Success rate of dacryocystorhinostomy with and without silicone intubation: a comparative study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20254081Keywords:
Dacryocystorhinostomy, Nasolacrimal duct obstruction, Silicone intubationAbstract
Background: Dacryocystorhinostomy (DCR) is the gold standard operation for nasolacrimal duct obstruction, (NLDO) creating a bypass between the lacrimal sac and nasal cavity to restore tear drainage and alleviate epiphora. The role of silicone intubation as a method of improving surgical outcomes is contentious, with conflicting evidence regarding whether it is effective and necessary.
Methods: The prospective comparative study was conducted at a tertiary care hospital in Dhaka, Bangladesh, from July 2019 to June 2024. Two hundred patients of chronic dacryocystitis were randomly placed in two groups: DCR with silicone intubation (n=100) and DCR without silicone intubation (n=100). Success was defined as freedom from epiphora, patent lacrimal passage on syringing, and no need for revision surgery. Data were analyzed using SPSS version 25, and statistical significance was established at p<0.05.
Results: The age was 30.41±7.41 years in the silicone group and 31.98±7.55 years in the non-silicone group, with female predominance (62% vs 58%). Success was higher in the silicone intubation group (96%) compared to the non-silicone group (88%). Failure was 4% in the silicone group and 12% in the non-silicone group. Binary logistic regression revealed that silicone intubation increased the chance of success by 5.26 times (95% CI: 1.24-22.34, p=0.024), and it was the most significant predictor of surgical success.
Conclusions: DCR with silicone intubation was more successful than DCR without intubation. High odds ratio supports the clinical benefit of routine silicone intubation for external DCR operations.
Metrics
References
Penttilä E, Smirnov G, Tuomilehto H, Kaarniranta K, Seppä J. Endoscopic dacryocystorhinostomy as treatment for lower lacrimal pathway obstructions in adults. Allergy Rhinol. 2015;6(1):ar-2015. DOI: https://doi.org/10.2500/ar.2015.6.0116
Shapira Y, Macri C, Selva D. Functional versus anatomical nasolacrimal obstruction: Are there differences in epiphora severity, symptoms, or effects on quality of life? Ophthalm Plast Reconstruct Surg. 2022;38(6):567-70. DOI: https://doi.org/10.1097/IOP.0000000000002208
Weber RK. Minimally invasive lacrimal surgery. In Minimally Invasive Ophthalmic Surgery. Berlin, Heidelberg: Springer Berlin Heidelberg. 2010;33-57. DOI: https://doi.org/10.1007/978-3-642-02602-7_3
Pramod KC, Pipariya PR. A comparative study of DCR versus TOTI's procedure. J Evolut Med Dental Sci. 2014;3(17):4688-98.
Mandeville JT, Woog JJ. Obstruction of the lacrimal drainage system. Curr Opin Ophthalmol. 2002;13(5):303-9. DOI: https://doi.org/10.1097/00055735-200210000-00003
Alturkistany W, Allen R, Aloqab A, Schellini S, Yuen H, Strianese D, et al. DCR preferences among oculoplastic surgeons: barriers and facilitators to adoption of endoscopic DCR. Europ J Ophthalmol. 2024;34(1):102-11. DOI: https://doi.org/10.1177/11206721231175933
Feng YF, Cai JQ, Zhang JY, Han XH. A meta-analysis of primary dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol. 2011;46(6):521-7. DOI: https://doi.org/10.1016/j.jcjo.2011.09.008
Smirnov G, Tuomilehto H, Terasvirta M, Nuutinen J, Seppa J. Silicone tubing is not necessary after primary endoscopic dacryocystorhinostomy: a prospective randomized study. Am J Rhinol. 2008;22(2):214-7. DOI: https://doi.org/10.2500/ajr.2008.22.3132
Ali MJ, Psaltis AJ, Wormald PJ. Dacryocystorhinostomy ostium: parameters to evaluate and DCR ostium scoring. Clin Ophthalmol. 2014;8:2491-9. DOI: https://doi.org/10.2147/OPTH.S73998
Ali MJ, Paulsen F. Human lacrimal drainage system reconstruction, recanalization, and regeneration. Current Eye Res. 2020;45(3):241-52. DOI: https://doi.org/10.1080/02713683.2019.1580376
Fayers T, Laverde T, Tay E, Olver JM. Lacrimal surgery success after external dacryocystorhinostomy: functional and anatomical results using strict outcome criteria. Ophthal Plast Reconstruct Surg. 2009;25(6):472-5. DOI: https://doi.org/10.1097/IOP.0b013e3181b81e9f
Tsui KH, Shvarts O, Smith RB, Figlin RA, Dekernion JB, Belldegrun A. Prognostic indicators for renal cell carcinoma: a multivariate analysis of 643 patients using the revised 1997 TNM staging criteria. J Urol. 2000;163(4):1090-5. DOI: https://doi.org/10.1016/S0022-5347(05)67699-9
Zannad F, Garcia AA, Anker SD, Armstrong PW, Calvo G, Cleland JG, et al. Clinical outcome endpoints in heart failure trials: a European Society of Cardiology Heart Failure Association consensus document. Europ J Heart Failure. 2013;15(10):1082-94. DOI: https://doi.org/10.1093/eurjhf/hft095
Vitale C, Jankowska E, Hill L, Piepoli M, Doehner W, Anker SD, et al. Heart Failure Association of the European Society of Cardiology position paper on frailty in patients with heart failure. Europ J Heart Failure. 2019;21(11):1299-305. DOI: https://doi.org/10.1002/ejhf.1611
Gleich SJ, Nicholson WT, Jacobs TM, Hofer RE, Sprung J. Inability to ventilate while using a silicone-based endotracheal tube. J Clin Anesth. 2008;20(5):389-92. DOI: https://doi.org/10.1016/j.jclinane.2008.03.008
Sales De Castro EM, Semail B, Amberg M. Low Frequency Ultrasound Diagnostics Sensor for Pressure Ulcers. Online event, Poland. EPUAP Virtual Meeting. 2021.
Akbari M, Jalali MM, Nasirmohtaram S, Habibi AF, Moghadam RS, Mazloom F, et al. Comparison of Results of Primary Endoscopic Dacryocystorhinostomy with and Without Silicon Stent Placement: A Randomized Clinical Trial. Indian J Otolaryngol Head Neck Surg. 2025;77(5):2097-103. DOI: https://doi.org/10.1007/s12070-025-05453-0
Ing EB, Bedi H, Hussain A, Zakrewski H, Ing R, Nijhawan N, et al. Meta-analysis of randomized controlled trials in dacryocystorhinostomy with and without silicone intubation. Canad J Ophthalmol. 2018;53(5):466-70. DOI: https://doi.org/10.1016/j.jcjo.2017.12.006
Kaçaniku G, Spahiu K. The success rate of external dacryocystorhinostomy. Med Arch. 2009;63(5):292.
Naik L, Bhardwaj N, Sen IM, Sondekoppam RV. Intubation Success through I‐Gel® and Intubating Laryngeal Mask Airway® Using Flexible Silicone Tubes: A Randomised Noninferiority Trial. Anesthesiol Res Pract. 2016;2016(1):7318595. DOI: https://doi.org/10.1155/2016/7318595
Xie C, Zhang L, Liu Y, Ma H, Li S. Comparing the success rate of dacryocystorhinostomy with and without silicone intubation: a trial sequential analysis of randomized control trials. Scient Rep. 2017;7(1):1936. DOI: https://doi.org/10.1038/s41598-017-02070-y