Abstract:AIM:To evaluate the clinical efficacy and safety of the silk thread traction intubation as a rescue technique for intraoperative silicone stent perforation during RS bicanalicular lacrimal intubation, and to clarify the value of technical innovation and promotion in primary care.
METHODS: A retrospective analysis was conducted on patients with silicone stent perforation and failed conventional RS intubation treated at the Department of Ophthalmology, the Second People's Hospital of Changzhou from July 2022 to June 2025. All patients underwent reconstruction of the physiological lacrimal-nasal passage using Zhang's memory guidewire lacrimal probing and guiding needle. Repositioning and implantation of the damaged silicone stent were completed via 3-0 silk thread traction. Standard follow-up was performed for at least 6 mo postoperatively. Intraoperative and postoperative conditions of the patients were observed.
RESULTS: A total of 21 patients(21 eyes)were enrolled in this study, including 6 males and 15 females, with a mean age of 59.6±10.8 y. The intraoperative salvage intubation success rate was 100% for all 21 eyes. Among them, 3 eyes required immediate removal of the silicone stent after implantation(1 eye developed a nasal corneal ulcer requiring priority treatment of ocular infection; 2 eyes had intolerable epiphora and discomfort and requested stent removal voluntarily). The remaining 18 eyes had no re-displacement or stent prolapse during indwelling, and the stents were successfully extracted after 3 mo of indwelling as scheduled. The complete lacrimal patency rates at 1, 3 and 6 mo after successful silicone stent implantation were 95%(20 eyes), 90%(19 eyes)and 81%(17 eyes), respectively. At 6 mo postoperatively, 17 eyes(81%)presented complete lacrimal passage patency, 3 eyes(14%)showed incomplete lacrimal patency, and 1 eye(5%)had complete obstruction. Postoperative complications included mild lacrimal puncta tearing in 2 eyes, lacrimal puncta granulation hyperplasia in 1 eye, and lacrimal puncta eversion in 1 eye. Among the 3 eyes with immediate silicone stent removal, only 1 eye developed recurrent lacrimal passage obstruction at 3 wk postoperatively, which was effectively treated by re-intubation. The remaining 2 eyes were cured without aggravation of corneal ulcer, lacrimal stenosis, or persistent lacrimal obstruction.
CONCLUSION: The silk thread traction intubation represents a safe, efficient and minimally invasive salvage approach for stent perforation during RS lacrimal intubation. With the advantages of precise localization, high operative efficiency and minimal tissue damage, it greatly increases the success rate of silicone stent repositioning and reintubation accompanied by manageable complications.
