Monocanalicular Stent Research Articles

Management of Canalicular Lacerations: Epidemiological Aspects and Experience with Mini-Monoka Monocanalicular Stent

To report the epidemiological data, clinical profile, and surgical outcome of canalicular lacerations in an Indian population. Retrospective interventional case series. All patients who underwent canalicular laceration repair from July 1, 2002 to June 30, 2005 at a tertiary eye care center were retrospectively reviewed. Demographics, cause of eyelid injury, associated ocular injury, surgical management with Mini-Monoka monocanalicular stent, and its outcome were analyzed. Sixty-six patients underwent eyelid laceration repair, of which 24 (36%) had involvement of the canalicular system. The mean age at presentation was 16 years (range, 10 months to 52 years); 20 (83.3%) patients were males. Mode of injury included the blouse-hook fastener in five (20.8%) breast-feeding infants, bicycle handle injury in four (16.7%) children, and metal rod injury in five (20.8%) adults. Lower canaliculus was involved in 13 (54.1%), upper in eight (33.3%), and both in three (12.5%) patients. Simultaneous globe injury was noted in six (25%) patients, five (83.3%) of which had upper canalicular involvement. Twenty-seven canalicular lacerations (24 patients) underwent stenting with the Mini-Monoka monocanalicular stent. Three (11.1%) stents extruded within one month. At the final follow-up (mean, 18.5 months), canalicular block was noted in two (10%) out of 20 patients; none had epiphora. Canalicular involvement occurs in 36% of eyelid injuries. Injury by the "blouse-hook fastener" is unique to infants in the Indian context. Simultaneous globe injury is present in 25% of cases, especially when the upper canaliculus is involved. Mini-Monoka stent extrusions occur within one month. With an 11.1% extrusion rate, Mini-Monoka stents achieved good anatomical (90%) and functional (100%) success in the management of canalicular injury.

Persistence of tearing while monocanalicular stents are in place as a predictor of clinical outcome after stent removal

Introduction: Persistent tearing while bicanalicular stents are in place is common and does not necessarily predict a poor outcome following stent removal. This study was performed to see if the same observations are true with regard to monocanalicular stents. Methods: Thirty-two patients (47 eyes) with congenital NLDO who had monocanalicular stent placement were enrolled. A telephone survey of the parents was performed to ascertain the presence of tearing with and without the stents in place. Results: Minimal or no symptoms with the stent in place occurred in 32 of 47 eyes (68%) and 30 of these 32 eyes (94%) had minimal or no symptoms after stent removal. Persistent tearing while the stent was in place occurred in 15 of 47 eyes (32%) and 11 of these 15 eyes had minimal or no symptoms following stent removal (73%). Conclusions: Compared with bicanalicular stents, patients undergoing monocanalicular stent placement are less likely to experience persistent tearing while the stent is in place. The majority of patients who experience tearing with the stent in place will not tear after the stent is removed.

Acquired External Punctal Stenosis: Surgical Management and Long-Term Follow-Up

Purpose: To introduce and assess the results of a long-term follow-up of a one-snip punctoplasty with monocanalicular stent (Mini Monoka) for acquired external punctal stenosis (AEPS) with and without associated internal punctal and canalicular stenosis. Design: Prospective non-comparative interventional case series. Methods: Thirty-five eligible patients (53 eyes) with AEPS underwent a horizontal one-snip punctoplasty and Mini Monoka tube insertion by or under supervision of a consultant Oculoplastic surgeon from June 1999 to May 2002. Diagnostic probing and irrigation were performed before operation and after operation at the last follow-up. Patients with canalicular obstruction, nasolacrimal duct stenosis and obstruction, and those with less than 6 months' follow-up were excluded. The Chi-square (X2), Fisher's exact, Pearson correlation, and multiple logistic regression analysis tests, with 95% confidence interval when appropriate, were used for statistical analysis. Results: The age range was 39 to 90 years (mean: 67.2, SD: 11.8, SE: 2). Twenty-seven patients (77.1%) were female. There was a normal canalicular system in 21 (39.6%), lower canalicular stenosis in 10 (18.8%), and internal punctal stenosis in 22 (41.5%) eyes. Postoperative follow-up was from 6 to 41 months (mean: 18.5, SD: 9.2, SE: 1.2). There was a 77.4% complete functional success, 7.5% partial functional success, and 96.2% anatomical success at the last follow-up. The success rate was not significantly different between the eyes with and without preoperative internal punctal and canalicular stenosis (p = 0.4). The lower success rate was significantly correlated with a final abnormal probing and irrigation (p < 0.01). Conclusion: The use of a monocanalicular Mini Monoka stent together with a one-snip punctoplasty is helpful to prevent the recurrence of punctal stenosis in the healing phase and addresses the associated internal punctal and canalicular stenosis.

Mini Monoka silicone monocanalicular lacrimal stents: Subjective and objective outcomes

BACKGROUND . Canalicular injuries and anomalies are relatively common. Despite this, controversy still exists regarding the indications for surgery and best surgical methods. The most favourable intervention would be one that is simple, associated with a high level of subjective and objective outcome, and does not threaten the uninjured or unaffected part of the lacrimal drainage system. This study assesses outcomes of intervention with the Mini Monoka silicone monocanalicular lacrimal stent. METHOD . A single cohort, hospital-based study with retrospective and prospective components. Participants were all identifiable patients at Bristol Eye Hospital in whom the Mini Monoka silicone monocanalicular stent was used for any indication. Retrospective analysis of patient records for all related pre-operative, operative and postoperative data was performed. Prospective analysis of subjective outcome via confidential patient questionnaire and objective outcome via clinical examination was performed. RESULTS . Complete data were obtainable in 13 patients (14 canaliculi) of the identified 22 patients (23 canaliculi). Follow-up was from 12 to 70 months (mean 39 months). A high level of subjective outcome was noted with no patients experiencing significant or disabling symptoms. In terms of objective outcome, 79% achieved canalicular patency. The main complications with this technique were premature stent loss (29%) and stent migration (14%). CONCLUSIONS . The Mini Monoka monocanalicular stent is a safe, effective and simple surgical technique that, unlike bicanalicular procedures, does not threaten the uninjured / unaffected part of the lacrimal drainage system.

A novel method to convert bicanalicular intubation into monocanalicular intubation in endoscopic dacryocystorhinostomy

Endonasal endoscopic dacryocystorhinostomy (EN-DCR) is an effective treatmentfor acquired nasolacrimal duct obstruction. Although the exact role of siliconeintubation remains controversial, it is routinely performed to increase the success rate ofthe procedure. Occasionally, difficulty may be encountered during silicone tube intubationcommonly when one end of the bicanalicular stent has been successfully passed intothe nasal cavity but the other end fails. In which case either this has to be converted toa monocanalicular stent or leave without stenting. We hereby report a novel method totackle this situation by converting a bicanalicular stent into a monocanalicular stent usingsimple knotting steps. From our experience with three patients, the end-results were safeand well-tolerated. This modified lacrimal intubation stent may also be used when thestandard Monoka monocanalicular stent is not available.