A recent randomized clinical trial emphasizes the importance of tailoring treatment strategies for simple Congenital Nasolacrimal Duct Obstruction (CNLDO) based on patient age. The study, published in Scientific Reports, investigates the comparative efficacy of probing with or without intubation, and/or inferior turbinate fracture in children aged 12 to 36 months.
The research challenges the conventional age-based approach that treats CNLDO as a homogeneous disease. Some advocate for a one-stage approach, categorizing patients based on obstruction type (simple or complex) and individualizing treatment intra-operatively.
Impact of Intubation and Turbinate Fracture
The study reveals that adding interventions like intubation and/or turbinate fracture to conventional probing does not significantly alter the success rate of simple CNLDO resolution in children aged 12 to 24 months. However, in older cases (24 to 36 months), interventions including intubation may lead to higher success rates for disease resolution.
"Surgeons' preferences for simple CNLDO treatment should consider factors such as patient age, surgical skills, available instruments, and parental preferences," the authors noted.
Alignment with Existing Literature
The success rates observed in the study align with previous research. Probing alone has demonstrated resolution of CNLDO in 70–97% of cases, consistent with the study's rates of 93.1% and 72.7% for the 12–24 and 24–36 months age groups, respectively. Similarly, success rates after monocanalicular intubation in the study (95.7% and 93.3% for 12–24 and 24–36 months age groups, respectively) are comparable to previous studies reporting success rates between 79% and 96%.
The efficacy of intubation alongside probing is also consistent with existing literature. While some studies show no significant difference in success rates between probing with and without intubation, others demonstrate higher success rates with intubation, particularly in complex CNLDO cases or older children. A meta-analysis revealed that intubation alongside probing in simple CNLDO cases did not significantly increase the success rate (87% for probing versus 92% for probing and intubation), while it significantly improved outcomes in complex cases (46% for probing vs. 82% for probing and intubation).
Study Limitations
The authors acknowledge several limitations, including a small sample size in each group, a relatively short 3-month follow-up period, and the omission of nasal endoscopy during probing, which may have led to overlooking intraoperative findings associated with complex disease types. The single-center nature of the study also limits generalizability.
Conclusion
This study underscores the importance of tailoring simple CNLDO treatment strategies to individual patient characteristics, particularly age. While additional interventions such as intubation may offer higher success rates in older children, they may not significantly impact outcomes in younger children. Further multi-center studies with larger sample sizes and longer follow-up periods are warranted to validate these findings and assess the impact of CNLDO on the health-related quality of life of parents and children.
