Long-Term Outcomes of StopLoss Jones Tubes for Epiphora in Patients With Early or Multiple Loss of Lester Jones Tubes

Abstract

Purpose: Extrusion is the most common cause of failure in conventional Lester Jones tubes (LJTs). StopLoss Jones tubes (SLJTs) with distal flange are designed to reduce this complication. This study compared the survival of SLJTs with their prior LJTs and control patients with LJTs-only. Methods: Retrospective review of consecutive LJT or SLJT insertion between January 2014 and December 2016. Results: Twenty-eight eyes of 23 patients had 31 SLJTs. Before their SLJTs, these patients had 116 cumulative failed LJTs. Forty-seven eyes of 34 patients had 59 LJTs only. Fifty-two percent of SLJT group and 18% of LJT-only group had complex medial canthal conditions (p = 0.003). Compared to their previous LJTs, the SLJTs were less likely to extrude (3% SLJT vs. 64% prior LJT, p < 0.0001); there was no statistical difference in rates of sinking in (26% SLJT vs. 13% prior LJT, p = 0.0964). The median survival of LJTs in those who went on to have a SLJT was 3.5 months. SLJT insertion significantly lengthened the median survival to 26 months (p < 0.0001), comparable to the LJT-only group (25.5 months, p = 0.45). While extrusion was also the most common complication in the LJT-only group, this occurred only in 20% of eyes; tube failure from sink-in occurred in 14% of eyes. Conclusions: SLJTs, in patients prone to multiple or early prior LJT losses, can be used to rescue this group and allow them to regain a similar survival curve to the less complicated LJT-only group. Rates of tube extrusion are significantly reduced with the use of SLJT.

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

“…In this study, SLJTs were inserted as a primary procedure, whereas most of the cases have undergone prior failed DCR or LJT placement in the other SLJT studies. A higher proportion of complex medial canthal conditions (52%) occurred in patients with prior failed surgeries in Timlin's study [12]. Large bony ostium and disturbed tissue bed from prior surgeries may increase the trend of failure.…”

“…Further analyzing the outcomes of modifications in surgical procedures and bypass tubes would help determining their potential as an alternative to the conventional ones. Hence, our findings were compared with those reported in two previous SLJT studies, as described in Table 2 [11,12], albeit utilizing different surgical procedures. The success rates for bypass tube surgery vary in studies.…”

“…The primary success rate ranged *Final surgical success is deemed the eye with a well-placed functioning tube at the last follow-up SLJT StopLoss Jones Tube NA not available from 14 to 84%, and the overall symptomatic success rate from 57 to 100% [4]. Bagdonaite and Pearson [12] retrospectively analyzed 25 eyes of 19 patients with 29 SLJT placements. Among the 29 tubes, only 4 (14%) were conducted as a primary procedure.…”

“…They achieved a complication rate of 20% vs. 33% in this study and an overall final surgical success rate of 92% vs. 100% in this study. They concluded that SLJT appears to prevent the previously common problem of extrusion, whereas Timlin et al [12] retrospectively reviewed 28 eyes of 23 patients with SLJTs. These patients had undergone 116 cumulative early or multiple losses of LJTs.…”

“…However, until today, few studies investigated the success rate of the SLJT. Moreover, they mainly included patients with prior failed DCR or LJT implantation rather than primary surgery [11,12]. Given the numerous merits, there is a need to explore the possibility of applying SLJT in patients with primary surgery.…”