Superior versus inferior monocanalicular stent retention in the pediatric population

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B. Sajorda, J. Bregman, J. Taylormoore, B. Karwoski, H. De Beaufort, Children's National Medical Center, Washington, District of Columbia, UNITED STATES|B. Sajorda, Howard University, College of Medicine, Washington, District of Columbia, UNITED STATES|K. Hutcheson, New York Medical College, New York, UNITED STATES|

Tag(s) 2020 Annual Meeting, EY: Eye Movements / Strabismus / Amblyopia / Neuro-ophthalmology, Scientific presentation

Superior versus inferior monocanalicular stent retention in the pediatric population

Description

Purpose:
The use of monocanalicular stenting in the pediatric population for canalicular laceration repair and treatment of refractory nasolacrimal duct obstruction (NLDO) is an attractive alternative to bicanalicular intubation as a less traumatic procedure associated with easier insertion and removal, as well as comparatively less postoperative irritation. However, it has not been established whether superior versus inferior placement impacts the risk of early stent extrusion. The purpose of this study is to compare retention rates of superiorly versus inferiorly placed monocanalicular stents in pediatric patients.
Methods:
Single site, retrospective review of patients aged 6 months to 16 years old with monocanalicular stent placement between January 2009 and July 2019 by one of four pediatric ophthalmologists. Patients were excluded if there was no electronic medical record of premature extrusion or removal by the surgeon. A total of 36 eyes of 31 patients met inclusion criteria. Statistical analysis was conducted using Fisher’s exact test.
Results:
Of the 36 stents inserted, 17 (47.2%) were placed superiorly and 19 (52.8%) were placed inferiorly. 20 stents were placed for refractory NLDO and the remaining 16 were for canalicular laceration repair. Primary analysis revealed a trend towards more cases of extrusion in the superior group (n=7, 41.2%) versus the inferior group (n=5, 26.3%); however, this difference did not reach statistical significance (p=0.48). Secondary analysis revealed equivalent rates of extrusion in cases of NLDO (n=7, 35.0%) and cases of trauma (n=5, 31.3%). There was a trend towards more cases of extrusion in male patients (n=8, 40.0%) compared to female patients (n=4, 25.0%); however, this difference did not reach statistical significance (p=0.48). Stent extrusion was more likely to occur in patients under 5 years old (n=7, 38.9%) compared to patients 5 years and older (n=5, 27.8%), although this difference was not statistically significant (p=0.72).
Conclusions:
Preliminary results revealed that superior placement, male sex and younger age may be risk factors for premature stent extrusion. Review is ongoing to further power this study and elucidate these findings.

Brian Joseph Sajorda: Commercial Relationship: Code N (No Commercial Relationship) | Jana Bregman: Commercial Relationship: Code N (No Commercial Relationship) | Jonathan Taylormoore: Commercial Relationship: Code N (No Commercial Relationship) | Bethany Karwoski: Commercial Relationship: Code N (No Commercial Relationship) | Kelly Hutcheson: Commercial Relationship: Code N (No Commercial Relationship) | Heather De Beaufort: Commercial Relationship: Code N (No Commercial Relationship)