Five-year Study of 120 Endoscopic Conjunctivodacryocystorhinostomy Using Porous Polyethylene-Coated Tear Drain

Il Hun Seo; Tae Soo Lee

doi:10.3341/jkos.2009.50.9.1289

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Seo and Lee: Five-year Study of 120 Endoscopic Conjunctivodacryocystorhinostomy Using Porous Polyethylene-Coated Tear Drain

Original Article

J Korean Ophthalmol Soc 2009;50(9):1289-1294.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.9.1289

Five-year Study of 120 Endoscopic Conjunctivodacryocystorhinostomy Using Porous Polyethylene-Coated Tear Drain

Il Hun Seo, MD, Tae Soo Lee, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Tae Soo Lee, MD Department of Ophthalmology, Guro Hospital, Korea University College of Medicine #97 Gurodong-gil, Guro-gu, Seoul 152-703, Korea Tel: 82-2-2626-1260, Fax: 82-2-857-8580, E-mail: tsoooo@hanmail.net

Received 30 January 2008 Accepted 16 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the long-term surgical results of 120 endoscopic conjunctivodacryocystorhinostomy (CDCR) procedures using a porous polyethylene (MEDPOR^®) coated tear drain (MCTD^®).

Methods

From 2002 to 2007, 120 patients who had been treated with endoscopic CDCR using MCTD^® were investigated for its success rates and complications. After an osteotomy was made under nasal endoscopy, a tunnel was created from the caruncle in the conjunctival sac to the nasal cavity through the newly created ostium, and then the tunnel was enlarged to allow the insertion of the MCTD^® The length of the tube to be inserted was determined under endoscopic examination. An anchoring suture was placed at the medial canthus to both the conjunctiva and the skin using a 5-0 Vicryl suture in the fashion of a purse string suture.

Results

Causes of obstruction included failed dacryocystorhinostomy (DCR) (74 cases) and idiopathic obstruction (22 cases). Postoperative complications were encountered in four cases with tube loss, 21 cases with a buried tube, 8 cases of extrusion to the conjunctival side, and 11 cases with obstruction caused by conjunctival incarceration or granuloma. The postoperative success rate was 89.1%.

Conclusions

The authors concluded that endoscopic CDCR using MCTD^® is an alternative to the standard conventional method for preventing dislodgement of the tube postoperatively. However, surgeons should consider that it may be challenging to insert the MCTD^® and that in cases requiring removal, the tube can be difficult to remove due to adhesions.

Keywords: Conjunctivodacryocystorhinostomy, MCTD, Porous polyethylene coated tear drainage tube

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Figure 1.

A photograph of porous polyethylene (MEDPOR^®) -coated tear drain.

Figure 2.

Tunnel widening with a straight mosquito clamp.

Figure 3.

Multiple placements of 2-0 silk around the neck of the tube.

Figure 4.

Schematic drawing of Lee's purse string suture technique.

Table 1.

Size of tube used (mm)

Length of tube (mm)	Number of cases
16	9
17	14
18	20
19	17
20	14
22	10
24	4
Total	120

Table 2.

Causes of CDCR^∗ in 120 eyes

Causes	Number of patients (%)
Failed DCR^†	74 (61.6)
Idiopathic	22 (18.3)
Trauma	16 (13.3)
Congenital	3 (2.5)
Tumor	3 (2.5)
Inflammation	2 (1.5)
Total	120 (100)

^∗ CDCR=conjunctivodacryocystorhinostomy.

Table 3.

Success rates of endoscopic CDCR^∗ using MCTD^®

	Number of cases	%
Excellent	86	71.6
Good	21	17.5
Poor	13	10.9

^∗ CDCR=conjunctivodacryocystorhinostomy;

^† MCTD^®=MEDPOR^®-coated tear drain.

Table 4.

Postoperative complications of endoscopic CDCR^∗ using MCTD^®

Complications	Numberof cases (%)
Displacement of tube	33 (27.5)
Buried tube	21 (17.5)
Extrusion of tube	8 (6.7)
Loss of tube	4 (3.3)
Obstruction of tube	11 (9)
Infection	3 (2.5)
Broken tube	1 (0.8)

^∗ CDCR=conjunctivodacryocystorhinostomy;

^† MCTD^®=MEDPOR^®-coated tear drain.

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