Co-existing lacrimal drainage anomalies in eyes with congenital Glaucoma

Aim To evaluate the occurrence of co-existing congenital nasolacrimal duct obstruction (CNLDO) and other lacrimal anomalies in eyes with congenital glaucoma (CG). Methods Retrospective analysis of children aged ≤1-year with co-existing CG and CNLDO seen between 1998 and 2019, treatment interventions and outcomes. Results During the study period, 1993 children had CG and 6203 children had CNLDO, among the children aged 1-year or less. Of these, 51 children (73 eyes) had co-existing CG and CNLDO. The prevalence of CNLDO in CG was 2.5% (51/1993) and the prevalence of CG among CNLDO was 0.8% (51/6203). Median age (Interquartile range, IQR) was 53 days (IQR: 8, 155), when they were diagnosed with CG. Among the children with CNLDO, 68 eyes (93.1%) had simple CNLDO, and 5 eyes (6.9%) had complex CNLDO. Associated lacrimal anomalies were present in 7/73 eyes, including congenital lacrimal fistula in two eyes, upper punctal agenesis and upper mid-canalicular obstruction in two eyes each, and upper single canalicular-wall hypoplasia in one eye. Lacrimal syringing and probing were successful in 69/72 eyes (95.8%), and failed in 3 eyes (4.2%). These 3 eyes had complex CNLDO and underwent Dacryocystorhinostomy (DCR) with Mitomycin-C and intubation. Sixty-two eyes underwent combined trabeculotomy and trabeculectomy, and two eyes underwent trabeculectomy. Median age at glaucoma surgery was 87 days (IQR: 54, 193). Median time delay for glaucoma surgery after probing was 18 days (IQR: 12, 35). Conclusion Among children aged ≤1-year presenting with congenital glaucoma coexisting lacrimal drainage anomalies was noted in 2.5% and simple CNLDO was the commonest. Early intervention is of paramount importance to prevent sight-threatening intraocular infection with CNLDO, and to minimize the delay of glaucoma surgery. The outcomes of lacrimal probing were excellent, however complex CNLDO required DCR.

Prevalence of Congenital Nasolacrimal Duct Obstruction and its related risk factors among newborns

Introduction: Lacrimal drainage system disorders are among the most common ocular disorders faced by physicians. The prevalence of congenital nasolacrimal duct obstruction (CNLDO) is different in various studies, and the role of such factors as maternal and neonatal demographic characteristics have not been completely investigated in CNLDO. The present study aimed to assess the prevalence of CNLDO and its related factors in newborns in Sabzevar. Methods: This cross-sectional study was conducted on 541 newborns in Shahidan Mobini hospital, Sabzevar, Iran from January to February 2015 after obtaining informed consent from their parents. Data were collected by interviewing mothers, filling out checklists, and physical examination of the newborns. Data analysis was carried out in Stata software using a logistic regression test at a 95% confidence interval. Results: The prevalence of CNLDO was 22.6%. Purulent ocular discharge was the most common symptom (16.82%). There was a significant relationship between the neonate’s head circumference and the incidence of CNLDO (P= 0.01); nonetheless, CNLDO in the newborns showed no significant association with weight, height, and Apgar score (P>0.05). Conclusion: Considering the significant prevalence of CNLDO in preterm and term neonates, as well as its variable prevalence rates reported in different studies and the absence of overlapping of various risk factors of such disorder, it is recommended to carry out more thorough studies from birth to 1 year of age.

Effect of Age on Primary Balloon Dacryocystoplasty and Probing Success in Congenital Nasolacrimal Duct Obstruction

Purpose: To compare the success rates of balloon dacryocystoplasty (BDP) and probing as a primary procedure in congenital nasolacrimal duct obstruction (CNLDO) and investigate the effect of age on both procedures.Methods: A total of 135 patients (171 eyes) with simple or incomplete complex CNLDO were included in this retrospective study; complete complex CNLDO cases were excluded. The success rates for primary BDP (118 eyes) and for probing (53 eyes) were compared as overall and among the age groups; Group 1 (12–24 months old), Group 2 (25–36 months old), and Group 3 (> 36 months old).Results: Mean age of the patients was 41.5±27.2 months for primary BDP, and 21.8±10.8 months for probing (p<0.001). Overall success rates for primary BDP and probing were 81.1% (43/53) and 76.3% (90/118), respectively (p=0.481). Success rates for BDP and probing among age groups were, 93.8% and 85.3% in Group 1 (p=0.306), 93.3% and 50.0% in Group 2 (p=0.012), and 63.6% and 27.3% in Group 3 (p=0.052), respectively. Cox regression analysis showed that the median ages were 18 months for probing and 36 months for primary BDP. Poisson regression model showed that, for every one-month increase in patients’ age, the success rate of probing decreased by 9.7%.Conclusion: Probing success decreased to a point where different treatment options such as primary BDP can be discussed with the patient’s parents after 18 months of age. The success of BDP decreased after 36 months, while it maintained a high success rate between 24-36 months as primary treatment.