Purse-string Suture Technique for Jones Tube Fixation in Conjunctivodacryocystorhinostomy

ABSTRACT

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.