Results of the Cultured Jones Tubes Used in Lacrimal Bypass Surgery

PURPOSE: We evaluated cultured specimens from removed Jones tubes and their antibiotic sensitivities. METHODS: In 16 patients who had received lacrimal bypass surgery to resolve nasolacrimal duct obstruction, the Jones tubes were removed due to either recurred symptoms, signs of chronic dacryocystitis, the tubes being obstructed, or migration of the tubes. Jones tubes were cultured to identify bacteria and tested for their antibiotic sensitivity. RESULTS The average duration from intubation to removal was 11.5 months. Nine cases showed the tube obstruction and six cases showed recurrent inflammation as the respective causes of tube removal. The species of cultured bacteria were Staphylococcus aureus in 9 cases, Pseudomonas in 4 cases, Streptococcus in 2 cases and coagulase negative Staphylococcus in 2 cases. In 1 case, both Staphylococcus aureus and Pseudomonas were cultured. In antibiotics sensitivity tests, 8 of 9 cases of Staphylococcus aureus were resistant to penicillin. The symptoms and signs of nasolacrimal duct obstruction were improved after the tube removal. CONCLUSIONS: When treating an obstruction of the lacrimal apparatus due to chronic dacryocystitis using lacrimal bypass surgery with Jones tubes, Staphylococcus aureus and Pseudomonas aeruginosa should be suspected as the main cause of inflammation of the nasolacrimal system or nasal cavity.

Management of Complications after Conjunctivodacryocystorhinostomy with Jones Tube

PURPOSE: To analyze the surgical outcomes of conjunctivodacryocystorhinostomy(CDCR) with Jones tube on the postoperative management of complications. METHODS: We retrospectively analyzed the medical records of 87 eyes (79 patients) with at least 3 months follow-up who had undergone CDCR with Jones tube between January 1993 and December 2002. The patients were divided into several cases according to the results of postoperative management. RESULTS: Thirty eyes (34%) experienced no complications of Jones tube, over a mean follow-up period of 26.77 +/- 34.41 months. Forty-five eyes (52%) were improved by postoperative management of complications, over a mean follow-up period of 45.00 +/- 42.70 months. In these 45 eyes, the medial migration of the tube was corrected in 7 eyes after repositioning without fixed suture, in 9 eyes after repositioning with fixed suture, in 10 eyes after endonasal endoscopy-assisted repositioning with fixed suture, and in 1 eye after endonasal endoscopy-assisted tube exchange. The lateral migration of the tube was corrected in 1 eye after repositioning with fixed suture, and in 7 eyes after endonasal endoscopy-assisted tube exchange with fixed suture. The extrusion of the tube was corrected in 3 eyes after endonasal endoscopy-assisted tube reinsertion with fixed suture. Consecutive dacryocystitis improved in 1 eye after tube exchange with dacryocystectomy. The conjunctival obstruction of the tube was corrected in 6 eyes after resection of conjunctival tissue. Twelve eyes (14%) were not improved by CDCR or postoperative managements of complications, over follow-up period of 38.50 +/- 35.39 months. CONCLUSIONS: The complications of Jones tube occurred anytime during the postoperative period. If extrusion of the tube occurred reinsertion had to be done as soon as possible. Migration or obstruction of the tube was mostly improved by postoperative managements.

Surgical Effect of Canaliculodacryocystorhinostomy in Patients with Failed Conjunctivodacryocystorhinostomy

PURPOSE: To analyze outcomes of the canaliculodacryocystorhinostomy and the combined procedure of canaliculodacryocystorhinostomy and Jones tube reinsertion, in patients who had complications of conjunctivodacryocystorhinostomy, which required other surgical procedures. METHODS: We retrospectively analyzed the outcomes of 18 eyes (16 patients) who visited the Department of Ophthalmology, Yeungnam University Hospital for functional failures and complications of conjunctivodacryocystorhinostomy, and who underwent either the canaliculodacryocystorhinostomy or the combined procedure between February 1994 and October 2003. These patients had submerged, prolapsed, lost, or obstructed Jones tubes, with a length of patent canaliculi from the puncta of more than 7mm, identified with probing, irrigation and dacryocystography. RESULTS: Complete or significant improvement of epiphora was achieved in 83.3% (15 of 18 eyes) after a follow-up period ranging 6 to 70 months (average 28.5 months). CONCLUSIONS: Canaliculodacryocystorhinostomy and the combined procedure can be expected to achieve functional success in patients who suffer from complications of the Jones tube. We recommend these procedures in cases of common canalicular obstruction and upper and lower canalicular obstruction with a length of patency greater than 7mm.

Clinical Evaluation of Endoscopic Endonasal Conjunctivodacryocystorhinostomy (CDCR) with Jones Tube Placement

PURPOSE: To evaluate the efficacy of endoscopic endonasal primary conjunctivodacryocysto-rhinostomy (CDCR) and revision CDCR after primary CDCR. METHODS: Twenty patients who had undergone endoscopic endonasal CDCR with Jones tube and who were followed for over 6 months at our hospital were reviewed retrospectively. Our analysis included success rate, operation time and causes of failure. RESULTS: The indications for revision CDCR were prolapse of Jones tube and inadequate tube length. The initial success rate in the primary and revision groups was 78.6% (11/14) and 100% (6/6), respectively. Two initial failures in the primary group were later successful after revision. The mean operation time in the groups was 23.9 minutes ( +/- 6.3) and 21.7 minutes ( +/- 6.1), respectively. The main causes of failure included inaccurate tube length and abnormal tube position. CONCLUSIONS: Endoscopic endonasal CDCR appears to be a reasonable approach for revision, as well as primary, because of accurate measurement of Jones tube length during surgery and the shortened operation time.

Conjunctivodacryocystorhinostomy with Rubber-Tipped Jones Tube

One of the problems of conjunctivodacryocystorhinostomy which employs the conventional Jones tube is that the end of Jones tube has to be manipulated by the surgeon so that the tube resides within the nasal cavity while not touching the middle turbinate and the nasal septum. As a result, for most of the patients who have high nasal septal deviation, paradoxical curvature, or middle turbinate hypertrophy, there wasn't enough room within the nasal cavity where one end of Jones tube could rest. Such patients required either septoplasty or turbinectomy before they underwent conjunctivodacryocystorhinostomy. In order to overcome such a problem, the authors connected a 4 Fr. rubber tube to the conventional Jones tube, and helped the end of the tube to reside within the nasal cavity regardless of the anatomical variation of either the nasal septum or the middle turbinate. When such modified procedure is used, the conven tional Jones tube will make contact with the conjunctiva, lacrimal sac, and the nasal mucosa while the rubber tube remained afloat within the nasal conjunctiva. Such modification helps the tube to reside within the nasal cavity without foreign body reactions and granulation tissue complications, and there is no need to change tubes in order to make up for the loss of tube length due to post operative tissue contracture. Between April 2000 and August 2001, the authors performed conjunctivodacryo cystorhinostomy with rubber-tipped Jones tube on 8 patients with nasolacrimal duct obstruction, and obtained satisfactory results without complications.

A Survey of Post-Operative Satisfaction in Patients with Canalicular Obstruction after Jones Tube Intubation

PURPOSE: This study was devised to evaluate the post-operative satisfaction and daily life behavior in the patient who underwent Jone tube intubation. METHODS: 60 patients who underwent Jones tube intubation replied to the questionaire consisted of twenty questions. The questionare consisted of six groups: Basic statistical informations, past medical history, post operative satisfaction, post operative complications, questions about anesthesia, patients compliance. RESULTS: 28 (46.7%) patients were satisfied with outcomes of Jones tube intubation. 9 (15.0%) patients replied acceptable, and 23 (38.3%) patients were dissatisfied. Age, sex were not significantly associated with the post operative satisfaction (P-value>0.05). Air blowing in the eye was the most frequent complications (41.6%) and other concerning ocular symptoms are regurgitation of nasal discharge (35.0%), persistent tearing (35.0%), fogging of eyeglasses (18.3%) and etc. 23 patients (46.0%) refused to receive bilateral surgery because of post operative complications, old age, economic problems. CONCLUSIONS: Post operative satisfaction after Jones tube intubation is not associated with its functional success rate due to numerous postoperative complications.

Comparison of Surgical Results between Endoscopic and Conventional Conjunctivodacryocystorhinostomy

Conventional Conjunctivodacryocystorhinostomy[CDCR]which is performed for canalicular obstruction or failed DCR, is well known as one of the most effective treatment modalities. The authors compared surgical results of endoscopic with those of conventional method to evaluate advantages of endoscopic method over conventional CDCR and important success factors. Primary success rates were 90%[86/96]in endoscopic method and 86%[214/217]in conventional method. Final success rates were 97%[93/96]and 96%[237/247]in endoscopic and conventional method, respectively[p>0.05]. We considered that endoscopic method was superior to conventional method in accurate measurement of Jones tube length at the time of endoscopic operation. It was considered the most important success factor.

Treatment of Obstructed Lacrimal Apparatus by Bowman's Probe Guided Lacrimal Bypass Surgery

The purpose of this study is to evaluate clinical utility of lacrimal bypass surgery using Bowman's probe In treatment of obstruction of the lacrimal apparatus. The lacrimal bone was penetrated between lacrimal sac and nasal mucosa through the incised caruncle with Bowman #0 probe. A Jones tube was Introduced over the probe into the nasal cavity and fixed at caruncle with non-absorbable suture material. Epiphora was completely resolved in 120 (96.8%) of 124 eyes for mean follow-up of 17.1 months. Only 4 eyes failed to reach resolution of epiphora. Postoperative complications were as follows. coverage of the tube with conjunctiva in 10 eyes (8.1%), recurrent migration of tube to the nasal cavity 7 eyes(5.6%), persistent chronic dacryocystitis 7 eyes(5.6%), nasal mucosal granulation 6 eyes(4.8%), septal touch by tube 6 eyes(4.8%), conjunctival granulation 3 eyes (2.4%), and tube extrusion to the conjunctiva 2 eyes (1.6%). However no clinically significant complication developed postoperatively. The above procedure has many advantage such as no operations scar, short operation time, no need of expensive instruments and simple procedure. Therefore, this procedure seems to be of value in treatment of obstruction of lacrimal apparatus.

Treatment of Common Canalicular Obstruction Using Lacrimal Trephine

Conjunctivodacryocystorhinostom.y using Jones tube has been the treatment of choice for patients with epiphora due to common canalicular obstruction. But this procedure carries a lot of disadvantages including external scar formation and many complications result from general anesthesia, and necessity of permanent prosthesis and long-term follow-up. So authors have used a new instrument, the lacrimal trephine designed for creating an opening through 8 distally occluded lacrimal canaliculus to treat the common canalicular obstruction. From June 1996 to December 1996, we performed 8 lacrirnal trephination with silicone tube insertion in five patients diagnosed as common canalicu-lar obstruction. All of them have achieved the anatomical success and four of thein have shown clinical success.

The Surgical Results of Dacryocystorhinostomy with Internal Punctoplasty for Common Canalicular Obstruction

Conjunctivodacryocystorhinostomy using Jones tube has been the treatment of choice for patients with epiphora secondary to canalicular or internal punctal stenosis. This procedure requires a permanent prosthesis, and long-term follow up because of possible complications. From November 1990 to July 1994, 15 of the 87 dacryocystorhinostomy patients (17%) were noted to have canalicular or internal punctal stenosis prior to surgery by diagnostic lacrimal probing. We performed a dacryocystorhinostomy with internal punctoplasty in those patients. All patients underwent silicone intubation, with the tubes removed at an average of 5.6 months after surgery. Patent lacrimal system was established in 14 patients(93%), whereas 12 patients(80%) remained asymptomatic. We believe dacryocystorhinostomy with internal punctoplasty for patients with canalicular or internal punctal stenosis offers good results and obviates the necessity of conjunctivodacryocystorhinostomy using Jones tube.

Clinical Study Conjunctivodacryocystorhinostomy with Jones Tube

Conjunctivodacryocystorhinostomy(CDCR) with Jones tube is indicated in the cases with upper and lower or common canaliculi obstruction or failed cases of dacryocystorhinostomy. We made a clinical evaluation of the 247 CDCR with Jones tube which had been performed from May of April of 1990. The results were as follows: 1. Canalicular obstruction occured mainly in economic age. 2. The most common cause of the canalicular obstruction was trauma involving canaliculi. 3. The overall success rate of CDCR with Jones tube was 96%. 4. The cases that needed reoperation were extrusion or loss of tube, tilting of tube anteriorly or superiorly, and being buried of Jones tube to nasal cavity in decending order of frequency. 5. Postoperative complications were obstruction of tube with mucoid discharge, granuloma formation, clogging of tube with conjungvtiva, and inflammation around the tube in decending order of frequency. 6. By the development of surgical technique, amount of intraoperative blood loss has been decreased and the duration operation time has become shortened.

A Case of Bilateral Dacryocystocele with Absence of the Lacrimal Puncta

A 33-year-old female suffered from bilateral mass in the medial area and epiphora for 20 years. The mass recurred after incomplete removal several times. Ocular examination showed that the puncta and papillae of the both lower and upper lids were completely missing. At operation, there was obstruction in the bony portion of the nasolacrimal duct. The mass was a distended lacrimal sac. The lacrimal sac and the mucosa of the nasolacrimal duct were compJetely excised in the right side. The excision of lacrimal sac and mucosa of the nasolacrimal duct and conjunctivo-rhinostomy using Jones tube were performed in the left side. Nine months after operation, the patient was happy with the results and there was no recurrence.