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Kira Lauren Segal, Sarah Haseltine Van Tassel, Charles Kim, Ashutosh Kacker, Gary J Lelli; Comparison of Extrusion Rate of Crawford Tubes with and without Suture. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4071.
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Dacryocystorhinostomy (DCR) is a procedure commonly performed in patients with nasolacrimal duct obstruction (NLDO). As part of the procedure, silicone stents, most commonly Crawford tubes at our institution, are inserted to maintain the patency of mucosal passages to the nose. Crawford tube with suture in the lumen (CTS) is an alternative intubation tool. When using CTS, the distal silicone ends of the tubing are stripped and the sutures are tied to make a continuous loop in the nose. CTS simplifies tube removal in the office and is useful for patients in whom office removal of tubes would be difficult. However, lateral prolapse of CTS, can cause corneal or conjunctival irritation, punctal erosion and patient discomfort. Early removal of tubes as a result of prolapse may limit the effectiveness of DCR if complete epithelialization of lacrimal passage has not yet been achieved.
Retrospective case series consisting of all patients who underwent DCR by the Ophthalmology department at New York-Presbyterian Hospital/Weill Cornell Medical College between 2008 and 2013. These patients were followed post-operatively for at least six months. Primary endpoints assessed included tube prolapse, time to tube removal, and recurrent symptoms.
A total of 55 patients underwent 65 DCR procedures for NLDO within the study interval. Forty-four were endoscopic (eDCR) and 21 were external DCRs (xDCR). Twenty-five percent (25%) (n=16) of cases were re-operations and 8% (n=5) were bilateral. Lacrimal intubation was achieved by CTS in 6 patients. Prolapse of tubes was noted in 8% (n=5) of patients with traditional Crawford tubes (TCT) vs. 50% (n=3) of patients with CTS. Average time to tube removal was shorter in patients with prolapse when compared to patients without prolapse (10 vs. 18 weeks, p=0.001). Recurrence of symptoms was more common in patients with tube prolapse.
DCR has emerged as a safe and effective procedure for patients with nasolacrimal duct obstruction. CTS enables simplified tube removal in the office, however, poses greater risk for lacrimal tube prolapse. Early removal of stents may limit treatment success.
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