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Minimally invasive bypass surgery effective for lacrimal obstructions
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A minimally invasive procedure for conjunctivodacryocystorhinostomy is time-effective and well tolerated by patients, according to a recently published study. The procedure is simpler to perform than traditional open techniques, the study authors said.
Traditional conjunctivodacryocystorhinostomy (CDCR) is a difficult and time-consuming bypass surgery for lacrimal obstructions, usually involving a skin incision and large osteotomy, according to Martin H. Devoto, MD, and colleagues. They published their results with a minimally invasive CDCR technique using the Jones tube in 55 patients treated between 1997 and 2004.
The new procedure is performed endoscopically, and can be done under local anesthesia, the authors said. In their study, local anesthesia was used in 35 patients and general anesthesia in 20 patients. The study included 32 women and 23 men whose mean age was 41 years.
The minimally invasive CDCR technique is performed by excising the lower third of the patient's caruncle and inserting a 14-gauge intravenous catheter into the semilunar fold at the excision point. The catheter is directed through the thin lacrimal bone, posterior to the anterior lacrimal crest, and slowly advanced until it can be seen inside the nose.
Once the nasal cavity is breached, the catheter needle is withdrawn and replaced by a Teflon sheath. A guide wire is inserted through the sheath, and then the sheath is removed and a glass Jones tube is inserted in its place and anchored by nylon sutures, according to the study authors.
Operative time in the study averaged 16 minutes, compared to average surgical times of 59 minutes to 74 minutes reported for more invasive CDCR techniques. No patients experienced intraoperative complications and none required enlarging the osteotomy, the authors noted.
Postoperatively, seven patients experienced tube migration nasally, and surgeons successfully repositioned the tubes under topical anesthesia in four cases. The other three cases required minor surgical revision under local anesthesia, the study authors said.
All patients experienced complete relief of tearing. There were no reported cases of acute dacryocystitis or lacrimal sac problems, the study authors said.
The study is published in the July/August issue of Ophthalmic Plastic and Reconstructive Surgery.