Lacrimal Surgery

Abstract

We read Mombaerts and Colla’s article with interest,1Mombaerts I. Colla B. Modified Jones’ lacrimal bypass surgery with an angled extended Jones’ tube.Ophthalmology. 2007; 114: 1403-1408Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar and have a few comments concerning their technique. First, we believe that the use of an endoscope or direct intranasal visualization to assist in the insertion of the tube is critical to avoid contact of the tube with the middle turbinate or nasal septum. This is also very important to decide the appropriate length of the tube. If the surgical tract is not seen, the tube may even be inadvertently placed through the middle turbinate. We described a technique of insertion of the standard Jones tube through a closed approach but under endoscopic or nasal view.2Devoto M.H. Bernardini F.P. de Conciliis C. Minimally invasive conjunctivodacryocystorhinostomy with Jones tube.Ophthal Plast Reconstr Surg. 2006; 22: 253-255Crossref PubMed Scopus (35) Google Scholar In our series, only 3 of 55 patients (5.5%) required a secondary procedure to reposition the migrated tube, versus a reintervention rate to correct tube migration of 23% described by the authors. Also, all our patients (100%) experienced a complete relief of epiphora, versus only 87% reported by the authors. We believe that the use of a 14-gauge angiocatheter placed under endoscopic view with minimal or no dilation of the tract may improve the short- and long-term stability of the tube. Finally, we agree with the authors that a minimally invasive CDCR without bone removal offers a time-efficient and low-complication surgery. Author replyOphthalmologyVol. 115Issue 4PreviewWe are grateful to Devoto et al for their interest in our article. Devoto et al kindly included a reference to a minimally invasive conjunctivodacryocystorhinostomy with the Jones tube as a new technique.1 However, their article did not refer to the first publication in 1996 on exactly the same technique with the angled extended tube.2 The authors encourage the use of direct or endoscopic intranasal visualization for inserting a standard Jones tube, mainly to choose the appropriate length of the tube to prevent contact with the middle turbinate or nasal septum. Full-Text PDF