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.
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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
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
