A Clinical Study Associated with Anatomical and Functional Outcomes in the Repair of Canalicular Laceration

PURPOSE: To identify risk factors influencing the anatomical and functional outcomes of canaliculoplasty in canalicular laceration patients. METHODS: A retrospective investigation of 122 eyes of 122 patients diagnosed with canalicular laceration and treated in our hospital from January 2000 to October 2008 was conducted. Sex, age, cause and location of laceration, combined injury, preoperative duration, combined operation, duration of follow-up, and anatomical and functional outcomes of canaliculoplasty were investigated. RESULTS: The mean age of the 122 patients was 41.2 years; 102 (83.6%) were men, and 20 (16.4%) were women. The most common cause and combined injury of laceration was sharp object Injury (20.5%) and orbital wall fracture (14.7%). No statistically significant correlation was found between pretreatment duration, duration of silicone tube insertion, and anatomical outcome. The causes of decreasing functional outcome of canaliculoplasty were traumatic facial nerve palsy, cicatrical entropion and ectropion, and partial canalicular obstruction. CONCLUSIONS: Repair of a combined eyelid injury close to the normal anatomical structure is an important factor for increasing the functional outcome.

Delayed Canaliculoplasty in Unrepaired Canalicular Laceration

PURPOSE: Conjunctivodacryocystorhinostomy with a Jones tube has been the standard treatment for canalicular obstruction secondary to unrepaired canalicular laceration. We sought to evaluate the efficacy of delayed canaliculoplasty with bicanalicular silicone intubation for patients whose canaliculi were not repaired by initial surgery. METHODS: We retrospectively studied the medical records of 4 patients who had bicanalicular obstruction from previous unrepaired canalicular laceration. After careful dissection through the scarred medial canthal region, canaliculoplasty with bicanalicular silicone intubation was performed. The time interval from initial trauma to canaliculoplasty was between 5 months and 10 years. Follow-up periods ranged from 3 weeks to 13 months. RESULTS: All of the canaliculi were reanastmosed. Epiphora disappeared in two, occurred intermittently in one, and persisted in the last at 3 weeks postoperatively. CONCLUSIONS: Delayed canaliculoplasty was functionally effective in three out of four patients. Even though canalicular reconstruction was delayed for a long time, attempting canalicular reconstruction would be recommendable before considering conjunctivodacryocystorhinostomy with a Jones tube.

Ballooning Canaliculoplasty and Silicone Tube Intubation after Lacrimal Trephination

PURPOSE: The purpose of this study was to assess the satety and effectiveness of lacrimal trephination and balloon dilatation in treatment of obstruction of the lacrimal canaliculus. METHODS: Lacrimal trephination and subsequent balloon dilation was performed in 7 eyes of 7 consecutive patients with epiphora due to lacrimal canalicular obstruction and common canalicular obstruction. RESULTS: The average age of patients was 50.3 years old and the average follow-up period was 17.7 months. Anatomical success was 7 of 7 eyes (100%) and functional success , resolution of epiphora was 5 of 7 eyes (71%) CONCLUSIONS: Lacrimal trephination and subsequent ballooning canaliculoplasty in treatment of obstruction of the lacrimal canaliculus seems to be safe and valuable as an primary procedure before Jones tube bypass surgery.

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.