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.

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(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.