Minimally Invasive Conjunctivodacryocystorhinostomy with Jones Tube

Ophthalmic Plastic and Reconstructive Surgery
Vol. 23, No. 3, pp 252–257 ©2007 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.

Martin H. Devoto, M.D.*, Francesco P. Bernardini, M.D., and Carlo de Conciliis, M.D. *Consultores Oftalmologicos, Buenos Aires, Argentina; Ospedale Evangelico Internazionale, Genova and Ospedale Evangelico Valdese, Torino, Italy; and Ospedale S. Giuseppe, Milano, Italy.

Purpose:
To describe a minimally invasive technique for conjunctivodacryocystorhinostomy with the Jones tube. This technique creates a direct communication between the conjunctiva and the middle meatus with the use of a 14-gauge angiocatheter. The glass tube is inserted under endoscopic or direct visualization.

Methods:
A retrospective review of consecutive patients who underwent the minimally invasive technique for conjunctivodacryocystorhinostomy for complete bicanalicular lacrimal obstruction was performed.

The surgical time, intraoperative and postoperative complications, length of the tubes, long-term patency, tube displacement, and need for secondary revision were evaluated.

Results:
Fifty-five consecutive patients were included in the study. All surgical procedures were successfully performed without significant complications, in an operating time that averaged 16 minutes. In one early case, a patient had persistent postoperative bleeding that required cauterization of the middle turbinate. In 3 patients, late migration of the Jones tube into the nasal cavity required secondary intervention with successful Jones tube
repositioning.

Minor office tube cleaning was performed without removal of the tube. The patency of the Jones tube was regularly tested with demonstration of aspiration of 2% fluorescein solution from the tear meniscus in the tear lake opening of the tube at the slit lamp, the passage of the same solution in the nose with endoscopic view, and finally, with irrigation of saline solution in the tube.

Conclusions:
The minimally invasive technique for conjunctivodacryocystorhinostomy with the Jones tube can be successfully performed with a simple “poke-through” technique from the conjunctiva to the nose with direct or endoscopic control. This technique has proved to be time-effective and well tolerated by patients.

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