Conjunctivodacryocystorhinostomy using Métaireau Tube with Endoscopy Assistance

Özet

Objectives: The purpose of this study was to analyze the surgical outcome of conjunctivodacryocystorhinostomy (CDCR) operations with permanent silicone tube implantation (Métaireau tube) with the aid of nasal endoscopy and to obtain subjective measure of patient satisfaction. Methods: Charts of 13 eyes of 13 patients (five males and eight females) with proximal canalicular obstruction who had undergone CDCR with permanent silicone tube insertion were reviewed retrospectively. Diagnosis of the upper lacrimal system obstruction was confirmed by lacrimal system irrigation. During operation, the length of the tube was adjusted with the aid of nasal endoscopy using the endoscopic scissors to prevent contact of the distal end of the tube to the nasal septum in the nasal cavity. The patients were asked to subjectively rate their epiphora according to Munk Epiphora Grading System before surgery and at 1st, 3rd, and 6th months, and 1 year following surgery. Results: Improvement of epiphora was statistically significant at all visits when compared with values before injection (p<0.001). Tube dislocation was seen in 4 patients (30.7%), proximal obstruction due to conjunctival granuloma formation was seen in 3 patients (23%). Two patients who had tube dislocation intranasally were revised for 2 times with endoscopy and proximal ends of tubes were resutured. Repositioning of the tube by pulling out from caruncle area with fine forceps was performed only once in two patients. Conclusion: CDCR with permanent silicone tube insertion and adjustment of the length of the tube with assistance of endoscopy provides easier and efficient approach in patients with proximal lacrimal system obstruction.