PURPOSE: To compare the clinical outcomes of two treatment approaches for bilateral nasolacrimal duct obstruction (NLDO) in infancy. DESIGN: Multicenter, randomized clinical trial. METHODS: We studied 57 infants between the ages of 6 and <10 months who had bilateral NLDO. Participants were randomized to receive either (1) immediate office-based probing within two weeks (n = 31) or (2) 6 months of observation and nonsurgical management followed by surgical facility-based probing for unresolved cases (n = 26). Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) in both eyes on masked examination at 18 months of age. RESULTS: In the observation and deferred facility probing group, resolution without surgery occurred by 6 months after randomization in both eyes for 14 participants (56%), in one eye for 5 (20%), and in neither eye for 6 (24%). Eight participants in the observation and deferred facility probing group underwent facility probing (one of whom later had a second facility probing). Four participants in the immediate office probing group later underwent an additional procedure in a surgical facility. In the immediate office probing group, treatment success at 18 months of age occurred in both eyes for 19 of 29 (66%) participants and in one eye for 3 (10%); in the observation and deferred facility probing group, treatment success occurred in both eyes for 19 of 25 (76%) participants and in one eye for 3 (12%) (difference in success = -10%; 95% CI = -35% to 14%). CONCLUSIONS: Both the immediate office probing approach and the observation and deferred facility probing approach are successful and reasonable treatment options for infants with bilateral NLDO.
RCT Entities:
PURPOSE: To compare the clinical outcomes of two treatment approaches for bilateral nasolacrimal duct obstruction (NLDO) in infancy. DESIGN: Multicenter, randomized clinical trial. METHODS: We studied 57 infants between the ages of 6 and <10 months who had bilateral NLDO. Participants were randomized to receive either (1) immediate office-based probing within two weeks (n = 31) or (2) 6 months of observation and nonsurgical management followed by surgical facility-based probing for unresolved cases (n = 26). Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) in both eyes on masked examination at 18 months of age. RESULTS: In the observation and deferred facility probing group, resolution without surgery occurred by 6 months after randomization in both eyes for 14 participants (56%), in one eye for 5 (20%), and in neither eye for 6 (24%). Eight participants in the observation and deferred facility probing group underwent facility probing (one of whom later had a second facility probing). Four participants in the immediate office probing group later underwent an additional procedure in a surgical facility. In the immediate office probing group, treatment success at 18 months of age occurred in both eyes for 19 of 29 (66%) participants and in one eye for 3 (10%); in the observation and deferred facility probing group, treatment success occurred in both eyes for 19 of 25 (76%) participants and in one eye for 3 (12%) (difference in success = -10%; 95% CI = -35% to 14%). CONCLUSIONS: Both the immediate office probing approach and the observation and deferred facility probing approach are successful and reasonable treatment options for infants with bilateral NLDO.
Authors: Michael X Repka; B Michele Melia; Roy W Beck; C Scott Atkinson; Danielle L Chandler; Jonathan M Holmes; Alexander Khammar; David Morrison; Graham E Quinn; David I Silbert; Benjamin H Ticho; David K Wallace; David R Weakley Journal: J AAPOS Date: 2008-07-02 Impact factor: 1.220
Authors: Aaron M Miller; Danielle L Chandler; Michael X Repka; Darren L Hoover; Katherine A Lee; Michele Melia; Paul J Rychwalski; David I Silbert; Roy W Beck; Eric R Crouch; Sean Donahue; Jonathan M Holmes; Graham E Quinn; Nick A Sala; Susan Schloff; David K Wallace; Nicole C Foster; Kevin D Frick; Richard P Golden; Scott R Lambert; D Robbins Tien; David R Weakley Journal: J AAPOS Date: 2014-02 Impact factor: 1.220