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Self-Retaining Bicanaliculus Stents as an Adjunct to 3-Snip Punctoplasty in Management of Upper Lacrimal Duct Stenosis: A Comparison to Standard 3-Snip Procedure

Chalvatzis, Nikolaos T. M.D., Ph.D.*; Tzamalis, Argyrios K. M.D., Ph.D.*; Mavrikakis, Ioannis M.D., Ph.D.; Tsinopoulos, Ioannis M.D., Ph.D.*; Dimitrakos, Stavros M.D., Ph.D.*

Ophthalmic Plastic and Reconstructive Surgery: March/April 2013 - Volume 29 - Issue 2 - p 123–127
doi: 10.1097/IOP.0b013e31827f5a10
Original Investigations

Purpose: To evaluate the efficacy of self-retaining bicanaliculus stents when used as an adjunct to 3-snip punctoplasty in comparison with standard 3-snip procedure between fellow eyes.

Methods: Prospective, randomized, comparative study. Thirty-two eyes of 16 consecutive patients with acquired, nontraumatic stenosis of the proximal lacrimal duct were randomly distributed into 2 equal study groups. Lower punctal stenosis was a standard prerequisite. Group A (16 eyes) received a simple 3-snip punctoplasty, while group B (16 fellow eyes) underwent a modified 3-snip punctoplasty combined with insertion of self-retaining bicanaliculus stents. Duration of follow ups: 6 months. Anatomical, functional, and subjective parameters were evaluated.

Results: A statistically significant difference in anatomical success rates was observed in favor of group B (p = 0.011) 6 months postoperatively. Complete relief from epiphora was noted in 8 eyes of group B compared with 2 eyes of group A (p = 0.057). In regard to mixed (absolute and partial) functional success rates, group B exceeded with statistically significant difference (15 eyes group B vs. 6 eyes group A; p = 0.002). A nasolacrimal duct obstruction was subsequently diagnosed in 3 of the nonpatient eyes. Reintroduction of silicone tubes was required in 4 eyes of group B.

Conclusions: The use of self-retaining bicanaliculus stents seems to improve anatomical, functional, and subjective scores when combined with standard 3-snip punctoplasty in patients with acquired upper lacrimal duct stenosis.

Self-retaining bicanaliculus stents improve outcomes of traditional 3-snip procedure when combined together in cases of acquired, nontraumatic upper lacrimal duct stenosis.

*2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece; and Metropolitan Hospital, Athens, Greece

Accepted for publication November 14, 2012.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Nikolaos T. Chalvatzis, M.D., Ph.D., Amorgou 25, 55337, Thessaloniki, Greece. E-mail:

©2013The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.