Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Prognosis and Cost Effectiveness of the Monocanalicular Intubation with Re-Sterilized Silicone Tubes in Canalicular Lacerations: Observational Case Series
Kanalikül Laserasyonlarında Tekrar Sterilize Edilmiş Silikon Tüpler ile Yapılan Monokanaliküler Entübasyonun Prognozu ve Maliyet Etkinliği: Gözlemsel Olgu Serisi
Ali Altan Ertan BOZa , Kadriye DEMİR BONCUKÇUa , Eda GÜMRÜKÇÜOĞLUa , Nilgün ÖZKAN AKSOYa
aSakarya University Faculty of Medicine, Department of Ophthalmology, Sakarya, Türkiye
Turkiye Klinikleri J Ophthalmol. 2024;33(3):156-62
doi: 10.5336/ophthal.2023-100707
Article Language: EN
Full Text
ABSTRACT
 Objective: Canalicular lacerations are usually treated with monocanalicular or bicanalicular silicon stent intubation. This study aimed to report the prognosis and cost-effectiveness of monocanalicular intubation using re-sterilized silicone tubes for canalicular lacerations. Material and Methods: Patient demographics, surgery timing, surgical time, postoperative treatment, follow-up, timing of the silicon tube removal, and postoperative lacrimal patency (anatomical success) and subjective epiphora (functional success) were investigated. Five-centimeter silicone tubes remaining from dacryocystorhinostomy surgery, re-sterilized with ethylene oxide, were used. The silicone tube was left approximately 1.5 centimeters beyond the lacrimal punctum to avoid corneal contact. The free end of the tube was sutured to the skin and orbicularis muscle, positioning it downward. Anatomical success was determined with the lacrimal irrigation test upon removal, and functional success was assessed using the Munk score. Results: Twenty-seven patients with an average age of 47.5 years and a mean follow-up of 7.6 months were included. Canalicular reconstruction was performed within 24 hours of injury, with an average surgical time of 24.7 minutes. No intraoperative complications, ocular surface irritation, stent migration, spontaneous stent loss, or infection were observed. Granuloma formation occurred in one (3.7%) patient, and medial ectropion of the lower eyelid in one (3.7%) patient. Anatomical success was 100%, and functional success was 96.2%. Conclusion: Repairing lacerated canaliculi with re-sterilized silicon tubes was successful and cost-effective. This technique avoids manipulation of the uninjured canaliculus, making tube insertion and removal straightforward. Its significant advantage is the lack of additional costs or instruments, valuable during limited instrument availability, such as the COVID-19 pandemic.

Keywords: Monocanalicular intubation; re-sterilized silicon tube; epiphora; lacrimal irrigation; Munk score
ÖZET
 Amaç: Kanaliküler laserasyonlar genellikle monokanaliküler veya bikanaliküler silikon tüp entübasyonu ile tedavi edilir. Bu çalışmada, kanalikül laserasyonlarının tedavisinde tekrar sterilize edilmiş silikon tüpler kullanılarak yapılan monokanaliküler entübasyonun prognozu ve maliyet etkinliğinin araştırılması amaçlandı. Gereç ve Yöntemler: Hasta demografisi, cerrahi zamanlaması, ameliyat süresi, ameliyat sonrası tedavi, takip süresi, silikon tüp çıkarılma zamanı ve postoperatif lakrimal geçiş (anatomik başarı) ve subjektif epifora (fonksiyonel başarı) araştırıldı. Dakriyosistorinostomi ameliyatından kalan beş santimetrelik silikon tüpler etilen oksit ile tekrar sterilize edilerek kullanıldı. Korneal teması önlemek için silikon tüp lakrimal punktumdan itibaren yaklaşık 1.5 santimetre uzun bırakıldı. Tüpün serbest ucu cilde ve orbiküler kasa sütüre edilerek aşağı yönde konumlandırıldı. Anatomik başarı, tüp çıkarıldığında lakrimal irrigasyon testi ile, fonksiyonel başarı ise Munk skoru ile değerlendirildi. Bulgular: Yaş ortalaması 47.5 yıl olan ve ortalama 7.6 aylık takip süresi olan 27 hasta çalışmaya dahil edildi. Kanaliküler rekonstrüksiyon, yaralanmadan sonraki 24 saat içinde gerçekleştirildi ve ortalama cerrahi süresi 24.7 dakika idi. Ameliyat sırasında komplikasyon, oküler yüzey irritasyonu, stent göçü, spontan stent kaybı veya enfeksiyon gözlemlenmedi. Bir (%3.7) hastada granüloma oluşumu ve bir (%3.7) hastada alt göz kapağının medial ektropiyonu gözlendi. Anatomik başarı %100 ve fonksiyonel başarı %96.2 olarak bulundu. Sonuç: Tekrar sterilize edilmiş silikon tüplerle kanaliküler laserasyonlarının onarımı hem başarılı hem de maliyet etkin bulundu. Bu teknikte, sağlam kanalikülün manipülasyonu gerekmemektedir ve silikon tüp yerleştirme ve çıkarma işlemleri nispeten basittir. Tekniğimizin en önemli avantajı, ek maliyet ve donanım gerektirmemesidir, bu da COVID-19 pandemisi gibi enstrüman bulunabilirliğinin sınırlı olduğu dönemlerde özellikle değerlidir.

Anahtar Kelimeler: Monokanaliküler entübasyon; tekrar sterilize edilmiş silikon tüp; epifora; lakrimal irrigasyon; Munk skoru
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