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

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

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.

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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).
jkos-60-1121f1.tif
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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