Randomized Controlled Trial on Silicone Intubation in Endoscopic Mechanical Dacryocystorhinostomy (SEND): An 11-year Outcome Report

To compare the long-term outcomes of mucosal-sparing mechanical endoscopic dacryocystorhinostomy (MMED) for primary acquired nasolacrimal duct obstruction (PANDO) with or without silicone intubation. An 11-year follow-up study of the Silicone intubation in Endoscopic Dacryocystorhinostomy (SEND) ran...

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Published in:	Seminars in ophthalmology pp. 1 - 7
Main Authors:	Chan, Karen Kar-Wun, Yung, Grace Wing, Chee, Arnold Shau Hei, Chin, Joyce Kar Yee, Ong, Tiffany Ho Ling, Yiu, Angela On Ying, Lo, Thomas Chun Hei, Zhang, Yuzhou, Hiu Ping Lai, Frank, Yip, Wilson Wai Kuen, Young, Alvin Lerrmann, Yuen, Hunter Kwok Lai, Ali, Mohammad Javed, Chong, Kelvin Kam Lung
Format:	Journal Article
Language:	English
Published:	England 08-09-2024
Subjects:	Endoscopic dacryocystorhinostomy epiphora long-term outcome silicone intubation randomized controlled trial
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Summary:	To compare the long-term outcomes of mucosal-sparing mechanical endoscopic dacryocystorhinostomy (MMED) for primary acquired nasolacrimal duct obstruction (PANDO) with or without silicone intubation. An 11-year follow-up study of the Silicone intubation in Endoscopic Dacryocystorhinostomy (SEND) randomized controlled trial (RCT) was conducted at a university-affiliated dacryology clinic from December 2019 to March 2023. Questionnaires on symptoms, anterior segment examination, endoscopic examination with functional endoscopic dye test (FEDT) and FICI grading, and ostial size measurements using software were performed by a masked ophthalmologist. The primary outcome was surgical success, defined by Munk's score ≤1 and a positive fluorescein endoscopic dye test. Secondary outcomes included risk factors for failure and outcomes of revision surgeries. Fifty-three of the original 118 patients were evaluated at 155 ± 21 (136-218) months postoperatively. Seventy-seven percent (46/60) ostia remained successful, including 70% (19/27) of unstented and 82% (27/33) of stented ostia (p = .3). Stented ostia had larger size (p = .003), but this did not confer higher success (p = .14). Successful ostia had higher FICI scores and better ostial dynamicity (p < .05). Ostium movement was the only parameter associated with surgical success on multivariate analysis (OR 13.1, p = .01). Four (1 stented) underwent revision MMED, intraoperative mitomycin-C, and 12-week intubation. All revision ostia were functional after 141 ± 43 months. Surgical success of MMED after 11-years was 77%, a notable reduction compared to 96% success at 1-year. Statistical advantage of silicone intubation for primary MMED was not demonstrated, though clinically, stented ostia had a higher success (82% vs 70%). The presence of a dynamic internal common opening was highly associated with long-term surgical success.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0882-0538 1744-5205 1744-5205
DOI:	10.1080/08820538.2024.2385391