Korean J Ophthalmol.  2018 Dec;32(6):438-444. 10.3341/kjo.2018.0044.

Combination Surgery of Silicone Tube Intubation and Conjunctival Resection in Patients with Epiphora

• Kim ST
• Jin LY
• Ahn HB

• KMID: 2427957
• DOI: http://doi.org/10.3341/kjo.2018.0044

Abstract

PURPOSE
To compare the success rates of performing only silicone tube intubation versus carrying out both conjunctival resection and silicone tube intubation.
METHODS
The subjects of this study involved 62 patients (96 eyes) between October 2015 and May 2017 who were diagnosed as having punctal stricture or nasolacrimal duct stenosis. Out of 96 eyes, 47 underwent only silicone tube intubation, and 49 underwent both silicone tube intubation and conjunctival resection. Three parameters were measured at 1, 3, and 6 months after the surgery: the area of the tear meniscus using RTVue-100 anterior segment optical coherence tomography, the height of the tear meniscus using a slit lamp microscope, and the subjective satisfaction of patients as a result of improved sympotms like epiphora. The surgery was considered successful when the patients' experienced the resolution of symptoms and reduction of the area and height of the tear meniscus.
RESULTS
The area of the tear meniscus, height of the tear meniscus, and subjective satisfaction of patients was superior in the group that underwent both silicone tube intubation and conjunctival resection compared silicone tube intubation only. Based on these results, the success rate of the surgery was 68.9% in the group that underwent only silicone tube intubation and 78.7% in the group that underwent both silicone tube intubation and conjunctival resection.
CONCLUSIONS
The resection of relaxed plica semilunares seems to increase the success rate of silicone tube intubation through the reduction of the area and height of the tear meniscus. Therefore, after determining the degree of conjunctivochalasis, if it was found to be severe, a combination with conjunctival resection was expected to increase the success rate of the surgery.

Keyword

Conjunctival resection; Plica semilunaris; Silicone tube intubation; Success rate; Tear meniscus

MeSH Terms

Constriction, Pathologic
Humans
Intubation*
Lacrimal Apparatus Diseases*
Nasolacrimal Duct
Silicon*
Silicones*
Slit Lamp
Tears
Tomography, Optical Coherence
Silicon
Silicones

Figure

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  Fig. 1 The arrow showing the conjunctivochalasis. Bulged plica semilunaris is blocking lower punctum.

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  Fig. 2 The process of conjunctival resection. (A) Preoperative state. (B) The conjunctivochalasis of plical semilunaris was marked by pen. (C) Marked area was resected and followed by electrocauterization. (D) Postoperative state after 6 months.

• 

  Fig. 3 The area of the tear meniscus. (A) The arrow shows the longitudinal plane of tear meniscus. (B) The area was measured bymanually drawing a line along the boundary of the tear meniscususing RTVue-100 anterior segment optical coherence tomography.

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  Fig. 4 The height of the tear meniscus was measured using the caliper of the slit lamp microscope. The yellow dot line and arrowhead show the area and heights of tear meniscus.

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  Fig. 5 The RTVue-100 anterior segment optical coherence images show that the area of tear meniscus was de creased after surgery. (A) Preoperative state and (B) postoperative state.

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  Fig. 6 The height of the tear meniscus, as shown through the yellow dot line, using the caliper of the slit lamp microscope was decreased after surgery. (A) Preoperative state and (B) postoperative state.

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