Computed tomographic dacryocystography in children undergoing balloon dacryoplasty

• Published in: Journal of AAPOS Vol. 16; no. 5; pp. 464 - 467
• Main Authors: Limongi, Roberto M., MD, Magacho, Leopoldo, MD, Matayoshi, Suzana, MD, Carneiro, Haroldo M., MD, Ávila, Marcos, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-10-2012
• Subjects: Child; Child, Preschool; Contrast Media; Dacryocystorhinostomy - methods; Dilatation, Pathologic - etiology; Dilatation, Pathologic - surgery; Humans; Iohexol; Lacrimal Duct Obstruction - congenital; Lacrimal Duct Obstruction - diagnostic imaging; Nasolacrimal Duct - diagnostic imaging; Nasolacrimal Duct - surgery; Ophthalmology; Prospective Studies; Radiography, Interventional - methods; Tomography, X-Ray Computed - methods
• ISSN: 1091-8531; 1528-3933
• DOI: 10.1016/j.jaapos.2012.07.001

Purpose To ascertain whether the volume and circumference of the lacrimal sac and nasolacrimal duct as measured by contrast-enhanced computed tomographic dacryocystography (CT-DCG) before and after balloon dacryoplasty could be used to predict clinical success in children with congenital nasolacrimal obstruction. Methods Nasolacrimal ducts of children aged 2 to 6 years with clinical signs of congenital nasolacrimal duct obstruction undergoing balloon dilation were imaged with contrast-enhanced CT-DCG before and 5 minutes after the procedure. The circumference of the most dilated portion of the lacrimal sac was measured on the axial plane. The volume of contrast within the nasolacrimal duct and sac was also measured before and after the procedure. Clinical success was defined as the disappearance of signs of epiphora. Results A total of 18 nasolacrimal ducts of 13 children were included. The average circumference of the most dilated portion of the lacrimal sac was 1.30 ± 0.45 cm (range, 0.64–2.50 cm) before the procedure. The average contrast volume was 0.12 ± 0.08 cm3 (range, 0.01-0.38 cm3 ) before and 0.07 ± 0.06 cm3 (range, 0.01–0.20 cm3 ) after ( P = 0.01). Data were analyzed using multivariate logistic regression with a backward variable input model; a decrease in contrast volume before and after dilation ( P = 0.04) was associated with clinical success, whereas the larger size of the most dilated portion of the lacrimal sac ( P = 0.01) was associated with clinical failure. Conclusions Contrast-enhanced CT-DCG provides useful information about nasolacrimal anatomy in children with congenital nasolacrimal duct obstruction. The decrease in contrast volume before and after balloon dilation was predictive of success; A larger size of the most dilated portion of the lacrimal sac was associated with clinical failure.