The Change of the Pathogen in Cultured Jones Tubes according to the Postoperative Periods

PURPOSE: To evaluate the change in pathogens in cultured Jones tubes used in lacrimal bypass surgery according to postoperative period and to provide basic data related to preventive antibiotics or functional lacrimal stent development. METHODS: Fifty patients who underwent Jones tubes removal were enrolled in this study. Removed Jones tubes were cultured to identify bacteria and were tested for antibiotic sensitivity. The results were further analyzed according to the period between lacrimal bypass surgery and tube removal. RESULTS: Among 50 cases, 24 (48%) showed cultured bacteria of Staphylococcus aureus, 5 (10%) were Pseudomonas, and another 5 (10%) were Gram-positive bacilli. Although Staphylococcus aureus was the most frequently cultured organism, Proteus mirabilis was the most common cultured organism in patients who underwent tube removal more than 10 years after lacrimal bypass surgery. There was no significant correlation between cultured organism and the period between lacrimal bypass surgery and tube removal. Eighty four percent of cultured Staphylococcus aureus showed resistance to penicillin, and 53% of cultured Staphylococcus aureus showed resistance to methicillin. CONCLUSIONS: Staphylococcus aureus was the most frequently cultured organism according to Jones tube-related lacrimal bypass surgery. A large proportion of cultured Staphylococcus aureus showed resistance to penicillin and methicillin. Proteus mirabilis should be considered the most common pathogen in patients more than 10 years after lacrimal bypass surgery.

Medpor-coated tear drain in lacrimal bypass surgery without skin incision / 局解手术学杂志

Abstrac:Objective To analyze the efficacy and safety of medpor-coated tear drain in lacrimal bypass surgery without skin incision. Methods The data of 7 patients(7 eyes) who underwent no skin incision of lacrimal bypass surgery with medpor-coated tear drain were ret-rospective reviewed. The operation result and complications were observed. Results All patients were followed up for 5~17 months. Com-plete or significant improvement of epiphora was achieved in 5 cases at the last follow-up. Complications included conjunctival granulation hy-perplasia (3 eyes),nasal mucosal granulation hyperplasia (2 eyes),and discomfort (4 eyes). Conclusion The lacrimal bypass surgery with medpor-coated tear drain could be expected to improve epiphora of refractory lacrimal obstruction. The main complications are granulation hyperplasia and discomfort.

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.