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A. M. Moll, J. Torres, S. Myint, G. Gladstone; Success Rates of Endoscopic-Assisted cDCR With a Modified Jones Tube. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1920.
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The purpose of this study is to evaluate the clinical and subjective success of lacrimal bypass surgery by endoscopic-assisted conjunctivodacryocystorhinostomy (cDCR) with placement of a modified Jones tube. In an effort to better define surgical success, we describe a new 4-point scale to grade tear drainage. We believe this scale will serve as a valuable guidepost for future comparison of success rates with Jones tube placement by varied approaches.
This is a retrospective review of the charts of 45 patients who underwent endonasal cDCR with insertion of a modified Jones tube by one of two surgeons (GG, SM) from 2001 to 2005. Success was evaluated objectively by implementation of a pre-determined 4-point drainage scale, with class I-IV ranging from spontaneous drainage into the Jones tube upon instillation of irrigating solution into the surgical eye (class I) to inability to achieve any delivery of fluid into the nasal cavity despite active irrigation of the tube (class IV). Subjective success was defined by patients' reported post-operative improvement in epiphora. Intra- and post-operative complications, as well as tube displacement, need for subsequent surgery/revision and long-term Jones tube patency were also evaluated.
Mean follow-up was 32 months (range: 6-119 mos.). 42% of patients achieved success, both subjectively and objectively, after a single surgery. 9 patients (2%) achieved objective success according to the drainage scale, but continued to experience epiphora despite a successful first procedure. Of the 18 patients undergoing a second cDCR, 50% achieved both objective and subjective success. 4 patients had an overall successful outcome after a 3rd surgery, with an additional 25% obtaining objective success only. One patient underwent a 4th cDCR at most recent follow-up.
cDCR surgery has been considered a final effort in the arduous task of treating patients with chronic epiphora. This procedure has been plagued by marginal surgical success and low patient satisfaction following surgery. Endoscopic assistance in performing cDCR in combination with the use of a modified Jones tube may increase the likelihood of long-term success with this procedure. In this study, objective success is uniformly defined by the use of a new 4-point drainage scale. If implemented, this scale may lend to more concrete comparisons of success among various surgical techniques.Bibliography: Jong Sl. Treatment of LAO with inner canthal Jones tube. OSL. 1/2 2001. 32(1): 48-54.Rosen N. Patient Dissatisfaction after functionally successful cDCR. AJO. 5/1994. 117:636-42.
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