Dacryoendoscopic surgery and tube insertion in patients with common canalicular obstruction and ductal stenosis as a frequent complication.
OBJECTIVE
To report the performance of a new technique and strategy for treating common canalicular obstruction (CCO). Since ductal stenosis is a frequent complication of CCO, access to the whole lacrimal passage is important for CCO treatment.


METHODS
In a retrospective, nonrandomized clinical trial, 46 patients (57 CCO cases, 42-93 years old) were treated with either dacryoendoscopic canalicular incision (EI) dacryoendoscope-guided tube insertion (EGT), EI plus inferior meatal dacryocystorhinostomy (iDR)/EGT, EI plus endonasal dacryocystorhinostomy (enDCR), or external canaliculo-DCR depending on the degree of ductal stenosis. The dacryoendoscope was used for incisional positioning, examination and guidance.


RESULTS
Ductal stenoses/obstructions were complicated in 14 of 57 CCO cases (24.5%). The success rate after 6-25 months of postoperative follow-up was 89.5% (51/57 cases). The success rates after EI/EGT alone, EI plus enDCR, and EI/EGT plus iDR were 90.4% (38/42 cases), 100% (4/4 cases), and 90% (9/10 cases), respectively. In one case, false passages through the submucosa of the canaliculi were identified, and the surgical approach was converted from EI/EGT to canaliculo-DCR.


CONCLUSIONS
EI/EGT alone is an effective, minimally invasive method for treatment of simple CCO. Additional lacrimal surgery (iDR/ EGT, enDCR, and canaliculo-DCR) is effective for complicated CCO.
Sasaki
Tsugihisa
T
Department of Ophthalmology, Kanazawa University School of Medicine, Kanazawa, Japan. sasatsug@gmail.com.|Sasaki Eye Clinic, Mikuni, Sakai, Japan. sasatsug@gmail.com.|Department of Ophthalmology, Fukui Prefectural Hospital, Fukui, Japan. sasatsug@gmail.com.|Sasaki Eye Clinic, 5-2-6 Mikuni, Sakai, 913-0016, Japan. sasatsug@gmail.com.
Sounou
Tsutomu
T
Department of Ophthalmology, Kanazawa University School of Medicine, Kanazawa, Japan.|Department of Ophthalmology, NTT West Japan Kanazawa Hospital, Kanazawa, Japan.
Sugiyama
Kazuhisa
K
Department of Ophthalmology, Kanazawa University School of Medicine, Kanazawa, Japan.