Monocanalicular versus bicanalicular intubation in the treatment of congenital nasolacrimal duct obstruction

Pavel Komínek, Stanislav Cervenka, Tomáš Pniak, Karol Zeleník, Hana Tomášková, Petr Matoušek
Graefe's Archive for Clinical and Experimental Ophthalmology 2011, 249 (11): 1729-33

BACKGROUND: To compare the success rate of monocanalicular intubation (MCI) compared with bicanalicular silicone intubation (BCI) in congenital nasolacrimal duct obstruction (CNLDO) in infants and toddlers.

METHODS: In a prospective, nonrandomized, comparative study, MCI (n = 35 eyes) through the inferior canaliculus or BCI (n = 35 eyes) were performed under general anaesthesia in children aged 10 to 36 months with CNLDO. The tubes were removed 3-4 months after tube placement, and the children were followed up for 6 months after the removal of tubes. Therapeutic success was defined as the fluorescein dye disappearance test grade 0-1, corresponding with a complete resolution of previous symptoms. Partial success was defined as improvement with some residual symptoms.

RESULTS: Complete and partial improvement was achieved in 31/35 (88.57%) in the BCI group and 34/35 (97.14%) in the MCI group. The difference between the two groups was not significant (p = 0.584). Complications occurred in both groups. Dislodgement of the tube and premature removal was observed in four BCI cases, and loss of the tube was observed twice in the MCI group. Canalicular slitting was observed in five eyes in the BCI group. Granuloma pyogenicum observed in 2 cases with MCI revealed a few weeks after the tube removal. Corneal erosion in the inferior medial quadrant was observed in one MCI eye and revealed in a few days after the local treatment without tube removal.

CONCLUSIONS: Both MCI and the BCI are effective methods for treating CNLDO. MCI has the advantage of a lower incidence of canalicular slit and easy placement.

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