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Milap Mehta, Nitasha Gupta; Suture fixation for Monocanalicular stenting. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4730.
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Epiphora may result from multiple etiologies including increased lacrimation, decreased tear outflow, and eyelid malposition. Monocanalicular stenting using the mini-Monoka has been used to treat punctal stenosis but often results in premature stent extrusion or migration. We sought to test a simple technique to reduce stent extrusion using an externalized fixation suture.Our study was a retrospective chart review of 3 patients undergoing a modified surgical technique.
Our exclusion criteria included patients with canalicular stenosis, nasolacrimal duct obstruction, dry eyes or significant ectropion as a cause for epiphora. Probing and irrigation were performed on each patient to demonstrate canalicular and nasolacrimal duct patency. Tear break-up time and fluoroscein staining were used to evaluate for dry eyes. Three patients (4 puncta) fulfilled our exclusion criteria and demonstrated only punctal stenosis. One patient had bilateral punctal stenosis. Our cohort included 2 male and 1 female patients with an average age of 52 years. Each patient underwent punctal dilation, limited punctoplasty with a single vertical blade incision using a # 11 blade, insertion of mini-Monoka® stenting, and suture fixation. A double-armed 6-0 chromic suture or double-armed 6-0 vicryl suture was first looped around the stent lip. Each arm was then passed from the punctal lumen through the eyelid skin and externalized. The ends of the sutures were tied 3 millimeters from the eyelid margin to prevent corneal irritation. The sutures were allowed to reabsorb and the patients were followed at 1 week, 1 month and 3 month intervals. Our end points were extrusion or migration of the stent prior to surgical removal. Each stent was removed after 3 months.
There were no cases of premature migration or extrusion. All 3 patients underwent uncomplicated stent removal after 3 months. One punctum (25%) developed a conjunctival pyogenic granuloma which was treated conservatively. All 3 patients (100%) developed symptomatic relief and all 4 puncta (100%) maintained anatomic patency at 3 month follow-up with a repeat probe and irrigation.
The mini-Monoka® stent is an excellent option for the treatment of epiphora from punctal stenosis. Suture fixation with a double-armed 6-0 chromic or 6-0 vicryl suture reduces the risk of stent migration and extrusion with limited complications.
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