Visual and Refractive Outcomes in Early Versus Late Congenital Nasolacrimal Duct Obstruction Spontaneous Resolution or Intervention
Thomas B. Gillette, MD; Kristina Tarczy-Hornoch, MD, DPhil; Leona Ding, MS; Calvin Lee; Darren Liu; Michelle T. Cabrera, MD
University of Washington
Introduction: Among patients presenting with congenital nasolacrimal duct obstruction over 9 months old, this study investigates whether late (> 1 year) spontaneous resolution or late (> 15 months) surgical intervention results in poorer visual outcomes compared to early resolution or intervention.
Methods: The medical records of patients at a single tertiary pediatric ophthalmology clinic from 2007 to 2017 were retrospectively reviewed. Rates of clinically significant anisometropia (>/= 1 D of sphere or cylinder) and amblyopia (>/= 2 lines difference in Teller acuity or optotype testing) between eyes over 15 months of age were compared between groups
Results: Of 319 patients included, 167/319 (52.3%) were unilateral and 152/319 (47.6%) were bilateral. Fifty-five of 319 (17.2%) had early intervention/resolution, 214/319 (67.1%) had late intervention/resolution, and 50/319 (15.7%) were unknown. Of those with known intervention/resolution, 239/267 (89.5%) received surgery and 28/267 (10.5%) resolved spontaneously. The median age at surgical intervention in the early group was 13 (range: 2-15) months compared to 27 (range: 16-142) months in the late group (P < 0.01). Anisometropia was found in 9/34 (26.5%) early and 17/166 (10.2%) late group patients (P = 0.021). Amblyopia was found in 4/55 (7.3%) early and 13/206 (6.3%) late group patients (P = 0.762).
Discussion: This study is limited by small sample size in the early intervention/resolution group.
Conclusion: Anisometropia was significantly higher in the early group while amblyopia showed no significant difference between groups. This suggests that delaying intervention in congenital nasolacrimal duct obstruction may not result in worse visual outcomes. Larger studies are needed to confirm these findings.
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