title: Nasolacrimal stents for the treatment of epiphora: technical problems and long-term results.
abstract: OBJECTIVE
  To evaluate the long-term effectiveness of nasolacrimal stents for the treatment of obstructive epiphora, and the complications related to the procedure.
  
  
  METHODS
  This study is a non-randomized prospective clinical trial. Eighty-five patients underwent fluoroscopally-guided placement of polyurethane stent in 86 lacrimal systems for the treatment of severe idiopathic obstructive epiphora. The sites of obstruction were: sac-duct junction (n = 65), sac (n = 10), and nasolacrimal duct (n = 11). The procedure was performed in an outpatient basis under local anesthesia. Patients were followed for a mean of 24 months (1-84) with clinical examinations and/or dacryocystography. Clinical success was defined as symptoms resolution or improvement, and the patency of the lacrimal system to irrigation.
  
  
  RESULTS
  Stent placement was technically successful in 76 (88.4%) eyes. Technical failures (11.6%) were caused by inability to pass the guide-wire through the lacrimal system. Immediate complications occurred in 19 (22%) eyes, were mild and included: self-limited epistaxis (7), mild palpebral hematoma (7), moderate pain (3), lacrimal puncta bleeding (1), palpebral emphysema (1), and false passage (1). Of the 76 inserted stents, 33 (43.4%) became occluded, and 43 (56.6%) remained patent after a mean of 24 months. Mean duration of stent patency was 38 months. Clinical success was achieved in 40 (52.6%) of the successfully implanted stents.
  
  
  CONCLUSIONS
  The procedure is well tolerated and can be performed on an outpatient basis. Patency decreases with follow-up, and, in the long-term, the success rate is inferior to that achieved by external dacryocystorhynostomy. However, it many be considered as a valid alternative to surgery in selected patients.
authors.affiliation: Department of Radiology, Hospital Universitario La Paz, Madrid, Spain. i.pinilla@telefonica.net
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Pinilla
authors.forename: Andrés F
authors.initials: AF
authors.lastname: Fernández-Prieto
authors.forename: Mónica
authors.initials: M
authors.lastname: Asencio
authors.forename: Alvaro
authors.initials: A
authors.lastname: Arbizu
authors.forename: Natalia
authors.initials: N
authors.lastname: Peláez
authors.forename: Remedios
authors.initials: R
authors.lastname: Frutos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct; D011140:Polyurethanes; D015641:Radiography, Interventional; D015607:Stents / Q000009:adverse effects
chemical_list: D011140:Polyurethanes