Comparison of the Efficacies of 0.94 mm and Double Silicone Tubes for Treatment of Canalicular Obstruction

Comparison of the efficacies of 1.0 and 1.5 mm silicone tubes for the treatment of nasolacrimal duct obstruction

This retrospective observational study analyzed the postoperative outcomes of bicanalicular intubation using different diameters of tube stents for treating postsaccal nasolacrimal duct obstruction. A total of 130 patients diagnosed with postsaccal obstruction who underwent endoscopic-assisted silicone tube intubation were included in the study. Patients intubated with a 1.5-mm large-diameter tube were designated as the LD group, and those with a 1.0-mm normal-diameter tube were designated as the ND group. The patency rates of the two groups at 1 year after tube removal were compared using the Kaplan–Meier curve and restricted mean survival time (RMST) method with τ = 365 days. Results demonstrated that the recurrence rate after tube removal was significantly lower in the LD group as compared with the ND group (p = 0.001). The patency rates at 1 year after removal in the LD and ND group were 85.7% (95% confidence interval [CI]: 75.4, 91.9) and 73.9% (95% CI: 61.7, 82.8), respectively. When comparing the patency rates by the RMST method at τ = 365 days, the RMST difference, RMST ratio, and RMTL ratio were higher in the LD group at p = 0.045, 0.052, and 0.046, respectively.

Changes in Eyelid Position Following Silicone Tube Insertion and Removal in Dacryocystorhinostomy

AIMS

The authors sought to assess the changes in eyelid position after silicone tube insertion and removal in endoscopic dacryocystorhinostomy.

METHODS

The authors retrospectively reviewed 60 eyes of 48 consecutive patients who underwent endoscopic dacryocystorhinostomy operation at Korea University Guro Hospital, Seoul, Republic of Korea, between April 2019 and November 2019. All cases were evaluated to discern eyelid positioning, focusing on the marginal reflex distance 1, medial palpebral fissure, central palpebral fissure (PF-2), lateral palpebral fissure (PF-3), and medial canthal angle (MCA) before surgery and at 1 week and 1, 2, 3, and 4 months postoperatively.

RESULTS

Twelve patients (25%) were operated on bilaterally and 36 patients (75%) were operated on unilaterally. The average patient age was 56.5 years and 9 men (18.8%) and 39 women (81.3%) were included in this study. At 2 months postoperatively, all values of interest (marginal reflex distance 1 , medial palpebral fissure, PF-2, PF-3, and MCA) had decreased significantly (P < 0.05, Friedman test), but the changes in PF-3 immediately after surgery were not significant (P = 0.062, Wilcoxon rank-sum test). From 2 to 3 months after surgery, all 5 indicators of interest increased significantly. After silicone tube removal, whereas there was no statistically significant difference in medial palpebral fissure, PF-3, and marginal reflex distance 1 values; the changes in PF-2 and MCA values as compared with before surgery was 0.47 mm (P = 0.02, Wilcoxon test) and 3.25° (P = 0.000, Wilcoxon test), respectively, which was significantly different. However, with these small gaps, it will be difficult to notice the changes in PF-2 and MCA values during clinical examination.

CONCLUSION

Insertion of a silicone tube during endoscopic dacryocystorhinostomy leads to temporary deformation of the lid position. However, after silicone tube removal, all eyelids recovered to their original shape.

[Conjunctival dacryocystorhinostomy in the treatment of proximal lacrimal drainage obstruction]

The problem of reconstruction of the lacrimal drainage system in cases of obliteration of both lacrimal points and/or both lacrimal canaliculi remains one of the most difficult in dacryology. The most common and effective operation for this pathology is Conjunctival dacryocystorhinostomy using tubes developed by L. Jones in 1962. However, wearing the tube for a long time and the complications associated with it can cause dissatisfaction with the treatment, even if the surgery was successful. The surgery technique and the tubes design have undergone numerous modifications to increase the amount of positive outcomes and reduce the number of complications. The results of original studies on this problem were analyzed revealing a lack of knowledge about the optimal design and material of the implant. There are few studies aimed at developing methods that ensure persistent preservation of the anastomosis after tube removal.

Repositioning a Prolapsed Tube After Bicanalicular Intubation of the Lacrimal System

OBJECTIVE

Prolapse of silicone tubes is one of the most common complications after bicanalicular intubation of the lacrimal system. This study describes a new method of repositioning prolapsed silicone tubes by using a suture-probe.

METHODS

This study was a retrospective chart review of 12 patients who experienced complete silicone tube prolapse after bicanalicular intubation. The silicone tube was repositioned by using a suture-probe; a double-stranded suture was placed in the lacrimal duct with a lacrimal probe with a hole in the front blunt tip, then interlocked with the prolapsed silicone tube. Subsequently, the suture loop was slowly stretched from the nasal cavity, and the silicone tube was repositioned. The silicone tube at the medial canthus was cut and loosened, then pulled out of the nasal cavity.

RESULTS

In all 12 cases, the silicone tube was restored with 100% success by using the suture-probe. Three patients were extubated immediately after the repositioning. For another 9 patients with an indwelling tube, extubation was performed after 3-4 months, and no patients experienced further tube dislocation during that time.

CONCLUSIONS

The suture-probe technique is a simple, low cost, and minimally traumatic method for repositioning a prolapsed silicone tube after bicanalicular intubation of the lacrimal system.A new technique, the suture-probe with thread interlocking the silicone tube ring can reposition the prolapsed silicone tube in lacrimal sac.

Assessing the Usefulness of Different Silicone Tubes in External Dacryocystorhinostomy

Introduction:

External dacryocystorhinostomy is a surgical procedure for the treatment of lacrimal drainage system disorders.

Aim:

To assess the usefulness of different silicone tubes in external dacryocystorhinostomy.

Material and Methods:

This study sampled 97 patients with lacrimal drainage system disorders who underwent the external dacryocystorhinostomy using two different silicone tubes. Forty one patients (Group A) underwent external dacryocystorhinostomy with silicone intubation using Nunchaku-style tubes, while in 56 patients (Group B) dacryocystorhinostomy was performed with O‘Donoghue silicone tubes. The data was analyzed using T-test, Chi-squared test and Fisher’s test.

Results:

The success rate was evaluated by achieved patency to irrigation and relief of epiphora. Patency in the group with Nunchaku-style tubes was 95.1% compared to 94.6% in the group with O‘Donoghue silicone tubes (p>0.05).

Conclusion:

Both tubes in external dacryocystorhinostomy were useful in the management of lacrimal drainage system disorders. Although it is easier and quicker to intubate and extubate Nunchaku-style tubes compared to O‘Donoghue silicone tubes, there was no statistically significant difference in success rate between the compared groups.