Early Experience with the StopLoss Jones Tube.

PURPOSE: Extrusion is the most common reason for failure after Jones tube placement. The StopLoss Jones tube (SLJT) is a new innovation in Jones tubes that incorporates a flexible silicone internal flange to resist extrusion. We present our early experience of using this new tube and associated introducer system. METHODS: We retrospectively analysed the case notes of a single surgeon consecutive series of patients having SLJT placement from November 2011 to November 2013. RESULTS: 29 SLJTs were placed in 25 eyes of 19 patients. Tube follow-up ranged from 1-25 months (mean 10 months) with a total of 291 tube-months. The indications for SLJT placement were: previous LJT complications (52%), failed canalicular-DCR surgery (31%), primary placement for inoperable canalicular occlusion (14%) and patent non-functioning DCR (3%). Tube length ranged from 10-16 mm. The tube introducer system was simple and effective and there were no intra-operative complications. The tube extrusion rate was 0%. Complications occurred in 5 tubes: 1 was too long, and 4 others (14%) developed conjunctival overgrowth/medial tube migration. Patient satisfaction with the tube was: 86% fully satisfied, 10% was moderately satisfied, 3% not satisfied. The overall final surgical success rate at last follow-up was 92%. CONCLUSIONS: In this short follow-up initial study the SLJT is simple to use and has a high rate of success and patient satisfaction. The addition of the internal silicone flange appears to prevent the previously common problem of extrusion.

Twelve-Year Experience of Lester Jones Tubes­Results and Comparison of 3 Different Tube Types.

PURPOSE: Conjunctivodacryorhinostomy with insertion of a bypass Lester Jones tube is effective in treating epiphora due to canalicular failure. There is little information in the literature that directly compares different types of tubes. We report our results of Jones tube placements over a 12-year period with comparison of 3 tube types: plain, frosted, and a new tube with an additional flexible internal silicone flange (StopLoss Jones tube). METHODS: Case notes review of a single surgeon consecutive series of patients having Jones tube placement. RESULTS: One hundred twenty-seven tubes were inserted in 81 eyes of 65 patients. Information on 121 tubes was available for comparison (67 plain, 25 frosted, 29 StopLoos Jones Tube [SLJT]), with flange sizes 3.5 and 4.0 mm. There were 31 males, 34 females, mean age 59 years. After mean follow up of 20 months (range 0.5-108), there were no complications in 50% of tube insertions. Forty-three percentage of tubes needed replacing. The overall rate of complications was higher with a 3.5-mm flange tube than with a 4.0-mm flange (67% vs. 43%). There were no cases of extrusion in the SLJT group after follow up to a maximum of 25 months. The risk of extrusion for both frosted and plain tubes was significantly higher than for SLJT (p = 0.0040). There was no significant difference in the risk of extrusion between frosted and plain tubes. Overall, the risk of complications requiring tube replacement was not significantly different between frosted and plain tubes; however, the risk was significantly higher with both frosted and plain tubes compared with the SLJT (p = 0.036 and p = 0.042, respectively). Patient satisfaction was full in 86% and moderate in a further 5% of patients. CONCLUSIONS: Although patient satisfaction with LJT surgery is high, complications occur frequently, although seem to be less common with the larger 4.0 mm flange. Frosted tubes do not protect against tube displacement. The addition of the internal silicone flange on the SLJT seems to prevent the previously common problem of extrusion.

Adult alveolar rhabdomyosarcoma of the lacrimal sac.

Lacrimal sac tumours are rare, but must be considered in the diagnosis of patients presenting with masses in the medial canthal region. We report a single case of lacrimal sac rhabdomyosarcoma in a 31-year-old man. The patient self-presented to the eye department with a 4-week history of discomfort, epiphora and a medial canthal mass. After no response to 1 week of oral antibiotics for a presumed diagnosis of dacryocystitis and the presence of firm mass extending above the medial canthal tendon, surgical exploration was carried out which revealed a lacrimal sac mass. Histologically this showed an alveolar rhabdomyosarcoma, which was confirmed on immunohistochemistry. After 4 rounds of chemotherapy and 50.4Gy of radical radiotherapy, the patient is well with no signs of further local or distant disease at 11-months follow-up and 20 months following initial diagnosis. To our knowledge, there are no previously reported adult cases of lacrimal sac alveolar rhabdomyosarcoma in the peer-reviewed literature. We want to highlight the unique diagnosis in this case as well as drawing attention to the possibility of malignancy in patients responding poorly to management when an initial diagnosis of dacryocystitis is made in the presence of a medial canthal mass.

Multidisciplinary management of adult orbital rhabdomyosarcoma*.

We report the case of a 52-year-old man who presented with a 10-day history of right eye and eyelid inflammation and intermittent diplopia following blunt trauma to the right eyebrow. The CT and MRI scans revealed an extraconal soft tissue mass on the orbital floor with maxillary and ethmoid sinus wall destruction, which on orbital biopsy was proven to be an Alveolar Rhabdomyosarcoma. The patient had a central retinal vein occlusion due to mass effect that resulted in total visual loss at 2 months. He was referred to oncologists who treated him according to the paediatric RMS protocol and is still in remission at 2-year follow-up. Rhabdomyosarcoma is a rare tumour in adults which requires multi-disciplinary management. This highlights the necessity of considering rhabdomyosarcoma in the differential diagnosis of orbital tumours in any age group.