Controversies of the lacrimal system

Kalin-Hajdu, Evan; Cadet, Nicolas; Boulos, Patrick R.

doi:10.1016/j.survophthal.2015.12.003

Cited by 31 publications

(17 citation statements)

References 35 publications

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“…Latest literature advocates surgical repair of every lacerated lacrimal canaliculus by a speciality trained ophthalmic plastic surgeon for best clinical outcomes and predicts a poorer outcome in road-traffic accidents and in whom a 20-gauge silicone rod is used in place of monocanalicular stents. [ 22 23 24 ] Table 2 compares the anatomical and functional success of our and previous studies reported in literature. In complications, we found spontaneous stent extrusion in 8 patients who were managed with stent repositioning with or without a suture.…”

Section: Discussionmentioning

confidence: 94%

Is the distance from punctum a factor in the anatomical and functional success of canalicular laceration repairs?

Singh

Seth

Ahir

et al. 2017

Indian J Ophthalmol

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Purpose:The aim is to analyze the influence of the location of lacrimal canalicular laceration over the eventual anatomical and functional success after surgery.Methods:Retrospective, observational study of proximal canalicular laceration (PCL) and distal canalicular laceration (DCL) repairs by a single surgeon (MS). The distance between lacrimal punctum and the lateral canalicular lacerated end was defined as proximal (<6 mm) and distal (≥6 mm). The operation theater setup, microscopic magnified view, local adrenaline, and pigtail probe were used to locate the medial canalicular lacerated end. All patients underwent lacrimal stenting and the stents were removed after 3 months (12th week visit). After stent removal, a fluorescein dye disappearance test and lacrimal irrigation were performed to assess the anatomical and functional success of the operation.Results:Of 36 canalicular lacerations, 30 (83.33%) were monocanalicular lacerations which were repaired using monocanalicular stents. Of 6 (16.67%) bicanalicular lacerations, three were repaired using bicanalicular stents while in the remaining three, one monocanalicular stent was placed in each lacerated canaliculi. The medial cut end was identified by magnified visualization in 27 (75%), with adjunctive local adrenaline in four (11.11%) and pigtail probe in five (13.89%) patients. The mean post stent removal follow-up was 44 weeks. The DCL (n = 24, 66.67%) showed better functional and complete success as compared to PCL (75% vs. 33.33%, P = 0.03). Eight (22.22%) had spontaneous stent extrusion, two (5.56%) had loop prolapse, four (11.11%) had punctum granuloma, and three (8.33%) had medial canthus dystopia.Conclusion:The location of canalicular laceration may help to prognosticate the functional and qualified success rate. We experienced better-qualified success in the distal canalicular laceration group.

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Section: Discussionmentioning

confidence: 94%

Is the distance from punctum a factor in the anatomical and functional success of canalicular laceration repairs?

Singh

Seth

Ahir

et al. 2017

Indian J Ophthalmol

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“…Sowohl die bikanalikuläre als auch die monokanalikuläre Intubationstechnik erzielen beide ähnlich gute Erfolgsraten bei Verletzungen der Tränenwege [21]. Bei Tränenwegstenosen ist der zusätzliche Nutzen einer Tränenwegintubation nach Eröffnung der Stenose ebenso nicht immer eindeutig belegt [33,44]. Neuere Metaanalysen bspw.…”

Section: Diskussionunclassified

Intubationssysteme in der Tränenwegchirurgie – eine aktuelle Übersicht

Rokohl

Guo

Mor

et al. 2019

Klin Monatsbl Augenheilkd

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ZusammenfassungMit dem Einsatz von Mikroendoskopen in der Tränenwegchirurgie und dem dadurch bedingten Einzug der neueren, transkanalikulären, anatomieerhaltenden Operationsverfahren wurden verschiedenste Tränenwegintubationssysteme entwickelt. Je nach Lokalisation und Ausmaß der Tränenwegstenose können bikanalikuloanuläre, monokanalikuläre, monokanalikulonasale, bikanalikuläre und bikanalikulonasale Intubationstechniken und -systeme sowie Kombinationen daraus zum Einsatz kommen. Der isolierten Intubation der Tränenpünktchen dienen perforierte Punctum Plugs, während eine rein monokanalikuläre Intubation mit einer Mini-Monoka® erfolgen kann. Als monokanalikulonasale Intubationssysteme stehen neben der Monoka (Wide-Collarette-Typ), der Monoka von Fayet (Crawford-Typ), der selbsteinfädelnde Monoka (Ritleng®-Typ), der Masterka® sowie der LacriJet® für den ophthalmoplastischen Chirurgen zur Auswahl. Zu den bikanalikulonasalen Intubationssystemen zählen verschiedene BIKA®-Systeme, das Ritleng-Intubationssystem, das Crawford-Intubationsset und der FCI Nunchaku®. Indikationen sowohl für monokanalikulonasale als auch bikanalikulonasale Intubationssysteme stellen kanalikuläre Obstruktionen, Stenosen oder Lazerationen aller Art sowie sakkale und postsakkale Obstruktionen und Stenosen nach deren Eröffnung oder nach einer Dakryozystorhinostomie (DCR) dar. Bei einer Konjunktivodakryozystorhinostomie (CDCR) können bspw. die klassischen Lester Jones Tubes, Metaireau Tubes oder die StopLoss® Jones Tubes verwendet werden. Obwohl die Studienlage nicht eindeutig ist und daher eine Tränenwegintubation nicht als obligat angesehen werden darf, verzichten die meisten Ophthalmochirurgen trotz höherer Kosten und einer geringfügig längeren Operationsdauer in den meisten Fällen nicht auf eine solche. Für welches Intubationssystem der Operateur sich letztendlich entscheidet, hängt in den meisten Fällen von der gewählten Intubationsform, den Kosten sowie seinen persönlichen Präferenzen und Erfahrungen ab.

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“…1 ). The role of temporary intracanalicular stents in the restoration of continuity and patency of lacerated canalicular system is well documented and established [ 5 , 6 ]. Literature has also demonstrated that meticulous eyelid and medial canthal tendon repair, irrespective of the technique, accounts for optimal cosmetic and functional outcomes [ 5 , 7 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, there is a wide range of functional success rates reported, from 61.1 to 100% [ 6 , 10 - 12 ]. Previously, the distance of the laceration from the punctum has been evaluated as a factor that determines post-operative success [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Canalicular lacerations in a tertiary eye hospital: our experience with monocanalicular stents

Raj

Thakur

Arya

et al. 2020

rjo

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Introduction: Canalicular injury is commonly encountered in lid trauma. A multitude of techniques and stents are available to manage canalicular lacerations. Monocanalicular stents offer a simple, technically easy and cost-effective solution for managing such cases. Objective: This is a retrospective review of the patients presenting with canalicular lacerations to a tertiary eye hospital from January 2014 to September 2017. We evaluated factors like time of surgery, cause of injury, time of stent removal and their association with the surgical outcome. Additionally, we also reviewed the current data available in literature on the exclusive use of monocanalicular stents for the management of all types of canalicular injuries. Methods: Retrospective patient file review. Results: We evaluated 30 cases of canalicular injuries in 30 patients. The majority of our patients were males (24, 80%), and the mean age was 32.11±15.09 (4-59) years. The mode of injury was road traffic accidents (RTA) in 20 (66.7%), assault with sharp edged weapons in 8 (26.7%) and dog bite in 2 (6.6%) cases. The mean time of repair was 17.2±9.37 (6-36) hours after injury and the mean time of stent removal/ extrusion was 3.5±0.99 (0.5-5) months. The cases were divided based on time of repair i.e., within 24 hours (21 cases) or after 24 hours (9 cases) from the onset of injury. The extrusion rates were 14.3% (3) and 44.4% (4) respectively in the two groups. Our overall anatomical success rate was 86.7% and functional success rate of 76.7%. Conclusions: Overall failure rate was 23.3% (7 out of 30). Delay in surgery (>24 hours) and dog bites were associated with a poorer prognosis of canalicular repair using monocanalicular stents. Abbreviations: FDDT = Fluorescein dye disappearance test, SPSS = Statistical Package for Social Sciences, RTA = Road Traffic Accident

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Controversies of the lacrimal system

Cited by 31 publications

References 35 publications

Is the distance from punctum a factor in the anatomical and functional success of canalicular laceration repairs?

Is the distance from punctum a factor in the anatomical and functional success of canalicular laceration repairs?

Intubationssysteme in der Tränenwegchirurgie – eine aktuelle Übersicht

Canalicular lacerations in a tertiary eye hospital: our experience with monocanalicular stents

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