Rajat D Maheshwari, Maanvi Maheshwari
Purpose: Pigtail probe as a procedure of choice for canalicular laceration. Methods: Retrospective, consecutive interventional case series of patients with eyelid laceration involving the canaliculus undergoing repair. All patients were subjected to repair with pigtail probe as first choice and only if this was not possible, they were repaired by other method. Outcome was analyzed in terms of cosmetic, functional, and anatomic success. Results: A total of 35 patients (mean age, 10.88 years) underwent eyelid and canaliculus repair by a single surgeon (RM). In all, 32 (91.42%) canalicular lacerations were repaired by annular intubation using a pigtail probe, while the remaining 3 (8.58%) lacerations in which pigtail probe intubation was not possible, were repaired by an alternative method. Upper canaliculus was involved in 6 (17.14%) and lower canaliculus in 29 (82.86%) eyes. Mean follow-up was 8.2 months (range 3–13 months). Intubation tubes were removed after at least 3 months (range 12–20 weeks). None of the patients had complaints of epiphora. All the patients had good cosmesis, anatomic alignment and functional success as assessed by dye disappearance test in younger children and lacrimal irrigation in older children and adults. Conclusion: Bicanalicular annular repair with pigtail probe achieved excellent functional and cosmetic results. The loop minimizes the chances of extrusion of the tube, maintains natural anatomic alignment of the cut ends of the canaliculus and thus retains the integrity of the delicate canalicular system. Pigtail probe intubation can be considered as the first choice in canalicular lacerations.
Edward J. Wladis, Vinay K. Aakalu, Jeremiah P. Tao, Rachel K. Sobel, Suzanne K. Freitag, Jill A. Foster, Louise A. Mawn
To determine the efficacy and complication rates of monocanalicular stents in the setting of canalicular lacerations.
A literature search was performed in May 2018 in the PubMed database to identify all English-language reports of monocanalicular stenting to address canalicular lacerations. Studies that did not include at least 10 patients with at least 3 months of follow-up evaluation after surgery were excluded. Ninety-nine articles were identified, and 15 of these met criteria for data abstraction and were included in this assessment. The panel methodologist (V.K.A.) evaluated the quality of evidence and assigned a level-of-evidence rating to each of these studies.
All 15 studies were rated as level III evidence. Anatomic and functional success rates after surgery ranged from 68% to 100% and 79% to 100%, respectively. Stents were generally well tolerated, although extrusion rates varied from 0% to 29%.
Only level III evidence was available, and studies were not powered to detect differences between groups for rare complications or failure. Monocanalicular stents seem to be efficacious and well tolerated in the management of canalicular lacerations. Potential complications include extrusion (most commonly), tube displacement, granuloma, ectropion, slit punctum, fistula, and infection. Further comparative studies would help to identify the optimal time for device removal and to directly compare monocanalicular with bicanalicular stents.
Yen-Chang Chu, Shu-Ya Wu, Yueh-Ju Tsai, Yi-Lin Liao, Hsueh-Yen Chu
To determine whether delayed repair of traumatic canalicular laceration affects the final outcome.
Retrospective case series.
The medical records of 334 patients who underwent primary traumatic canalicular laceration repair were retrospectively reviewed. Patients were divided into 2 groups according to the surgical timing within 48 hours (early) or after 48 hours (delayed). The anatomic results were compared between these 2 groups. The causes of delayed repair and the mean operation time were also analyzed.
There were 23 failed cases among 301 patients (7.6%) who had a repair within 48 hours and 3 failed cases among 33 patients (9.1%) who had a repair after 48 hours (P = .732). The mean operation time was 62 minutes in the early group and 66.3 minutes in the delayed group, which showed no significant difference (P = .371). The major cause of delayed surgery was traumatic brain injury, followed by facial or orbital fracture, long bone fracture, and chest injury.
Md. Shahid Alam, Neha Shrirao Mehta, Bipasha Mukherjee
To evaluate the anatomical and functional outcomes of canalicular laceration repair with self retaining monocanalicular intubation system (Mini-MONOKA).
Materials and methods
The data of 29 patients undergoing canalicular laceration repair from 2010 to 2014 were retrospectively analyzed. Operative details and complications were noted. The stent was removed earliest at 3 months. Anatomical and functional success was defined by a patent syringing and the absence of epiphora respectively.
Out of 29 patients, 23 (79.3%) were males. Mean age at presentation was 19.3 ± 13.8 years. Lower canaliculus was involved in 19 (65.5%), upper in 8 (27.5%) and both canaliculi in 2 (6.8%). Ten patients presented later than 11 days after trauma (range 12–168 days), and repair was attempted successfully in all.
Fourteen (48.2%) cases reported for stent removal, at a mean follow-up period of 4.64 ± 2.12 months. Anatomical success was noted in 12 (85.71%) and functional success in 13 (92.85%) cases. Four patients had stent related complications.
Tavakoli, Mehdi M.D., F.I.C.O.; Karimi, Sayeh M.D.; Behdad, Bahareh M.D.; Dizani, Setareh M.D.; Salour, Hossein M.D.
Purpose: This study evaluated the efficacy of a new pushed monocanalicular silicone tube in reconstructing traumatic canalicular laceration.
Methods: This interventional case series enrolled 48 patients with a traumatic canalicular laceration. Patients with bicanalicular involvement were excluded. Canalicular repair was performed under an operating microscope and involved proximal end exploration of the canaliculus, stenting of the canaliculus with a 35-mm Masterka tube, and approximation of the lacerated canaliculi margins. After 6 months, anatomical and functional success rates were evaluated by diagnostic probing and by asking the patients (or their guardians) about tearing.
Results: The mean age of patients was 32.2 ± 21.2 years (1.5–75 years). Of the 48 patients included, 38 were males. Lower canaliculus was involved in 35 patients. Other ocular injuries were observed in 38 patients. The average interval between the surgery and Masterka removal was 12.2 ± 1.4 weeks (10–16 weeks). Early tube extrusion was observed in 3 patients. No significant complication was observed in this series. Anatomical and functional success rates were 87% and 100%, respectively.
Conclusion: The results demonstrated that intubation of lacerated canaliculi with Masterka tube for canalicular repair was safe, effective, and simple with minimal complications.