The Effect of Punctoplasty with Pigtail Probe for Canalicular Intubation in Patients with Punctal Obstruction

PURPOSE: To assess the surgical results of a punctoplasty with insertion of a silicone tube using a pigtail probe for the management of acquired punctal obstruction. METHODS: The medical records of 61 patients who underwent an operation for the management of punctual obstruction were reviewed. After punctal dilation, fluorescein dye disappearance test was performed to evaluate its efficacy. In the case of no functional delay after punctal dilation, three-snip punctoplasty with a silicone tube using a pigtail probe was performed. In the case of a functional delay, three-snip punctoplasty with a silicone tube into the nasolacrimal duct was performed. RESULTS: The surgical success over 1 year was 39.1% in patients who underwent only three-snip punctoplasty, 79.2% in patients who underwent a three-snip punctoplasty with a silicone tube insertion into the nasolacrimal duct, and 85.7% in patients who underwent a three-snip punctoplasty with canalicular intubation using a pigtail probe. CONCLUSIONS: The use of a pigtail probe for canalicular intubation together with a three-snip punctoplasty is useful to prevent the recurrence of punctal obstruction.

The Comparison of Punctoplasty and Silicone Tube Intubation in Patients with Punctal Obstruction

PURPOSE: To compare surgical results of two patient groups with punctal obstruction. One group underwent punctoplasty while the other group underwent silicone tube intubation. METHODS: We compared postoperatively 48 eyes of 37 patients with punctal obstruction within and after one year of the procedure. 24 eyes of 17 patients had punctoplasty and 24 eyes of 20 patients had silicone tube intubation by the same surgeon. RESULTS: Upon follow-up within one year after the punctoplasty, 13 eyes (54%) showed no epiphora, nine eyes (38%) showed intermittent epiphora, and two eyes (8%) showed persistent epiphora. However, after silicone tube intubation, 20 eyes (83%) showed no epiphora, three eyes (13%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. Over one year after the punctoplasty, one eye (4%) showed no epiphora, 19 eyes (78%) showed intermittent epiphora, and four eyes (17%) showed persistent epiphora. However, after the silicone tube intubation, 17 eyes (71%) showed no epiphora, six eyes (25%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. CONCLUSIONS: Silicone tube intubation is more effective than punctoplasty in the long term treatment of punctal obstruction.

Purse-string Suture Technique for Jones Tube Fixation in Conjunctivodacryocystorhinostomy

PURPOSE: To evaluate the usefulness of Jones tube fixation using a purse-string suture, and to minimize postoperative conjunctival incarceration into the collar opening of the tube and extrusion or intrusion of the tube in the early postoperative period. METHODS: Thirty-five conjunctivodacryocystorhinostomy (CDCR) with tube fixation by purse-string suture were performed over the period of 1 year with a mean follow-up of 8.3 months. At the end of endoscopic CDCR procedure, to secure the tube in both the surrounding conjunctiva and tissues in the canthus, a 5-0 Vicryl suture was passed through the conjunctiva and Tenon's capsule just lateral to the collar of the tube and then tied around the collar of the tube in the fashion of a purse string. Finally, it was externalized to the skin of the canthal area where it was fixed. The suture was left alone if it did not cause problems postoperatively. RESULTS: Of 35 cases, there were no cases of intrusion of the tube or clogging of the tube with the conjunctiva at 6 months postoperatively. Partially extrusion was found in only two cases at 6 and 9 months postoperatively. One case of inadvertent tube retrieval was noted while irrigating the tube at postoperative 1 month. CONCLUSIONS: This procedure is a simple and superior way of fixing a Jones tube to maintain tube position during the early postoperative period.