Assessing the outcomes of mini-Monoka stent dilatation for primary punctal stenosis using the lacrimal symptom questionnaire

Purpose: The objective of this study was to assess the quality of outcomes of mini-Monoka stent dilatation for punctal stenosis using the lacrimal symptom (Lac-Q) questionnaire. Methods: Prospective interventional case series of 45 eyes of 25 consecutive patients who underwent mini-Monoka stent dilatation for primary punctal stenosis were included in the study. The stents were extubated at 4 weeks. The Lac-Q questionnaire was administered preoperatively and at 12 weeks and 24 weeks following the intervention. Outcomes assessed were anatomical success, functional success, and changes in the questionnaire scores including total, social impact, and lacrimal symptom scores. Statistical analysis was performed using the Wilcoxon signed-rank test, and the probability of obtaining a certain score was calculated using the multinomial log-linear model. P < 0.05 was considered as significant. Results: Monoka stents were performed for 45 eyes. A total of 75 questionnaire responses were analyzed. At the last follow-up of 24 weeks, the anatomical and functional success rates were 93.3% (42/45). The changes in the mean total score (7.68 preoperatively to 0.82 at 24-week follow-up) were statistically significant (P ? 0.001). The mean social impact scores showed significant improvement postoperatively from 4.06 to 0.53 (P ? 0.001). The mean lacrimal symptom score changed from a preoperative value of 3.62 to 0.28 (P ? 0.001) at the last follow-up. Postoperative scoring correlated well with the anatomical and functional success rates. The symptom scores corroborated with changes in the clinical outcomes. Conclusion: Mini-Monoka stent dilatation is a very effective intervention for the management of primary punctal stenosis, and Lac-Q questionnaire is a simple and useful tool to evaluate the quality of outcomes in such cases.

Long-term results of mini-monoka® monocanalicular intubation in the repair of canalicular lacerations

Objective@#To report the epidemiology of canalicular lacerations and surgical outcomes of canalicular laceration repair with Mini-Monoka® (FCI Ophthalmics, Issy-les-Moulineaux, Cedex, France) intubation.@*Methods@#This is a retrospective interventional case series of patients who underwent Mini-Monoka® intubation in the repair of canalicular laceration from 2010 to 2015 at a tertiary state-owned hospital in Manila, Philippines. Patient demographics, surgical outcomes, and complications were analyzed.@*Results@#Fourteen patients (12 males and 2 females) underwent Mini-Monoka® intubation for monocanalicular laceration. The mean age at presentation was 27 years (range, 16-47 years). The mean duration of follow-up was 2.92 years (range, 1.28-6.15 years). Canalicular patency was achieved in 12 out of the 14 patients (86%). None of the 12 patients experienced epiphora following stent removal resulting in a functional success rate of 100%. Two patients had punctal slitting (14%). Premature stent loss occurred in 2 out of the 14 patients (14%).@*Conclusion@#Mini-Monoka® intubation is effective in maintaining the long-term anatomical patency of the lacerated canaliculus. It is a simple and minimally invasive procedure making it a safe and reasonable alternative to the traditional methods of canalicular repair.

Manejo de obstrucción de vía lagrimal en niños mediante intubación con sonda Monoka®: experiencia inicial en HCUCh / Management of lacrimal duct obstruction in children by intubation with Monoka®: initial experience at HCUCh

Introducción: La obstrucción congénita del ducto nasolacrimal (DNL) es motivo de consulta frecuente en menores de un año. Se encuentra en 6% de los recién nacidos, la mayoría de las veces secundario a la persistencia de una membrana mucosa en la porción distal del DNL (membrana de Hassner). Generalmente se presenta como epífora patológica, es decir, presente después del 3º mes de vida. Esta obstrucción puede evolucionar con resolución espontánea los primeros 12 meses de vida, requerir terapias complementarias o resolución quirúrgica. Objetivo: Analizar los casos de obstrucción de la vía lagrimal en población pediátrica usando sonda Monoka® en pacientes intervenidos en el Hospital Clínico de la Universidad de Chile, que consultaron por epifora; verificando tasas de éxito, complicaciones del procedimiento y seguimiento. Material y método: Se realizó un estudio descriptivo retrospectivo, incluyendo todos aquellos pacientes con diagnóstico de obstrucción de vía lagrimal, mayores de 24 meses de edad, que consultaron en el HCUCh entre julio 2012 y marzo 2014, que requiriesen resolución quirúrgica de su cuadro. Se realizó instalación de sonda Monoka® con la participación conjunta de oftalmología y otorrinolaringología. Resultados: Se reunieron 7 pacientes, obteniendo éxito de 85,7% (6) y 100% de mejoría respecto a los síntomas iniciales. Un paciente presentó una complicación intraoperatoria, definida como un sondeo frustro. La sonda permaneció instalada un promedio de 7,7 meses y fue retirada sin complicaciones. Conclusión: La instalación de sonda Monoka® como procedimiento quirúrgico destinado a la resolución de la obstrucción de vía lagrimal es una técnica sencilla, de fácil acceso, moderado costo y que constituye una solución exitosa para aquellos pacientes afectados. Presenta excelentes resultados a mediano plazo, sin recidiva de la obstrucción de la vía lagrimal y con baja tasa de complicaciones. Es una técnica exitosa que, luego de esta experiencia, podría ser considerada de primera línea en nuestro hospital para aquellos pacientes con diagnóstico de epífora patológica, mayores de 24 meses.

Introduction: Congenital nasolacrimal duct obstruction (DNL) is frequent complaint in under a year. It is found in 6% of infants, the most often secondary to the persistence of a mucous membrane in the distal portion of the nasolacrimal duct (Hassner membrane). It usually occurs as pathological epifora present after the 3rd month of life. This obstruction can evolve spontaneously resolved the first 12 months of life, require complementary therapies or surgical treatment. Aim: To analyze where we have used the Monoka® probe in pediatric population operated in the Clinical Hospital of the University of Chile, who consulted for pathological epiphora; verifying success rates, procedure complications and monitoring. Material and method: A retrospective descriptive study, which were included all patients with the diagnosis of pathological epiphora over 12 months old, who consulted in the HCUCH between July 2012 and March 2014, that required surgical resolution of their condition. Monocanalicular installation silicone catheter was used with the joint participation of ophthalmology and otorhinolaryngology. Results: We had a total of 7 patients with a success rate of 85.7% (6) and 100% improvement over the initial symptoms. Only one patient presented an intraoperative complication, defined as failed intubation. The probe remained installed an average of 7.7 months and was removed without complications. Conclusions: The installation of Monoka® probe as surgical intervention to resolve the pathological epiphora is a simple, easily accessible and amoderate cost procedure. It's a successful solution for those patients affected. It has excellent mid-term results, no recurrence of obstruction of DNL and low complication rate. It is a successful technique that would be considered frontline in our hospital for patients diagnosed with pathological epiphora over 12 months old.

Management of punctal occlusion post - viral conjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To evaluate the effect of different methods in managing punctual and canalicular stenosis as a complication of viral conjunctivitis. ?METHODS: A retrospective cohort study, including 35 cases of punctal stenosis post-viral conjunctivitis. Cases were diagnosed clinically and treated after 4wk of complete remission from epidemic keratoconjunctivitis. Patients were treated with mechanical dilatation, insertion of perforated silicon punctual plugs or the use of Mini-Monoka stent. ?RESULTS: Six out of 35 ( 17. 14%) had a satisfactory outcome by punctal dilatation alone. Punctal dilatation with insertion of perforated punctal plugs was done in 20 cases ( 57. 14%). Nine cases ( 25. 71%) had punctal dilatation with Mini - Monoka tube insertion. Disease severity and the use of Mini-Monoka silicon tube did not correlate with bilateral eye involvement or involvement of both upper and lower punctum. ?CONCLUSlON: Management of punctal occlusion post viral conjunctivitis may be treated easily using perforated punctal plugs. Silicon intubation with Mini-Monoka might be needed to manage resistant cases.

Delayed Lacrimal Stent Implantation Using Mini Monoka(R) in Canalicular Laceration

PURPOSE: Canalicular laceration is relatively common due to its exposed, vulnerable location in case of facial trauma. Conjunctivodacryocystorhinostomy has been the standard treatment for canalicular obstruction secondary to unrepaired canalicular laceration. In spite of a high rate of relieving tear-duct obstruction, this method is noted to be associated with low rate of patient satisfaction and a number of complications. The goal of this study is to report the good results of delayed lacrimal stent implantation with Mini Monoka(R) for patients whose canaliculi were not repaired by initial surgery. METHODS: From May of 2005 to February of 2007, four patients who underwent delayed lacrimal stent implantation using Mini Monoka(R) in canalicular laceration were retrospectively reviewed. First, the previous scar incision was made over the lower lid and we identified the cut end of proximal lacerated canaliculus. The Mini Monoka(R) was passed through the punctum to the cut end of the proximal lacerated canaliculus. We identified the cut end of the distal lacerated canaliculus, whose cut end has rolled white edges after careful excision of the scarred lid tissue. We then passed Mini Monoka(R) through the lacerated inferior canaliculus. Using an operating microscope, we placed three interrupted sutures of 8-0 Ethilon to join the canalicular ends. Silicone stent was left in place for 6 months. The mean age of the patients was 48.5 years (range, 35 to 59 years). The time interval from initial trauma to delayed lacrimal stent implantation was between 3 and 31 days. Follow-up periods ranged from 12 and 20 months. RESULTS: The results of reconstruction were classified into normal, fair and poor. Patent lacrimal drainage systems were achieved in three of the four cases. In one case, epiphora was encountered. No cases of stent displacement, conjunctivitis or granuloma formation were encountered. CONCLUSIONS: Even though canalicular reconstruction was delayed for a long time, attempting canalicular reconstruction would be acceptable before considering secondary operations like dacryocystorhinostomy and conjunctivodacryocystorhinostomy.

Study of Silicone Tube and Mini Monoka(R) for Reconstruction of Lacrimal Canaliculi

PURPOSE: In case of facial injury, a canalicular injury is common. Many methods and materials have been used for reconstruction of lacrimal canaliculi. Silicone tube is the most widely used material, generally with pigtail probe or stainless steel probe. But it has still many problems. The authors guess that reconstruction using Mini Monoka(R) will reduce those problems and will be more successful. METHODS: From July, 2003 to November, 2006 in 24 patients with canalicular injury, 11 cases were reconstructed with former silicone tube and 13 cases were treated with Mini Monoka(R). RESULTS: The mean follow-up period was 3 months. The results of reconstruction were classified into three groups(Normal, Fair, Poor). In 13 cases with Mini Monoka(R) stent, 10 cases were normal, 3 were fair, and no poor cases. But in 11 cases with bicanaliculus silicone stent, 6 cases were normal, 3 were fair, and 2 were poor. CONCLUSION: Compared with bicanaliculus silicone stent, Mini Monoka(R) stent is fixed well, has no aesthetic problems, makes less foreign body sensation. And the results were successful.

Monocanalicular Silicone Stent Insertion in Children with Nasolacrimal Duct Obstruction

PURPOSE: To determine the efficacy of Mini Monoka silicone stent insertion in treating nasolacrimal duct obstruction in children. METHODS: In 67 eyes of 61 children with nasolacrimal duct obstruction, the Mini Monoka silicone stent was inserted after probing under general anesthesia. The duration of epiphora or discharge, the age at the time of surgery, and probing history were recorded. The surgical results and postoperative complications were analyzed for the cases herein of Mini Monoka silicone stent insertion. RESULTS: The technical success rate of Mini Monoka silicone stent insertion was 91% in children with nasolacrimal duct obstruction, and the success rate for children without probing history was much higher than for those with probing history (81.5 : 97.5%, p=0.035). Postoperatively, the symptoms were resolved in 54 of 61 eyes (88.5%). The duration of preoperative symptoms was shorter in the successful group than in the failed group (15.9+/-7.1 : 21.9+/-8.8 months, p=0.044). Mini Monoka silicone tube was easily removed at 5.6 months after insertion in the clinic. Dacryocystitis was found to be a complication in two eyes yet was resolved without recurrence. Of the seven eyes with spontaneous extrusion of the stent, symptoms subsided in five eyes. CONCLUSIONS: Mini Monoka silicone stent insertion is an effective and relatively easy method, with a low risk of complication, to treatment children with nasolacrimal duct obstruction.

Monocanalicular Silicone Stent Insertion in Children with Nasolacrimal Duct Obstruction

PURPOSE: To determine the efficacy of Mini Monoka silicone stent insertion in treating nasolacrimal duct obstruction in children. METHODS: In 67 eyes of 61 children with nasolacrimal duct obstruction, the Mini Monoka silicone stent was inserted after probing under general anesthesia. The duration of epiphora or discharge, the age at the time of surgery, and probing history were recorded. The surgical results and postoperative complications were analyzed for the cases herein of Mini Monoka silicone stent insertion. RESULTS: The technical success rate of Mini Monoka silicone stent insertion was 91% in children with nasolacrimal duct obstruction, and the success rate for children without probing history was much higher than for those with probing history (81.5 : 97.5%, p=0.035). Postoperatively, the symptoms were resolved in 54 of 61 eyes (88.5%). The duration of preoperative symptoms was shorter in the successful group than in the failed group (15.9+/-7.1 : 21.9+/-8.8 months, p=0.044). Mini Monoka silicone tube was easily removed at 5.6 months after insertion in the clinic. Dacryocystitis was found to be a complication in two eyes yet was resolved without recurrence. Of the seven eyes with spontaneous extrusion of the stent, symptoms subsided in five eyes. CONCLUSIONS: Mini Monoka silicone stent insertion is an effective and relatively easy method, with a low risk of complication, to treatment children with nasolacrimal duct obstruction.

Clinical Experience of Lacrimal Canalicular Injury with Using Mini Monoka Tube

Reconstruction of lacrimal canalicular laceration has the difficulty to plastic surgeon due to the golden time. Many treatment methods have been developed, but they often ended up with treatment failure because of the difficulty in isolation of proximal segment of laceration canaliculi and the post-operative development of scar adhesion. Recently, silicone tube is the most widely used material in the canalicular reconstruction. Generally silicone tube is used with pigtail probe or stainless steel probe. However sometimes it affects normal punctum and the normal eyelid soft tissue. So, We have tried to reduce such problem by using mini monoka. Mini monoka is easily controlled, has no aesthetic problem, as well as easily removed, and has less foreign body sensation. We were treated with 10 case of canalicular laceration alternative silicone tube (Mini monoka). In conclusion, this method was easier to control than any other silicone tube intubation methods and also saved some time, no corneal irritation sign, any other complications. Mini monoka tube was superior to result of other silicone tube intubation methods.

Outcome of Mini Monoka Silicone Monocanalicular Lacrimal Stents in Canalicular Laceration

PURPOSE: To determine clinical outcomes of mini Monoka silicone monocanalicular lacrimal stent (from now, mini Monoka stent) in canalicular injury. METHODS: From June 1996 to December 2001, mini Monoka stent was used in 70 eyes(77 canaliculi) of superior, inferior and bicanalicular injury. Mini Monoka stent was shortened about 20 mm with round tip and intubated. Punctal fixation suture was not done. RESULTS: The mean follow-up period was 7.9+/-1.0 months (4-12 months). The outcome of our repair was judged by the existence of epiphora, dye disappearance test, probing and irrigation. In 57 eyes (81.4%), there was no epiphora. In 11 eyes (15.7%), epiphora was developed only after certain stimuli. In 2 eyes (2.9%), there was epiphora at all times. Postoperative complications were premature stent loss 6 eyes (8.6%), conjunctival injection 3 eyes (3.9%). CONCLUSIONS: The intubation of mini Monoka stent for the lacerated canaliculus is the simply operative procedure in the outpatient department. The shortening of mini Monoka stent made this procedure easier. Despite no punctal fixation suture, the occurrence rate of the premature stent loss was not higher than that for published reports of mini Monoka stent.

Monocanalicular Lacrimal Silicone Intubation for the Treatment of Pediatric Lacrimal Duct Obstruction

PURPOSE: To assess the clinical efficacy of monocanalicular lacrimal silicone intubation in the pediatric patients with lacrimal duct obstruction. METHODS: The medical records of 14 children with 14 eyes who underwent this procedure were reviewed retrospectively. RESULTS: Monoka(r) silicone tube was used in 3 eyes and Ritleng Self-threading Monoka(r) tube, in 11 eyes. Postoperatively, epiphora was resolved in all cases between one week and 7 months. Early postoperative extrusion of silicone tube occurred in 3 eyes(21.4%). Corneal erosion in 1 eye(7.1%), and granuloma formation in another eye(7.1%) were noticed but disappeared after removal of tubes. Removal of silicone tube was easily performed postoperatively between 3 and 7 months(mean, 4.6 months) in the clinic without sedation in all cases. CONCLUSIONS: Monocanalicular lacrimal intubation using especially Ritleng Self-threading Monoka(r) silicone tube is an easy technique for intubation and removal, and an effective method for the treatment of pediatric lacrimal duct obstruction.

The Effectiveness of Canaliculoplasty Using Mini-Monoka(r) or Bicanalicular Stent for Repair of Upper and Lower Canalicular Laceration

A retrospective study was designed to compare postoperative effect in 45 cases of patients of bicanaliculoplasty with lower canaliculoplasty. The 30 of 45 cases received bicanalicular stent and the 15 cases had lower canaliculoplasty using Mini-Monoka(r) (lower canaliculoplasty).The age ranged from 5 to 67 years (mean: 37.1 years).Thirty-two patients were men and 6 patients were women.After follow-up period of 6 to 12 month (mean 8.6 month), 27 cases (90%)of bicanaliculoplasty and 9 cases (60%)of lower canaliculoplasty became recanalized well. Postoperative complications included granuloma of the punctum in both cases (6 cases of bicanaliculoplasty, 3 case of lower canaliculoplasty)and loss of tube (3 case of bicanaliculoplasty, 6 case of lower canaliculoplasty). When both upper and lower canalicula were injuried, better result was seen in the method of lower canaliculoplasty using Mini-Monoka(r) than that of bicanaliculoplasty using bicanalicular stent. Both bicanalicular stent and Mini-Monoka(r) were good for canaliculoplasty.

Canaliculoplasty Using Mini-Monoka or Bicanalicular Stent for Repair of Canalicular Laceration

A retrospective study was designed to evaluate the clinical characteristics of canalicular injury including causes and associated ocular traumas, time of operation, and appropriate operating methods and materials. The authors retrospectively reviewed the charts of 60 patients who underwent repair of lacerated canaliculi from June 1992 to September 1997 at Chonnam University Hospital. Most injuries occurred at second and third decades(30, 50%). The most common cause was fist blow(19, 31.7%). Among a total of 44 patients who could be followed for more than 6 months, 30 of 32 eyes(93.8%) who were repaired with Mini-Monoka and 11 of 12 eyes(91.7%) with bicanalicular stent met with successful results. There were 8 prolapses of tube, 2 granuloma formations, 2 wound infections, one punctal slit, and one canalicular stenosis as the postoperative complication. All of them ware treated successfully. Canaliculoplasty was not successful in cases that operation was performed 48 hours after trauma and the tube was prolapsed within 3 months. No significant associations were found between presence of postoperative epiphora and sex, causes of injury, location of injury and type of canalicular stent. Canaliculoplasty with either Mini-Monoka or bicanalicular stent had successful postoperative outcomes without any significant complications.

Clinical Experience of Canaliculaoplasty Using Mini-Monoka

Surgical effects were evaluated in 37 cases of mono-canalicular laceration following canaliculoplasty using Mini-Monoka from April, 1993 through SEptember, 1997 in the Department of Ophthalomology, Yeungnam University, College of Medicine. Lower canalicular laceration was included in 33 cases and upper canalicular laceration was found in 4 cases. Distance from the punctum to the lacerated canaliculus was noted to be 1 to 9mm(mean 4.6mm) and age ranged from 3 to 57 years(mean29.3 years). Thirty-four patients were men and three were women. Punctal portion of Mini-Monoka was fixated at the punctum with 6-0 black silk suture. End to end anastomosis was performed with 9-0 Ethylone(spatula needle) or 6-0 Vicryl(round needle). Steroid and antibiotics eye drops were used for 6 months after surgery. Mini-Monoka was removed 4 months postoperatively. After the follow-up period of 6-49 months(mean 11.3 months), 36 cases became recanalized well but 1 case showed obstruction because the laceration site was distant, 9mm from the punctum. Postoperative complications included loss of tube(3 cases), granuloma of the punctum(3 cases) and corneal abrasion(2 cases). Canaliculoplasty using Mini-Monoka is a procedure of choice for repair of mono-canalicular laceration with prevention of loss of the tube by punctal fixation suture without damage of the intact another canaliculi and the inferior meatus.

Canaliculoplasty using Mini-Monoka(R) in Monocanalicular Injury

Sixteen canaliculoplasties using Mini-Monoka(R) were performed for repair of monocanalicalar lacerations. Mini-Monoka(R) was introduced into the dilated punctum and the proximal canaliculus, and passed through the distal end of the canaliculus. End-to-end anastomosis was done with 9-0 Ethylone(spatula needle) or 6-0 Vicryl(round needle). Fixation suture was placed with 6-0 black silk to secure the head portion of Mini-Monoka(R). Removal of the tube was performed 4 months after surgery. After the follow-up period of 6-14 months(mean 9.3 months), fifteen eyes were successful. One eye had intermittent epiphora with canalicular obstruction due to early loss of the tube. Postoperative complications were one case each of punctal slit, punctal granuloma and corneal erosion. The authors suggest that canaliculoplasty using Mini-Monoka(R) is an ideal procedure for repair of monocanalicular laceration. The advantages of this procedure include 1) no damage of the another intact canaliculus, 2) no passage through the nasal cavity, 3) easy technique, 4) short operation time, 5) less discomf ort and 6) cosmetically well acceptable.