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Purpose : To analyze the causes, success rate, and changes of Jones tube length in endoscopic conjunctivodacryocystorhinostomy (CDCR) re-operation through retrospective chart review.
Methods : The medical records of 40 patients, who underwent reoperation of conjunctivodacryocystorhinostomy (CDCR) with Jones tube reinsertion using endoscope from January 2013 to December 2018, were reviewed. We analyzed the causes of reoperation, length of used tubes, average interval time between initial operations to reoperation, and success rate of re-operation.
Results : Of 40 patients including 1 patient with bilateral operation, 6 patients underwent operation twice, and 2 patient underwent operation 3 times. Total of 52 cases were reviewed. The most common cause of reoperation was medial tube migration (28/52, 53.8%). As other causes, tube loss (9/52, 17.3%), obstruction related with conjunctival overgrowth or granulation (7/52, 13.46%), lateral tube migration (6/52, 11.53%), iatrogenic removal (1/52, 1.92%), acute dacryocystitis (1/52, 1.92%) were followed. Among 9 tube loss cases, 2 cases were caused by sneezing. In 28 patients who suffered from medial tube migration, average tube length used in prior operations was 18.75mm, and it was decreased to 17.64mm in re-operations. In 6 cases of lateral tube migration, initial average tube length was 16.16mm and increased to 17.16mm in revision surgery. Success rate of reoperation was 80% (32/40)
Conclusion : Tube migration seems to be the biggest problem of reoperation of conjunctivodacryocystorhinostomy (CDCR) using endoscope. Medial migration of Jones tube was the most common cause. Tube length used in CDCR operation seems to be related with certain type of complications and may affect the prognosis of operation. We report that CDCR reoperation achieves comparable success rate compared to that of primary CDCR surgery reported by other authors.
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