Abstract:AIM: To evaluate the efficacy, degradation characteristics, safety, and patient satisfaction of biodegradable amniotic lacrimal duct repair stent (ALDRS) in adult patients with acquired lacrimal obstruction. METHODS: A multicenter, retrospective cohort study. Patients were stratified by anatomical site and obstruction severity into three cohorts: incomplete upper lacrimal pathway obstruction (punctal, canalicular, or common canalicular, cohort 1), incomplete nasolacrimal duct obstruction (cohort 2), and complete nasolacrimal duct obstruction (cohort 3). The primary endpoint was anatomical patency on lacrimal irrigation at 6mo. Secondary endpoints included functional success, stent degradation, complications, and validated patient-reported outcomes. RESULTS: A total of 54 patients (54 eyes, 10 males) with a mean age of 53.36±12.42y (range 29–88) were enrolled. ALDRS insertion was successful in 98.15% of procedures. Complete degradation was observed in 90.74% of eyes at 30d and in 100% by 6mo, with no residual material. The overall anatomical patency rate at 6mo was 81.48%. By cohort, patency was 100% (11/11), 88.89% (16/18), and 68.00% (17/25) for cohort 1, 2, and 3, respectively. No granuloma, punctal laceration, or silicone tube related complications occurred. Pre-existing chronic dacryocystitis was an independent risk factor for reduced patency [B=0.607, 95% confidence interval (CI): 0.165–1.048, t=2.763, P=0.008]. Overall satisfaction was comparable among cohorts, with all patients ranking preoperative communication and explanation highest. CONCLUSION: Biodegradable ALDRS combines avoidance of secondary removal with promotion of epithelialization, offering a safe and patient friendly option for adult acquired lacrimal obstruction. Lacrimal probing with ALDRS achieves favorable outcomes in cohort 1 and 2. In cohort 3, ALDRS is best reserved as a prophylactic adjunct after dacryocystorhinostomy. Chronic dacryocystitis or severe lacrimal sac fibrosis compromises efficacy.
