Comparison of Hasner Valvulotomy Outcomes in Pediatric and Adult Patients: Does Age Matter?
Epiphora, or excessive tearing, is a common symptom among ophthalmic patients, often resulting from nasolacrimal duct obstruction (NLDO). In children, this condition is typically congenital (CNLDO), while in adults, it is usually acquired (ANDLO). A significant proportion of these obstructions occur at the level of the Hasner valve, a membranous structure at the distal end of the nasolacrimal duct. Traditional treatments for NLDO include probing, silicone intubation (SI), balloon dilatation, and dacryocystorhinostomy (DCR). However, these methods have varying success rates and are associated with potential complications such as false passage formation, punctum erosion, and nasal mucosa injury.
In recent years, Hasner valve incision has emerged as a novel surgical technique for treating inferior NLDO. This procedure involves making a precise incision at the Hasner valve under endoscopic guidance, allowing for direct visualization and minimizing trauma to surrounding tissues. While several studies have reported favorable outcomes with Hasner valve incision, there is limited data comparing its effectiveness between pediatric and adult patients. This study aims to fill this gap by evaluating whether age influences the surgical outcomes of Hasner valve incision.
The study retrospectively analyzed 53 eyes of 52 patients who underwent Hasner valve incision at Beijing Tongren Hospital between October 2016 and November 2019. Patients were divided into two groups: a pediatric group (23 eyes of 22 patients, aged <18 years) and an adult group (30 eyes of 30 patients, aged ≥18 years). The success of the surgery was determined using both subjective measures (complete resolution of epiphora) and objective measures (lacrimal passage irrigation and tear meniscus height (TMH)). Fisher's exact test was used to compare outcomes between the two groups.
The age range of the patients varied from 4 months to 79 years, with a mean age of 25.2 years. The pediatric group had a mean age of 2.4 years, while the adult group had a mean age of 42.7 years. In the pediatric group, 16 patients (72.7%) were 1 year old or younger, and three patients (13.6%) were between 1 and 5 years old. In the adult group, 16 patients (53.3%) were between 30 and 49 years old, and eight patients (26.7%) were over 50 years old.
Preoperative evaluation included clinical manifestations such as epiphora and mucopurulent discharge, as well as enhanced computed tomographic dacryocystography (CT-DCG) to confirm the obstruction at the Hasner valve. The surgical procedure involved general anesthesia, nasal endoscopy, and the use of a needle electrode to incise the Hasner valve. Antibiotic irrigation was performed to confirm the removal of the obstruction, and silicone stents were placed in cases where the inferior meatus was too narrow. Postoperative care included topical antibiotics, steroids, and nasal douching with saline solution.
The primary outcome measure was the complete resolution of epiphora, which was achieved in 95.7% of pediatric patients and 90.0% of adult patients. There was no statistically significant difference in the success rate between the two groups (P = 0.627). Lacrimal passage irrigation also showed significant improvement postoperatively, with 91.3% of pediatric patients and 90.0% of adult patients achieving unobstructed and no reflux (coded as 6). Again, there was no significant difference between the groups (P = 0.663).
TMH, a measure of tear film height, was significantly reduced postoperatively in both groups. The preoperative TMH was 0.63 mm, which decreased to 0.29 mm after surgery. In the pediatric group, TMH decreased from 0.58 mm to 0.21 mm, while in the adult group, it decreased from 0.64 mm to 0.31 mm. The number of patients whose TMH returned to the normal range (0.23–0.40 mm) was similar in both groups, with no significant difference (P = 0.561).
Complications were rare in both groups, with one case of recurrent obstruction in the pediatric group and three cases in the adult group. There was also one case of nasal mucosa adhesion in the adult group. No life-threatening or major complications were reported. The frequency of complications did not differ significantly between the groups (P = 0.339).
The study also noted that silicone stents were used more frequently in adult patients (70.0%) compared to pediatric patients (36.4%). This difference was attributed to the more complex nature of NLDO in adults, including longer disease duration and a history of previous surgeries. However, the success rate was similar between stented and non-stented patients, indicating that the use of stents did not significantly influence outcomes.
The findings of this study suggest that Hasner valve incision is an effective treatment for both pediatric and adult patients with inferior NLDO. The success rates, as determined by resolution of epiphora, lacrimal passage irrigation, and TMH, were comparable between the two groups. This indicates that age does not appear to be a prognostic factor for the surgical outcome of Hasner valve incision.
However, the study has several limitations. First, the pediatric group had a higher proportion of male patients (63.64%) compared to the adult group (6.67%). While this reflects the higher incidence of ANDLO in women, it could be a confounding factor. Second, the follow-up period was relatively short, ranging from 3 months to 2 years, with an average of 6.75 months. Longer follow-up periods would provide more robust data on the long-term efficacy of the procedure. Third, the sample size was limited, particularly in the pediatric group, which had only 23 eyes. Expanding the sample size in future studies would enhance the reliability of the findings.
In conclusion, Hasner valve incision is a promising surgical technique for treating inferior NLDO in both pediatric and adult patients. The procedure offers high success rates with minimal complications, and age does not appear to influence the outcomes. This makes Hasner valve incision a viable option for patients of all ages suffering from epiphora due to nasolacrimal duct obstruction.
doi.org/10.1097/CM9.0000000000001128
Was this helpful?
0 / 0