The Consequence of Premature Silicone Stent Loss after External Dacryocystorhinostomy
Received 31 January 2007; received in revised form 1 October 2007; accepted 3 October 2007. published online 12 December 2007.
Purpose
To investigate the clinical affects of premature silicone stent loss after external dacryocystorhinostomy (DCR).
Design
Retrospective chart review.
Participants
Two hundred thirty-three consecutive external dacryocystorhinostomies.
Methods
Demographic information was recorded, including length to follow-up, age, gender, number of days until stent removal, and success of surgery. All patients who extruded their silicone stent prematurely were identified. All were primary DCRs (i.e., all reoperations were excluded). All patients had had documented nasolacrimal duct obstruction before surgery, with or without current or prior dacryocystitis.
Main Outcomes Measures
Failure of DCR surgery was accepted as symptomatic epiphora with notable nasolacrimal duct blockage and/or infection at long term follow-up.
Results
Of the 233 DCRs, 42 stents extruded or had to be removed before the planned 2-month period. The overall success rate of the surgery was 94.9%, with a 90.5% success for those who had early extrusion and 95.8% for those who did not (P = 0.24). Moreover, of the 4 people who had a failed surgery (of 42 early extrusions), none had a recurrent infection or pain, and only 1 opted to have a revision of the surgery. Patient age, gender, or timing of the extrusion was not found to affect surgical success significantly.
Conclusions
Our experience and this study suggest that concerns over early stent extrusion or removal may not be wholly warranted. Moreover, our review of the literature shows no evidence-based recommendations that longer stent retention or reintubation after early extrusion results in a higher success rate. Although other surgeries (e.g., canalicular laceration, congenital epiphora) may benefit from intervention or reinsertion after early extrusion, we cannot extrapolate such a practice for the DCR.
Available online: February 20, 2008.
Department of Ophthalmology, University of Alabama—Birmingham, Birmingham, Alabama.
Correspondence and reprint requests to Matthew Vicinanzo, MD, 1000 19th Street South, Birmingham, AL 35205.
Manuscript no. 2007-144.
The authors have no financial support in this endeavor, nor do the authors have proprietary interest in the article, including any financial interest in any of the products described or the conclusions.
ABSTRACT