Clinical outcomes and factors associated with recurrence after bicanalicular silicone tube intubation: a large retrospective cohort study

Mehmet Göksel Ulaş; Efe Koşer; Yusuf Alperen Yaralı; Oğuzhan Altunkaya; Ayşe Çetin Efe; Fatma Poslu Karademir; Feyza Çukurova; Derya Özkan Tellioğlu; Ayşe Burcu Dirim; Pelin Kaynak; Muhittin Taşkapılı

doi:10.38053/acmj.1968492

Clinical outcomes and factors associated with recurrence after bicanalicular silicone tube intubation: a large retrospective cohort study

Abstract

Aims: To evaluate long-term clinical outcomes and factors associated with recurrence after nasolacrimal drainage procedures with bicanalicular silicone intubation. Methods: This retrospective cohort included 1576 patients (2094 eyes) treated between 2008 and 2025 at a tertiary referral center. All tubes underwent square-knot fixation without additional intranasal fixation; no comparator group was available. Success required a Munk score of 0–1 and patent irrigation at final follow-up, coinciding with tube removal for eyes followed for only three months. Generalized estimating equation (GEE) logistic regression accounted for bilateral eye correlation. Sensitivity analyses compared pediatric and adult patients, repeated multivariable GEE in adults, and stratified follow-up (3–12, 13–24, and >24 months). Results: Recurrence occurred in 5.9% of eyes (123/2094), ranging from 5.5% after external dacryocystorhinostomy to 13.2% after probing with intubation (p=0.016). External dacryocystorhinostomy comprised over 90% of procedures, limiting comparisons. Epiphora, postoperative complications, and tube exposure occurred in 6.7%, 11.0%, and 5.3%, respectively; exposure was not significantly associated with recurrence. Multivariable GEE identified associatio with probing [odds ratio (OR) 2.79, 95% confidence interval (CI) 1.22–6.37; p=0.015], increasing age (OR 1.01, 95% CI 1.00–1.03; p=0.048), and attending-surgeon procedures (OR 1.69, 95% CI 1.07–2.69; p=0.026). Recurrence was higher with longer documented follow-up. Conclusion: Standardized square-knot fixation was accompanied by 5.9% recurrence and 11.0% postoperative complications. Associations are descriptive and hypothesis-generating given subgroup imbalance, incomplete covariate information, variable follow-up, and residual confounding. The attending-surgeon association may reflect case selection or other unmeasured factors. These findings do not establish causality, fixation superiority, comparative effectiveness, or surgeon performance.

Keywords

Supporting Institution

No financial or institutional support was received for this study.

Ethical Statement

The study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the University of Health Sciences Hamidiye Non-Interventional Clinical Research Ethics Committee (Approval No: 25/840). Written informed consent for surgery was obtained from all patients prior to the procedure. Conflict of Interest: The authors declare that they have no conflict of interest. Funding: No financial support was received for this study. Author Contributions: MGU contributed to the study conception and design, statistical analysis, and manuscript preparation. EK, YAY, and OA contributed to data collection. All authors critically revised the manuscript, approved the final version, and agree to be accountable for all aspects of the work.

Thanks

The authors would like to thank all patients who participated in this study.

References

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Details

Primary Language

English

Subjects

Ophthalmology

Journal Section

Research Article

Authors

Mehmet Göksel Ulaş ^*
0000-0001-7049-7065
Türkiye

Efe Koşer
0000-0001-9750-0092
Türkiye

Yusuf Alperen Yaralı
0009-0002-2852-6234
Türkiye

Oğuzhan Altunkaya
0009-0000-2998-4486
Türkiye

Ayşe Çetin Efe
0000-0002-7699-0261
Türkiye

Fatma Poslu Karademir
0000-0001-9460-2501
Türkiye

Feyza Çukurova
0000-0002-9203-8342
Türkiye

Derya Özkan Tellioğlu
0000-0003-3742-1514
Türkiye

Ayşe Burcu Dirim
0000-0002-1041-021X
Türkiye

Pelin Kaynak
0000-0002-2193-2355
Türkiye

Muhittin Taşkapılı
0000-0002-3089-7782
Türkiye

Publication Date

September 11, 2026

Submission Date

June 12, 2026

Acceptance Date

August 1, 2026

Published in Issue

Year 2026 Volume: 8 Number: 5

DOI

https://doi.org/10.38053/acmj.1968492

IZ

https://izlik.org/JA47ZN33LP

Cite

RIS / Bibtex

APA

Ulaş, M. G., Koşer, E., Yaralı, Y. A., Altunkaya, O., Çetin Efe, A., Poslu Karademir, F., Çukurova, F., Özkan Tellioğlu, D., Dirim, A. B., Kaynak, P., & Taşkapılı, M. (2026). Clinical outcomes and factors associated with recurrence after bicanalicular silicone tube intubation: a large retrospective cohort study. Anatolian Current Medical Journal, 8(5), 968-976. https://doi.org/10.38053/acmj.1968492

AMA

1.Ulaş MG, Koşer E, Yaralı YA, et al. Clinical outcomes and factors associated with recurrence after bicanalicular silicone tube intubation: a large retrospective cohort study. Anatolian Curr Med J / ACMJ / acmj. 2026;8(5):968-976. doi:10.38053/acmj.1968492

Chicago

Ulaş, Mehmet Göksel, Efe Koşer, Yusuf Alperen Yaralı, et al. 2026. “Clinical Outcomes and Factors Associated With Recurrence After Bicanalicular Silicone Tube Intubation: A Large Retrospective Cohort Study”. Anatolian Current Medical Journal 8 (5): 968-76. https://doi.org/10.38053/acmj.1968492.

EndNote

Ulaş MG, Koşer E, Yaralı YA, Altunkaya O, Çetin Efe A, Poslu Karademir F, Çukurova F, Özkan Tellioğlu D, Dirim AB, Kaynak P, Taşkapılı M (September 11, 2026) Clinical outcomes and factors associated with recurrence after bicanalicular silicone tube intubation: a large retrospective cohort study. Anatolian Current Medical Journal 8 5 968–976.

IEEE

[1]M. G. Ulaş et al., “Clinical outcomes and factors associated with recurrence after bicanalicular silicone tube intubation: a large retrospective cohort study”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 5, pp. 968–976, Sept. 2026, doi: 10.38053/acmj.1968492.

ISNAD

Ulaş, Mehmet Göksel - Koşer, Efe - Yaralı, Yusuf Alperen - Altunkaya, Oğuzhan - Çetin Efe, Ayşe - Poslu Karademir, Fatma - Çukurova, Feyza et al. “Clinical Outcomes and Factors Associated With Recurrence After Bicanalicular Silicone Tube Intubation: A Large Retrospective Cohort Study”. Anatolian Current Medical Journal 8/5 (September 11, 2026): 968-976. https://doi.org/10.38053/acmj.1968492.

JAMA

1.Ulaş MG, Koşer E, Yaralı YA, Altunkaya O, Çetin Efe A, Poslu Karademir F, Çukurova F, Özkan Tellioğlu D, Dirim AB, Kaynak P, Taşkapılı M. Clinical outcomes and factors associated with recurrence after bicanalicular silicone tube intubation: a large retrospective cohort study. Anatolian Curr Med J / ACMJ / acmj. 2026;8:968–976.

MLA

Ulaş, Mehmet Göksel, et al. “Clinical Outcomes and Factors Associated With Recurrence After Bicanalicular Silicone Tube Intubation: A Large Retrospective Cohort Study”. Anatolian Current Medical Journal, vol. 8, no. 5, Sept. 2026, pp. 968-76, doi:10.38053/acmj.1968492.

Vancouver

1.Mehmet Göksel Ulaş, Efe Koşer, Yusuf Alperen Yaralı, Oğuzhan Altunkaya, Ayşe Çetin Efe, Fatma Poslu Karademir, Feyza Çukurova, Derya Özkan Tellioğlu, Ayşe Burcu Dirim, Pelin Kaynak, Muhittin Taşkapılı. Clinical outcomes and factors associated with recurrence after bicanalicular silicone tube intubation: a large retrospective cohort study. Anatolian Curr Med J / ACMJ / acmj. 2026 Sep. 11;8(5):968-76. doi:10.38053/acmj.1968492