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Balloon Catheter Dilation and Nasolacrimal Duct Intubation for Treatment of Nasolacrimal Duct Obstruction After Failed Probing
Pediatric Eye Disease Investigator Group*
Arch Ophthalmol. 2009;127(5):633-639.
Objective To compare the outcomes of balloon catheter dilation and nasolacrimal intubation as treatment for congenital nasolacrimal duct obstruction after failed probing in children younger than 4 years.
Methods We conducted a prospective, nonrandomized, multicenter study that enrolled 159 children aged 6 months to younger than 48 months who had a history of a single failed nasolacrimal duct probing and at least 1 of the following clinical signs of nasolacrimal duct obstruction: epiphora, mucous discharge, or increased tear lake. One hundred ninety-nine eyes underwent either balloon catheter nasolacrimal duct dilation or nasolacrimal duct intubation. Treatment success was defined as absence of epiphora, mucous discharge, or increased tear lake at the outcome visit 6 months after surgery.
Results Treatment success was reported in 65 of 84 eyes (77%; 95% confidence interval, 65%-85%) in the balloon catheter dilation group compared with 72 of 88 eyes (84% after adjustment for intereye correlation; 74%-91%) in the nasolacrimal intubation group (risk ratio for success for intubation vs balloon dilation, 1.08; 0.95-1.22).
Conclusion Both balloon catheter dilation and nasolacrimal duct intubation alleviate the clinical signs of persistent nasolacrimal duct obstruction in a similar percentage of patients.
*Authors/Group Information: The members of the Writing Committee and the Pediatric Eye Disease Investigator Group are listed here.
Writing Committee: The following individuals take authorship responsibility for the study results: Michael X. Repka, MD (Wilmer Ophthalmological Institute, The Johns Hopkins University, Baltimore, Maryland), and Danielle L. Chandler, MSPH (Jaeb Center for Health Research, Tampa, Florida), lead authors; Jonathan M. Holmes, BM, BCh (Mayo Clinic, Rochester, Minnesota), Darren L. Hoover, MD (in private practice in Pittsburgh, Pennsylvania), Christine L. Morse, MD (in private practice in Concord, New Hampshire), Susan Schloff, MD (in private practice in St Paul, Minnesota), David I. Silbert, MD (in private practice in Lancaster, Pennsylvania), and D. Robbins Tien, MD (in private practice in Providence, Rhode Island).
Site Investigators: Sites are listed in order by number of patients enrolled in the study. Personnel are listed as investigator (I), coordinator (C), or examiner (E): Nicholas A. Sala (I), Rhonda M. Hodde (C), and Veda L. Zeto (C) (Pediatric Ophthalmology of Erie, Erie, Pennsylvania); Darren L. Hoover, MD (I) and Pamela A. Huston (C) (Everett & Hurite Ophthalmic Association, Pittsburgh); Susan Schloff, MD (I) and Valori E. Host (C) (Associated Eye Care, St Paul); Christine L. Morse, MD (I) and Caroline C. Fang (C) (Concord Eye Care PC, Concord); D. Robbins Tien, MD (I), Glenn E. Bulan (I), Danielle M. Ledoux (I), Heidi C. Christ (C), Myra B. McGuinness (C), and Brenda G. Toro (E) (Pediatric Ophthalmology and Strabismus Associates, Providence); Don L. Bremer (I), Cybil M. Cassady (I), Richard P. Golden (I), Mary Lou McGregor (I), Gary L. Rogers (I), and Rae R. Fellows (C) (Pediatric Ophthalmology Associates, Inc, Columbus, Ohio); Evelyn A. Paysse (I), Kimberly G. Yen (I), Maria Castanes (C), and Michele L. Parker (C) (Texas Children's Hospital, Houston); C. Gail Summers (I), Jill S. Anderson (I), Erick D. Bothun (I), Stephen P. Christiansen (I), Andrew R. Harrison (I), Ann M. Holleschau (C), Kimberly S. Merrill (E), and Katherine M. Hogue (E) (University of Minnesota, Minneapolis*); Anna Steele (I), Christopher M. Bardorf (I), Justin T. Cohen (I), Diana M. DeSantis (I), Robert A. King (I), Jamie Kilpatrick (C), Shari A. Lufcy (E), Andrea X. Mosher (E), and Crystal X. Vasquez (E) (Children's Eye Physicians, Englewood, Colorado); Scott R. Lambert (I), Amy K. Hutchinson (I), and Rachel A. Robb (C) (Emory Eye Center, Atlanta, Georgia); David I. Silbert, MD (I) and Noelle S. Matta (C) (Family Eye Group, Lancaster); Katherine A. Lee (I) and Bonita R. Schweinler (C) (Intermountain Eye Centers, Boise, Idaho); Donny W. Suh (I), Marilee McNeece (C), Rhonda J. Countryman (E), and Lisa Fergus (E) (Wolfe Clinic, West Des Moines, Iowa); Benjamin H. Ticho (I), Alexander J. Khammar (I), and Deborah A. Clausius (C) (Eye Specialists Center, LLC, Chicago Ridge, Illinois); Lucas Trigler (I), R. Michael Siatkowski (I), Connie J. Dwiggins (C), and Kathy S. Weekley (C) (Dean A. McGee Eye Institute, University of Oklahoma, Oklahoma City); Deborah L. Klimek (I), Crystal A. Sigmon (C), and Lisa L. Winter (C) (Children's Eye Care & Adult Strabismus Surgery, South Charleston, West Virginia); Michael John Bartiss (I) and Tennille F. McGaw (C) (Family Eye Care of the Carolinas, Aberdeen, North Carolina); Dave H. Lee (I), Nieca D. Caltrider (I), and Kelly A. Martinez (C) (Children's Eye Center, Colorado Springs, Colorado); Laura B. Enyedi (I), David K. Wallace (I), and Sarah K. Jones (C) (Duke University Eye Center, Durham, North Carolina); Joel Weinstein (I), Michael J. Wilkinson (I), and Laura E. Walter (C) (Penn State University, Hershey, Pennsylvania); Mark D. Steinvurzel (I) (Mark D. Steinvurzel, MD, PLLC, South Charleston, West Virginia); Charles R. Whitfill (I), David A. Johnson (I), and Ruth D. Dannar (C) (Grene Vision Group, Wichita, Kansas); Mary Louise Z. Collins (I) and Maureen A. Flanagan (C) (Greater Baltimore Medical Center, Baltimore); William F. Astle (I), Michael E. Ashenhurst (I), Kenneth G. Romanchuk (I), Ania M. Paszuk (C), and Heather J. Peddie (C) (Alberta Children's Hospital, Calgary, Canada); David R. Weakley (I) and Clare L. Dias (C) (University of Texas Southwestern Medical Center, Dallas); Sean P. Donahue (I), David G. Morrison (I), Genise G. Mofield (C), and Sandy A. Owings (C) (Vanderbilt Eye Center, Nashville, Tennessee*); Brian J. Forbes (I), James A. Katowitz (I), Monte D. Mills (I), Graham E. Quinn (I), Alexandra Huebner (C), Tina Alvarado Taylor (C), Melissa L. Ehnbom (E), David R. Phillips (E), and Sonia Zhu (E) (Children's Hospital of Philadelphia, Philadelphia, Pennsylvania); Matthew D. Gearinger (I), Nancy M. Fedick (C), and Doreen M. Francis (C) (University of Rochester Eye Institute, Rochester, New York); James B. Ruben (I) and Dipti Desai (C) (Permanente Medical Group, Sacramento, California); Todd A. Goldblum (I), Angela Alfaro (C), Rachel Baca (C), and Regan R. Foster (E) (Children's Eye Center of New Mexico, Albuquerque); Monte A. Del Monte (I), Maya Eibschitz-Tsimhoni (I), and Jorie L. Jackson (C) (University of Michigan, Ann Arbor); David R. Stager (I) and Joost Felius (C) (Pediatric Ophthalmology, Dallas, Texas); Patrick J. Droste (I), Robert J. Peters (I), and Jan Hilbrands (C) (Pediatric Ophthalmology, PC, Grand Rapids, Michigan); Yasmin S. Bradfield (I) and Erika D. Soderling (C) (University of Wisconsin, Madison); David I. Silbert (I) and Noelle S. Matta (C) (Armesto Eye Association, Mechanicsburg, Pennsylvania); David T. Wheeler (I), John Ng (I), Ann U. Stout (I), Kimberley A. Beaudet (C), Claudia Nichols (E), Paula Rauch (E), and Sharon Susanka (E) (Casey Eye Institute, Portland, Oregon*); Mary O'Hara (I) and Maedi M. Bartolacci (C) (University of California, Davis, Sacramento); Andrew J. Levada (I), Jonathan E. Silbert (I), David N. Comstock (C), Cheryl Schleif (C), Tabitha L. Walker (C), Lakiesha M. Gentry (E), and Lisa A. Marcil (E) (Eye Care Group, PC, Waterbury, Connecticut); Deborah R. Fishman (I), Lisa C. Verderber (I), and JoAnn Spieker (C) (Pediatric Eye Associates, Wilmette, Illinois).
*Center received support for this project from an unrestricted grant from Research to Prevent Blindness Inc, New York, New York.
Nasolacrimal Duct Obstruction Treatment Study Steering Committee: Darron A. Bacal (2005), Danielle L. Chandler, Stephen P. Christiansen (2005), Eric R. Crouch III (2006-2007), Donald F. Everett, Jonathan M. Holmes, Katherine A. Lee (2006-2007), Noelle S. Matta (2005), Michael X. Repka, David I. Silbert, Susan Schloff (2006-2007), Bonita Schweinler (2007), D. Robbins Tien, David K. Wallace, and Lori Zeto (2006).
PEDIG Coordinating Center, Tampa: Roy W. Beck, Brian D. Becker, Nicole M. Boyle, Christina M. Cagnina-Morales, Debora A. Cagnina, Danielle L. Chandler, Laura E. Clark, Sharon R. Constantine, Katrina L. Dawson, Quayleen Donahue, Mitchell Dupre, Brooke P. Fimbel, Heidi A. Gillespie, Raymond T. Kraker, Stephanie V. Lee, Lee Anne Lester, Shelly T. Mares, B. Michele Melia, Pamela S. Moke, Jim L. Pyner, Nicole Reese, Diana E. Rojas, Sydney L. Shrader, and Heidi J. Strayer.
National Eye Institute, Bethesda, Maryland: Donald F. Everett.
PEDIG Executive Committee: Roy W. Beck, Eileen E. Birch, Stephen P. Christiansen (2007- 2008), Susan A. Cotter, Sean P. Donahue (2005-2006), Donald F. Everett, Jonathan M. Holmes, Darren L. Hoover (2007-2008), Raymond T. Kraker (2005-Present), Michael X. Repka, Nicholas A. Sala (2006), Mitchell M. Scheiman (2007-2008), and David K. Wallace (2006-current).
PEDIG Data and Safety Monitoring Committee: John D. Baker, William Barlow, Edward G. Buckley, Barry Davis, Velma Dobson, John L. Keltner, Hana Osman, Earl A. Palmer, Dale L. Phelps, Stephen W. Poff, Richard A. Saunders, Lawrence Tychsen, and Marie Diener-West.
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