Clinical outcomes and prognostic factors in patients with nasolacrimal duct obstruction or stenosis using dacryoendoscopy.

Objective: To evaluate the effectiveness of dacryoendoscopic-assisted laser dacryoplasty with silicone intubation (DLDI) for the management of nasolacrimal duct obstruction (NLDO) or stenosis, and to identify the factors associated with DLDI failure.

Methods and analysis: This study was designed as a prospective, single-centre cohort study. Patients with NLDO or stenosis who underwent DLDI from December 2019 to December 2021 at Tianjin Eye Hospital were considered for enrolment. The Kaplan-Meier estimator was used to assess the anatomical and functional success rate of DLDI within 2 years follow-up after removal of the silicone stent. Cox proportional hazards regression models were used to identify risk factors for treatment failure.

Results: 170, 174 and 178 eyes were included in Groups A (proximal NLDO), B (distal NLDO) and C (nasolacrimal duct stenosis), respectively. The overall anatomical success rate was 84.8% for the entire cohort at the 2-year follow-up. The cumulative anatomical or functional success rate for Groups B and C was significantly higher than that for Group A. In the multivariable model, a higher risk of failed DLDI surgery was associated with a history of chronic dacryocystitis (HR=3.07; p<0.001) and a longer duration of epiphora than 1 year (HR=2.67; p<0.001). Of the 522 eyes, 37 patients (7.1%) had surgery-related complications.

Conclusions: DLDI is an effective minimally invasive technique for treatment in patients with distal NLDO or stenosis. Factors associated with a higher risk of reoperation include a longer duration of epiphora and a history of chronic dacryocystitis.

Trial registration number: NCT05999058.