A Retrospective Review of Endoscopic Conjunctivodacryocystorhinostomy Reoperation Cases

Minji Woo; Sungwon Yang; Jinhwan Park; Hwa Lee; Sehyun Baek

doi:10.3341/jkos.2019.60.12.1121

Journal List > J Korean Ophthalmol Soc > v.60(12) > 1139571

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Woo, Yang, Park, Lee, and Baek: A Retrospective Review of Endoscopic Conjunctivodacryocystorhinostomy Reoperation Cases

Original Article

J Korean Ophthalmol Soc 2019;60(12):1121-1127.

Published online: 25 September 2019

DOI: https://doi.org/10.3341/jkos.2019.60.12.1121

A Retrospective Review of Endoscopic Conjunctivodacryocystorhinostomy Reoperation Cases

Minji Woo, MD, Sungwon Yang, MD, Jinhwan Park, MD, PhD, Hwa Lee, MD, PhD, Sehyun Baek, MD, PhD

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

Address reprint requests to Sehyun Baek, MD, PhD Department of Ophthalmology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: 82-2-2626-1260, Fax: 82-2-857-8580 E-mail: shbaek6534@korea.ac.kr

Received 26 July 2019 Revised 6 September 2019 Accepted 6 December 2019

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 analyze the causes, success rate, and the changes of Jones tube length in endoscopic conjunctivodacryocystorhinostomy (CDCR) reoperation cases.

Methods

The medical records of 40 patients (41 eyes, a total of 52 cases) who underwent reoperation of CDCR with Jones tube reinsertion using an endoscope from January 2013 to December 2018 were retrospectively reviewed. We analyzed the success rate, causes of reoperation, changes in lengths of used tubes, and the average interval times between operations.

Results

The most common cause of reoperation was medial tube migration (53.8%). As in other causes, tube loss (17.3%), obstructions related with conjunctival overgrowth or granulation (13.46%), lateral tube migration (11.53%), iatrogenic removal (1.92%), and acute dacryocystitis (1.92%) followed. In patients with medial tube migration, the average tube length used in reoperations decreased by approximately 1.11 mm compared to prior operations. In cases of lateral tube migration, the average tube length increased approximately 1.00 mm after the reoperation. The success rate of reoperations was 78.04%. The average interval time between the initial operation and the first reoperation was 52 months. In cases with several reoperations, the interval time decreased as the number of reoperations increased.

Conclusions

Because medial tube migration was found to be the most common cause of reoperations, it should be considered as a potential problem when performing surgery. The changes in the lengths of inserted Jones tubes were related to certain types of complication, which affected the prognoses. In endoscopic CDCR reoperations, the success rate was favorable. In recurrent cases, the average interval time between reoperations decreased as the number of operations increased.

Keywords: Complications, Conjunctivodacryocystorhinostomy, Endoscopic, Jones tube, Reoperation

References

1. Jones LT. Conjunctivodacryocystorhinostomy. Am J Ophthalmol. 1965; 59:773–83.

2. Lamping K, Levine MR. Jones tubes. How good are they? Arch Ophthalmol. 1983; 101:260–1.

3. Liarakos VS, Boboridis KG, Mavrikakis E, Mavrikakis I. Management of canalicular obstructions. Curr Opin Ophthalmol. 2009; 20:395–400.

4. Lim C, Martin P, Benger R, et al. Lacrimal canalicular bypass abdominal with the Lester Jones tube. Am J Ophthalmol. 2004; 137:101–8.

5. Rose GE, Welham RA. Jones' lacrimal canalicular bypass tubes: twenty-five years' experience. Eye (Lond). 1991; 5:13–1.

6. Steele EA. Conjunctivodacryocystorhinostomy with Jones tube: a history and update. Curr Opin Ophthalmol. 2016; 27:439–42.

7. Rosen N, Ashkenazi I, Rosner M. Patient dissatisfaction after abdominalally successful abdominal with Jones tube. Am J Ophthalmol. 1994; 117:636–42.

8. Sekhar GC, Dortzbach RK, Gonnering RS, Lemke BN. Problems associated with abdominal. Am J Ophthalmol. 1991; 112:502–6.

9. Vicinanzo MG, Allamneni C, Compton CJ, et al. The prevalence of air regurgitation and its consequences after abdominal and dacryocystorhinostomy in continuous positive airway pressure patients. Ophthal Plast Reconstr Surg. 2015; 31:269–71.

10. Ginat DT, Freitag SK. Orbital emphysema complicating Jones tube placement in a patient treated with continuous positive airway pressure. Ophthal Plast Reconstr Surg. 2015; 31:e25.

11. Kreis AJ, Mehat MS, Madge SN. Periorbital emphysema: an abdominal complication of lacrimal canalicular bypass surgery with the Lester-Jones tube. Clin Experiment Ophthalmol. 2014; 42:201–2.

12. Athanasiov PA, Madge S, Kakizaki H, Selva D. A review of bypass tubes for proximal lacrimal drainage obstruction. Surv Ophthalmol. 2011; 56:252–66.

13. Na J, Lee S, Park J, et al. Surgical outcomes of endonasal abdominal according to Jones tube location. J Craniofac Surg. 2017; 28:e500–3.

14. Han YS, Baek SH. Clinical evaluation of endoscopic endonasal abdominal (CDCR) with Jones tube placement. J Korean Ophthalmol Soc. 2004; 45:1221–6.

15. Trotter WL, Meyer DR. Endoscopic conjunctivodacryocystorhinostomy with Jones tube placement. Ophthalmology. 2000; 107:1206–9.

16. Kim SW, Lee JK, Lee TS. Comparison of surgical results between endoscopic and conventional conjunctivodacryocystorhinostomy. J Korean Ophthalmol Soc. 2000; 41:314–9.

17. Park MS, Chi MJ, Baek SH. Clinical study of endoscopic abdominal abdominal with Jones tube placement. Ophthalmologica. 2007; 221:36–40.

18. Bartley GB, Gustafson RO. Complications of malpositioned Jones tube. Am J Ophthalmol. 1990; 109:66–9.

19. Chung HS, Han DK, Lee KY. Conjunctivodacryocystorhinostomy with Jones Tube. J Korean Ophthalmol Soc. 1985; 26:215–9.

20. Hwang JG, Kwak MS. Clinical experience of lacrimal surgery. J Korean Ophthalmol Soc. 1998; 39:17–24.

21. Nissen JN, Sørensen T. Conjunctivodacryocystorhinostomy. A study of 21 cases. Acta Ophthalmol (Copenh). 1987; 65:30–6.

22. Gladstone GJ, Putterman AM. A modified glass tube for conjunctivodacryocystorhinostomy. Arch Ophthalmol. 1985; 103:1229–30.

23. Witters E, Mombaerts I. The survival of an angled extended Jones' tube. Br J Ophthalmol. 2015; 99:1523–6.

24. Dailey RA, Tower RN. Frosted jones pyrex tubes. Ophthalmic Plast Reconstr Surg. 2005; 21:185–7.

25. Fan X, Bi X, Fu Y, et al. The use of Medpor coated tear drainage tube in abdominal. Eye (Lond). 2008; 22:1148–53.

26. Chang M, Lee H, Park M, Baek S. abdominal outcomes of abdominal endonasal abdominal with Jones tube placement: a thirteen-year experience. J Craniomaxillofac Surg. 2015; 43:7–10.

27. Choi WC, Yang SW. Endoscopy-guided transcaruncular Jones tube intubation without dacryocystorhinostomy. Jpn J Ophthalmol. 2006; 50:141–6.

28. Lee TS, Lee H. Purse-string suture technique for Jones tube abdominal in abdominal. J Korean Ophthalmol Soc. 2008; 49:1553–8.

29. Vigo RL, Ortiz-Basso T, Vilas MN, Prémoli J. A millimetric ruler for Lester Jones tube placement in conjunctivodacryocystorhinostomy. Clinical Ophthalmology. 2015; 9:1523–30.

30. Hollsten DA. Complications of lacrimal surgery. Int Ophthalmol Clin. 1992; 32:49–66.

31. Welham RA, Guthoff R. The Lester Jones tube: a 15-year fol-low-up Graefes. Arch Clin Exp Ophthalmol. 1985; 223:106–8.

32. Zilelioglu G, Gunduz K. Conjunctivodacryocystorhinostomy with Jones tube. A 10-year study. Doc Ophthalmol. 1996; 92:97–105.

33. Can I, Aribal E, Yarangumeli A, et al. Changes in the conjunctival flora after abdominal (CDCR): a abdominal report. Eur J Ophthalmol. 1998; 8:142–7.

34. Seo IH, Lee TS. Five-year study of 120 endoscopic abdominal using porous polyethylene-coated tear drain. J Korean Ophthalmol Soc. 2009; 50:1289–94.

Figure 1.

Cases of complications leading to reoperations. (A) A case of medial migration of Jones tube. Because of the migration, the end of Jones tube was not observed (arrow). (B) A case of lateral migration of Jones tube. The end of the tube is protruded (arrow). (C) Granulomatous obstruction of Jones tube is seen (arrow).

Table 1.

Baseline characteristics of the patients

Characteristic	Value
Number of patients/eyes	40/41
Age (range, years)	55.95 (22–79)
Sex (female/male)	18 (45)/22 (55)

Values are presented as number (%).

Table 2.

Number of patients with more than two reoperations and success rate

Variable	Value
Number of patients with 2 reoperations	7
Number of patients with 3 reoperations	2
Successful/total (eyes)	32/41^*

^* Success rate is 78.04%.

Table 3.

Causes of reoperation

Cause of re-operation	Number of cases
Medial tube migration	28 (53.8)
Tube loss	9 (17.3)
Obstruction related with conjunctival overgrowth or granuloma	7 (13.46)
Lateral tube migration	6 (11.53)
Iatrogenic removal	1 (1.92)
Acute dacryocystitis	1 (1.92)
Total	52 (100)

Values are presented as number (%).

Table 4.

Changes in Jones' tube length

Type of migration	Average tube length in prior operation (mm)	Average tube length in re-operation (mm)	Changes in tube length (mm)
Medial tube migration	18.75	17.64	–1.11
Lateral tube migration	16.16	17.16	+1.00

Table 5.

Average interval time between operations

Type of interval	Average interval time (months)
Initial CDCR to 1st re-operati	ion 52
1st re-operation to 2nd re-ope	ration 24
2nd re-operation to 3rd re-ope	eration 14

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