Endoscopy-guided diode laser-assisted transcaruncular StopLoss Jones tube implantation for canalicular obstructions in primary surgery

Abstract

Purpose To introduce and evaluate a minimally-invasive endoscopy-guided transcaruncular laser-assisted StopLoss Jones tube (SLJT) implantation technique for severe canalicular obstructions in primary surgeries. Methods We 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. Results Primary 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. Conclusion Endoscopy-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.

Preliminary study on the efficacy of lacrimal duct reconstruction with pedicled conjunctival flap in the treatment of severe lacrimal canalicular obstruction with conjunctivochalasis

“…Also, in 1965 [22] it was reported that implantation of a Jones tube between the lacrimal lake of the medial canthus conjunctival sac and nasal cavity could be used to reconstruct the tear discharge passage in the treatment of severe obstruction of the superior and inferior canaliculi. Several studies [23][24][25] have reported improvements to the surgical procedure. However, The tube caused local irritation and discomfort to the patient [26][27] .…”

Grand Challenges and Opportunities in Surgical Ophthalmology: Together for a Shared Future

“…Ptosis surgery is now commonly carried out as a minimal incision levator advancement (MILA) or a posterior approach to Muller's muscle (MMR) and the levator to hide the wound completely. Dacryocystorhinostomies have been done endoscopically for some time, but in the last few years, transcanalicular laser-assisted lacrimal procedures have been studied and are already in use in some countries (84)(85)(86)(87).…”