Results of a new “mirror tuck technique” for fixation of lacrimal bypass tube in conjunctivodacryocystorhinostomy

Abstract

Context:Conjunctivodacryocystorhinostomy (CDCR) is the procedure of choice for proximal canalicular blocks. However, the complications of tube migration and extrusion limit its widespread practice.Aim:The aim of this study is to evaluate the efficacy and complications of the new “mirror tuck technique” for fixation of lacrimal bypass glass tube without holes in proximal canalicular blocks in laser CDCR.Materials and Methods:A prospective interventional study was conducted in forty consecutive eyes of adult patients, undergoing 980 nm diode laser CDCR for proximal canalicular blocks. After creating the tract under endoscopic guidance, the collar of the glass tube was fixed to the conjunctiva with 6-0 prolene suture by “mirror tuck technique.” Success was defined as the absence of extrusion of tube with patent tract and relief in epiphora at 1 year of follow-up.Results:Both anatomical and functional success was achieved in 39 (97.5%) cases. Tube displacement occurred in one patient suffering from allergic conjunctivitis in which the tube had to be removed. A temporary heaviness was reported by 5 (12.5%) patients till about 2 weeks. Conjunctival overgrowth over the tube occurred in 1 (2.5%) eye at 5 months which was excised and treated with application of 0.02% mitomycin C with no subsequent recurrence. There were no cases of suture abscess or suture intolerance warranting tube removal.Conclusion:“Mirror tuck technique” is an effective method for tube fixation (for tube without holes) in CDCR. However, it is important to position the conjunctival opening so as to leave sufficient space for passage of sutures for anchorage medially.

Conjunctivodacryocystorhinostomy (CDCR) success rates and complications in endoscopic vs non‐endoscopic approaches: a systematic review

“…The studies included were divided into 2 categories based on the surgical approach. The categories were as follows: studies that included CDCR with bypass tube placement under di-rect endoscopic visualization (21 studies) 5,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] (Table 1); and studies that reported CDCR with any type of nonendoscopic approach CDCR (33 studies) 2,30-58 ( Table 2). All studies included were case series, and all were retrospective except for 1 prospective study.…”

“…Only 4 studies 23,26,42,51 received a score of 8 or higher, indicating high quality and low risk of bias. Twelve 10,16,17,20,22,24,27,29,36,44,50,55 studies had a risk of 7, indicating medium risk for bias, and all other 38 articles had a score of 6 and below, indicating a high risk of bias.…”

“…The mean follow-up was specified in 41 studies. 2,[10][11][12][13][14][17][18][19][20][21]23,[25][26][27][28][29][30][32][33][34][38][39][40][41][42][43][44][45][46][47][48][49]51,54,[57][58][59][60][61] Mean follow-up of all included patients was 24 ± 17.6 months. In 12 studies only range or median of follow-up duration was reported.…”

“…The etiology of canalicular obstruction was reported in 44 studies, 2,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][30][31][32][33][34][35][36]38,39,[41][42][43][45][46][47][48][49][50][51][53][54][55]57,58 in which a total of 1845 patients were included. The distribution of patients according to etiology was as follows: trauma (25.5%); congenital (16.7%); cancer-related (secondary to surgery); radiation or chemotherapy (7.5%); idiopathic (6.5%); and defined as failed DCR (9.1%).…”

“…26,27 Other studies used other types of tubes: Putterman-Gladstone tube in 6 studies 11,17,23,28,41,45 ; silicone or polythene tubes in 6 studies 30,35,38,47,50,52 ; 3 studies used mucus membrane techniques. 32,49,54 Endoscopy-assisted approach Twenty-one (39%) studies 5,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] reported using a nasal endoscope or a combination of a non-endoscopy-assisted and endoscopy-assisted approach during the procedure. All these studies used Pyrex tubes and were published from 2000 onward.…”