Abstract
PurposeTo introduce and evaluate a minimally-invasive endoscopy-guided transcaruncular laser-assisted StopLoss Jones tube (SLJT) implantation technique for severe canalicular obstructions in primary surgeries.MethodsWe retrospectively identified 12 adult patients (12 eyes) with severe epiphora secondary to long-segment canalicular obstructions. All the 12 eyes underwent an endoscopy-guided transcaruncular SLJT implantation with an 810-nm diode laser’s assistance as the primary surgical approach. Surgical and functional success rates, intraoperative and postoperative complications, as well as the need for secondary surgery, are evaluated.ResultsPrimary surgical success was achieved in 11 of the 12 cases (92%); one patient (8%) required secondary surgery to replace an SLJT with a shorter one. Ultimately, all cases showed well-placed functioning tubes. Three of the 12 cases (25%) presented conjunctival scarring, conjunctival granulation tissue, with or without tube-associated irritation of the ocular surface. We observed no sink-in, extrusion, nor crack of the tube. Complete functional success was achieved in 83%, and moderate functional success in 17% of all patients. The functionally unsuccessful outcome was not present in this study.ConclusionEndoscopy-guided transcaruncular diode laser-assisted SLJT implantation seems to be a promising minimally invasive approach for primary treatment of severe canalicular dacryostenosis. This novel technique shows high functional success rates. It seems to avoid the risk of tube malposition and extrusion, septal and turbinate injury, nasal adhesion, drainage failure, ethmoiditis, postoperative bleeding, and cutaneous scars.
Highlights
Presented at: 38th Annual Meeting of European Society of Ophthalmic Plastic and Reconstructive Surgery, September 14, 2019, Hamburg, Germany.Conjunctivodacryorhinostomy (CDCR), with the insertion of a Lester Jones Tube (LJT), a hollow Pyrex glass tube, was first described in 1965 [1,2,3]
We identified twelve consecutive eyes in 12 patients with severe unilateral epiphora due to long-segment canalicular obstruction that underwent endoscopy-guided transcaruncular laser-assisted StopLoss Jones tube (SLJT) implantation as the primary therapeutic intervention
This study reports a modified endoscopy-guided transcaruncular diode laser-assisted technique for SLJT implantation
Summary
Conjunctivodacryorhinostomy (CDCR), with the insertion of a Lester Jones Tube (LJT), a hollow Pyrex glass tube, was first described in 1965 [1,2,3]. For conventional CDCR, a fistula between the medial canthus at the site between the caruncle and the nasal cavity is created, and an LJT is inserted for drawing tears through capillary action [1, 4]. CDCR is the “gold-standard” treatment for canalicular obstructions with less than 8 mm of patent canaliculus from the punctum remaining. It has been used to treat epiphora resulting from canalicular trauma, canalicular dysgenesis, poor lacrimal pump function, or symptomatic epiphora resistant to a functionally patent drainage system following dacryocystorhinostomy (DCR) surgery [4]. While CDCR has a high overall symptomatic success rate with more than 85% [4], some significant complications concerned the Graefes Arch Clin Exp Ophthalmol (2020) 258:2809–2817
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