Nasolacrimal stenting: toward improving outcomes with a simple modification of the song stent

• Published in: Cardiovascular and interventional radiology Vol. 29; no. 4; pp. 586 - 594
• Main Authors: Lanciego, Carlos, De Miguel, Silvia, Padilla, Manuel, Perea, Miguel, Rodriguez-Merlo, Rufo, García-García, Lorenzo
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 01.08.2006
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Equipment Design; ETIOLOGY; EYES; FAILURES; Female; Humans; Lacrimal Apparatus Diseases - surgery; Male; Middle Aged; Nose - surgery; PATIENTS; POLYURETHANES; RADIOLOGY AND NUCLEAR MEDICINE; SENSE ORGANS DISEASES; Stents; Treatment Outcome
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-004-0297-9

The purpose of this study was to evaluate, in a prospective, single-center study, the effectiveness of Song's polyurethane stents, modified "in-house," in the percutaneous management of epiphora. Patients (n = 170; age range 18-83, mean = 64; 50 male, 120 female) with severe epiphora had the modified stents inserted (183 eyes/195 stents) to treat unilateral/bilateral and complete/partial obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 119 cases (61%) and chronic dacryocystitis in 76 (39%). The set designed by Song was used in all patients but modified by us such that the extreme end is cone-shaped. The original technique was slightly modified by us and the procedure was conducted on an outpatient basis. The initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 180 eyes and partial in 3. On follow-up (mean = 18 months; range: 2 days to 24 months), 165 of 195 stents (85%) remained patent. Primary patency rates at follow-up were 86%, 84%, 84%, and 79% in the first 6 months, second and third 6 months, and the present (24 months), respectively. Stents became obstructed in 30 patients, but all but 2 were easily withdrawn and 20 of these patients remained asymptomatic for a mean of 14 months (secondary patency of 67%). Following stent removal, the withdrawn stent was replaced with a new stent in the same intervention on 14 occasions. In another six cases, patency was re-established without the need of a second stent. The procedure is simple and safe, both in stent insertion as well as in mechanical de-blocking and withdrawal when occluded. Success was >80 % in the short term (1-year follow-up). Stenting failure does not preclude other treatment because with the modification that we had introduced, the extreme end of the stent becomes more accessible to mechanical de-blocking, withdrawal, and relocation. The levels of primary and secondary patencies are promising and warrant more extensive investigation.