;273:2079–84.

    Article  CAS  PubMed  Google Scholar 

  40. Kalin-Hajdu E, Cadet N, Boulos PR. Controversies of the lacrimal system. Surv Ophthalmol. 2016;61:309–13.

    Article  PubMed  Google Scholar 

  41. Akcay E, Yuksel N, Ozen U. Revision external dacryocystorhinostomy results after a failed dacryocystorhinostomy surgery. Ophthalmol Ther. 2016;5:75–80.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Chen S, Le CH, Liang J. Practice patterns in endoscopic dacryocystorhinostomy: survey of the American Rhinologic Society. Int Forum Allergy Rhinol. 2016;6(9):990–7.

    Article  PubMed  Google Scholar 

  43. Jung SK, Kim YC, Cho WK, et al. Surgical outcomes of endoscopic dacryocystorhinostomy: analysis of 1083 consecutive cases. Can J Ophthalmol. 2015;50:466–70.

    Article  PubMed  Google Scholar 

  44. Yuksel D, Kosker M, Akoz I, et al. Long-term results of simultaneous bilateral external dacryocystorhinostomy in cases with bilateral dacryostenosis. Semin Ophthalmol. 2015;30:20–4.

    Article  PubMed  Google Scholar 

  45. Chisty N, Singh M, Ali MJ, et al. Long-term outcomes of powered endoscopic dacryocystorhinostomy in acute dacryocystitis. Laryngoscope. 2016;126:551–3.

    Google Scholar 

  46. Ali MJ, Psaltis AJ, Murphy J, et al. Powered endoscopic dacryocystorhinostomy: a decade of experience. Ophthal Plast Reconstr Surg. 2015;31:219–21.

    Google Scholar 

  47. Okuyucu S, Gorur H, Oksuz H, et al. Endoscopic dacryocystorhinostomy with silicone, polypropylene, and T-tube stents; randomized controlled trial of efficacy and safety. Am J Rhinol Allergy. 2015;29:63–8.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Ophthalmic Plastics Surgery, Royal Adelaide Hospital, Adelaide, Australia

    Edwin C. Figueira F.R.A.N.Z.C.O.

  2. Department of Ophthalmology, Wye Valley Trust, NHS, Hereford, UK

    Dan Brettell M.D., Andrea Zarkovic F.R.A.N.Z.C.O. & Simon N. Madge F.R.C.Ophth.

  3. Department of Ophthalmology, University of Hong Kong, Cyberport, Hong Kong

    Marcus M. Marcet M.D.

  4. Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia

    Dinesh Selva F.R.A.N.Z.C.O.

Authors
  1. Edwin C. Figueira F.R.A.N.Z.C.O.
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  2. Dan Brettell M.D.
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  3. Andrea Zarkovic F.R.A.N.Z.C.O.
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  4. Simon N. Madge F.R.C.Ophth.
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  5. Marcus M. Marcet M.D.
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  6. Dinesh Selva F.R.A.N.Z.C.O.
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Corresponding author

Correspondence to Dinesh Selva F.R.A.N.Z.C.O. .

Editor information

Editors and Affiliations

  1. Govindram Seksaria Insitute of Dacryology, L.V.Prasad Eye Institute, Hyderabad, India

    Mohammad Javed Ali

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© 2018 Springer Nature Singapore Pte Ltd.

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Figueira, E.C., Brettell, D., Zarkovic, A., Madge, S.N., Marcet, M.M., Selva, D. (2018). Debates in Dacryology: The Intubation Dilemma!. In: Ali, M. (eds) Principles and Practice of Lacrimal Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-10-5442-6_45

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  • DOI: https://doi.org/10.1007/978-981-10-5442-6_45

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  • Online ISBN: 978-981-10-5442-6

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