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Soydan Kurun, Pierre J. Bertaux, Audrey Baudot, Piotr Lasota, Monica Lacusteanu, Adina Agapie, Heni Mnasri, Jean M. Perone; Tarsal Strip Shortening And One Snip Puntoplasty Combined Surgery For Epiphora With Ectropion And Lacrimal Point Stenosis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1068.
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We show the efficiency of lacrymal point simple opening « one snip » combined with a tarsal strip shortening in the surgical cure of epiphora by ectropion and lacrimal point stenosis.
Inclusion criteria: epiphora for more than 6 months, ectropion by tarsal belt laxity, partial lacrimal points stenosis. 22 patients were included among which 12 presented a bilateral symptomatology, that is 34 eyelids. Average age: 80.0+/-9.9 years. All operated on by the same surgeon between January, 2009 and November, 2010. Surgical procedure: under local anesthesia, shortening of the tarsal strip by Lazy T(29.4%), Kunt-Szymanowski(35.3%), and lateral canthopexy(35.3%). Opening the posterior wall of the lacrimal point by "one snip" n=20 (58.8%) or by traditional "three snip" technique without suture n=14 (41.2%).The average follow-up is 10.5+/-4.2 months. Were defined as success : no epiphora and a lacrimal point spontaneously open and in good position.
In "three snip" group, 2 patients presented a remaining epiphora despite of lacrimal point open and in good position. In "one snip" group, 1 patient presented a point stenosis and 1 presented an unilateral epiphora despite of a lacrimal point open and in good position. That is 4 failures, the success rate is 88.2% (85.7% in the "three snip" group and 90.0% in the "one snip" group). There’s no statistical significant difference between both groups (Khi square =0.15)
Several techniques were described, from a triple triangular section +/- suture, causing an important amputation of the posterior wall, to a single vertical opening without loss of substance. In our study a simple opening seems as effective as the traditional triangular "3 snip" technique.We think that tarsal strip shortening, puts all the palpebral structures in tension and allows to separate the edges of the posterior cut wall during the healing phase. The "one snip" puntoplasty combined to a tarsal strip shortening in epiphora with ectropion and lacrimal point stenosis is a simple, efficient and less invasive technique, which allows a sufficient reopening of the lacrimal point. The choice of shortening’s technique must take into account the palpebral’s stato-kinetics to put the point in the most physiologic position before proceeding to the opening.
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