Abstract
Objective
To compare the surgical outcomes of dacryocystorhinostomy with retrograde intubation
and conjunctivo-dacryocystorhinostomy for the management of proximal mid-bicanalicular
lacrimal obstruction.
Design
Randomized, controlled trial.
Methods
The study was conducted in 50 eyes of 50 adult patients with bicanalicular obstruction ≤ 6
mm from the punctum. The etiology, duration of symptoms, and Munk scores were recorded.
Group A underwent dacryocystorhinostomy with retrograde intubation, and in group B,
conjunctivo-dacryocystorhinostomy was performed. Success was defined as anatomic patency
on syringing, a negative fluorescein dye disappearance test, and a Munk score < 2
twelve months postoperatively.
Results
There were 23 males and 27 females, 18–66 years of age, with a 6-month to 20-year
duration of epiphora. The etiologies were idiopathic, trauma, and allergic conjunctivitis
and ocular surface inflammation. In group A, the pseudopunctum was located medial
to the diagnosed level of canalicular block by 1.28 ± 0.54 mm and 1.04 ± 0.88 mm in
upper and lower canaliculi, respectively. Four post-traumatic cases required intervention
following closure of the pseudopunctum, all being located ≥ 7 mm from the true punctum
(p = 0.001). The complication rate was higher in group B than in group A (p = 0.001). At 12 months, the success rate was 100% in group A and 88% in group B (22
of 25; p = 0.74), with reduction in Munk scores from preoperative levels in both groups (p = 0.001).
Conclusion
Dacryocystorhinostomy with retrograde intubation and conjunctivo-dacryocystorhinostomy
have comparable success rates in the management of proximal mid-bicanalicular obstructions.
Dacryocystorhinostomy with retrograde intubation has lower complication rates and
does not require long-term maintenance of the bypass tube, unlike conjunctivo-dacryocystorhinostomy.
Résumé
Objectif
Comparer les résultats chirurgicaux de la dacryocystorhinostomie (DCR) avec intubation
rétrograde et de la conjonctivo-dacryocystorhinostomie (C-DCR) dans la prise en charge
d'une obstruction lacrymale mi-bicanaliculaire proximale.
Nature
Étude comparative randomisée.
Méthodes
L’étude a porté sur 50 yeux de 50 adultes présentant une obstruction bicanaliculaire
située à ≤ 6 mm du point lacrymal. Ont été notés l’étiologie, la durée des symptômes
et le score de Munk. Les patients du groupe A ont subi une DCR avec intubation rétrograde
et ceux du groupe B, une C-DCR. La réussite reposait sur la présence des critères
suivants 12 mois après l'intervention : perméabilité des voies lacrymales confirmée
à l'aide d'une seringue, résultat négatif du test à la fluorescéine et score de Munk
< 2.
Résultats
Les antécédents d’épiphora des patients – 23 hommes et 27 femmes âgés de 18 à 66 ans
– s’échelonnaient de 6 mois à 20 ans. Au nombre des étiologies, mentionnons l’épiphora
idiopathique, les traumatismes, la conjonctivite allergique et l'inflammation de la
surface oculaire. Dans le groupe A, le pseudo-punctum était localisé en position médiale
par rapport au blocage canaliculaire diagnostiqué, soit à 1,28 ± 0,54 mm et à 1,04 ± 0,88
mm des canalicules supérieur et inférieur, respectivement. Quatre patients qui avaient
subi un traumatisme ont dû faire l'objet d'une intervention après l'occlusion du pseudo-punctum
situé, dans tous les cas, à ≥ 7 mm du véritable point lacrymal (p = 0,001). Le taux
de complications était plus élevé dans le groupe B que dans le groupe A (p = 0,001).
À 12 mois, le taux de réussite se chiffrait à 100 % dans le groupe A et à 88 % dans
le groupe B (22 sur 25; p = 0,74). On a enregistré une baisse du score de Munk dans
les 2 groupes, comparativement aux scores préopératoires (p = 0,001).
Conclusion
La DCR avec intubation rétrograde et la C-CDR ont des taux de réussite comparables
dans la prise en charge des obstructions lacrymales mi-bicanaliculaires proximales.
La DCR avec intubation rétrograde s'accompagne d'un taux de complications moins élevé
et n'exige pas d'entretien à long terme de la sonde de dérivation, contrairement à
la C-CDR.
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Article info
Publication history
Published online: August 06, 2021
Accepted:
July 6,
2021
Received in revised form:
June 30,
2021
Received:
May 13,
2021
Identification
Copyright
© 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
