A new modification in the porous polyethylene-coated lester jones tube.

Purpose: Conjunctivodacryocystorhinostomy (CDCR) is the gold standard for the treatment of many cases of canalicular obstruction since 1965 (Kominek & Cervenka, 2004). With a proper CDCR and a well-placed Jones tube, the success rate in our experience is almost 100%. The most frequent complication is extrusion and dislocation. Rates as high as 49% have been reported in some studies (Rose & Welham, 1991). Various modifications have been introduced in the tube design in order to minimize extrusion, including tubes with suture holes, the frosted Jones tubes, and regular porous polyethylene-coated tubes. The regular porous polyethylene-coated tubes are covered by a long sleeve of porous polyethylene, which irritates the conjunctiva causing discharge and sometimes granuloma formation. We describe here a modification of this tube with a much shorter porous polyethylene sleeve to minimize the ocular irritation and discharge.
Methods: Ten patients, age 29-50 years, with complete canalicular obstruction and excessive tearing after failed DCR with canaliculoplasty were included in this study. All patients underwent CDCR with anastomoses of the sac mucosa with that of the nasal mucosa via posterior and anterior flaps. Subsequent placement of porous polyethylene-coated Lester Jones tubes were done at the site of carunculectomy. The regular porous polyethylene coat was shortened using a surgical blade to correspond to the fistula opening, only without extension to the caruncle. The average length of the coat in the 10 cases was about 5 mm.
Results: Postoperatively, all patients had surgically successful outcomes, with no complaints of epiphora or discomfort. All tubes are still in proper position and functioning well. Our follow-up has been limited to an 18-month period.
Conclusion: CDCR with the modified porous polyethylene-coated Lester Jones tube has the same advantages of the traditional porous polyethylene-coated tube. Moreover, it reduces the discharge and ocular irritation, which are the main complications of the CDCR with the current porous polyethylene-coated Jones tube.