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A modified method for punctoplasty: “Excisional punctoplasty with the guidance of a 27 G Rycroft cannula”

Year 2019, Volume: 3 Issue: 3, 258 - 261, 15.03.2019
https://doi.org/10.28982/josam.537361

Abstract

Aim: We modified conventional 2-snip punctoplasty to ease procedure and to perform with simple equipment which is widely accessible in the operation rooms. 

Methods: This new procedure has been performed to 10 eyes of 6 patients. After the appropriate width has been provided, a 27G anterior chamber cannula which is actually manufactured for cataract surgery was inserted to punctum and pushed forward 2 mm vertically and 1 mm horizontally. After that, the surgeon exposed the tip of cannulas by opening conjunctiva with conjunctival scissors (Westcott Conjunctival Scissors) from the projection site of the tip of the cannula. The Rycroft cannula is used for better guidance for canaliculus anatomy instead of lacrimal cannulas. After canaliculus was hanged with the cannula, a conjunctival incision was made from the entrance of cannula to the punctum towards the point where the cannula exposed from conjunctiva via Westcott scissors. In the next step, two sides of the formed flap were held with toothed forceps orderly and were removed by cutting with conjunctival scissors. 

Results: After 6 month follow-up, none of the patients complained with epiphora and satisfied with the surgery. All participants have been defined with the presence of Grade 3-5 punctal aperture with the references of Punctum Size Grading by Slit-Lamp Examination. 

Conclusion: In this article, we could apply this method to a very limited number of patients and our follow-up (6 months) is relatively short to claim the re-stenosis ratio but in the immediate postoperative period, we didn’t encounter any re-stenosis.

References

  • 1. Ulusoy MO, Atakan M, Kıvanç SA. Prevalence and associated factors of external punctal stenosis among elderly patients in Turkey. Arq Bras Oftalmol. 2017 Sep-Oct;80(5):296-99. doi: 10.5935/0004-2749.20170072.
  • 2. Soiberman U, Kakizaki H, Selva D, Leibovitch I. Punctal stenosis: definition, diagnosis, and treatment. Clin Ophthalmol. 2012;6:1011. doi: 10.2147/opth.S31904.
  • 3. Kashkouli MB, Beigi B, Murthy R, Astbury N. Acquired external punctal stenosis: etiology and associated findings. Am J Ophthalmol. 2003;136.6:1079-84. doi: 10.1016/S0002-9394(03)00664-0
  • 4. Tabbara KF, Bobb AA. Lacrimal system complications in trachoma. Ophthalmology. 1980;198787(4); 298-301.
  • 5. Jager GV, Bijsterveld OPV. Canalicular stenosis in the course of primary herpes simplex infection. Br J Ophthalmol. 1997;81(4):332.
  • 6. Bowman W. Methode de traitement applicable a l'epiphora dependent du renversement en dehors ou de l'obliteration des points lacrymaux. Ann Oculist. 1853;29:52–5.
  • 7. Graves B. Making a new lacrimal punctum. Am J Ophthalmol. 1926;9:675–7.
  • 8. Thomas JBT. A modification of Graves' operation for epiphora due to stenosis of the lacrimal punctum. Br J Ophthalmol. 1951;35:306.
  • 9. Viers ER. Disorders of the canaliculus in the lacrimal system, New York: Grune and Stratton.1955);46-7.
  • 10. Jones LT. The cure of epiphora due to canalicular disorders, trauma and surgical failures on the lacrimal passages. Trans Am Acad Ophthalmol Otolaryngol. 1962;66:506–24.
  • 11. Caesar R, McNab A. A brief history of punctoplasty: the 3-snip revisited. Eye (Lond). 2005;19(1):16. doi:10.1038/sj.eye.6701415
  • 12. Chak M, Irvine F. Rectangular 3-snip punctoplasty outcomes: preservation of the lacrimal pump in punctoplasty surgery. Ophthalmic Plast Reconstr Surg. 2009;25(2):134-5. doi: 10.1097/IOP.0b013e3181994062.
  • 13. Munk PL, Lin DT, Morris DC. Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology. 1990;177(3):687–90.
  • 14. Dolin SL, Hecht SD. The punctum pucker procedure for stenosis of the lacrimal punctum. Arch Ophthalmol. 1986;104(7):1086-7.
  • 15. Lam S, Tessler H. Mitomycin as adjunct therapy in correcting iatrogenic punctal stenosis. Ophthalmic Surg. 1993;24(2):123-4.
  • 16. Cowen D. Stenotic puncta: microsurgical punctoplasty. Ophthalmic Plast Reconstr Surg. 1993;9(3):201-5.
  • 17. Shahid H, Sandhu A, Keenan T, Pearson A. Factors affecting outcome of punctoplasty surgery: a review of 205 cases. Br J Ophthalmol. 2008;92(12):1689-92. doi: 10.1136/bjo.2008.140681.

Punktoplasti operasyonunun bir modifikasyonu: “27G Rycroft kanül kullanarak yapılan eksizyonel punktoplasti”

Year 2019, Volume: 3 Issue: 3, 258 - 261, 15.03.2019
https://doi.org/10.28982/josam.537361

Abstract

Amaç: Bu çalışmada, yaygın olarak bulunan ameliyat aletleri ile yapılabilmesi ve daha kolay uygulanabilmesi amacıyla, geleneksel 2-kesili punktoplasti ameliyatının bir modifikasyonunu tanımladık.

Yöntemler: Bu yeni operasyon tekniği 6 hastanın 10 gözüne uygulandı. Punktumda yeterli genişlik oluşturulduktan sonra, katarakt operasyonu için üretilmiş olan 27G ön kamara kanülü punktuma yerleştirildi, 2 mm dikey ve 1 mm yatay düzlemde ilerletildi. Daha sonra, kanülün konjonktivaya izdüşümünden Westcott konjonktiva makasıyla kesi yapılarak kanül ucu dışarı çıkarıldı. Kanalikül Rycroft kanülü ile asıldıktan sonra punktum ile konjonktivadan çıkan kanül arasına kesi yapıldı. Daha sonra, oluşturulan flep dişli penset ile tutulup konjonktiva makasıyla kesilerek operasyona son verildi.  

Bulgular: 6 aylık takip sonrasında hiçbir hastada epifora şikayetine rastlanmadı. Tüm hastalarda punktum büyüklüğü evreleme sistemine göre evre 3 ile 5 arasında açıklık bulunduğu görüldü.

Sonuç: Bu makalede tanımladığımız operasyon oldukça sınırlı sayıda hastaya yapılmıştır. Ayrıca kontrol süremiz (6ay) tekrar tıkanma oranını belirlemekte kısa sayılabilecek bir süredir. Ancak bu sürede hiçbir hastada yeniden tıkanma olmaması umut vadedicidir.

References

  • 1. Ulusoy MO, Atakan M, Kıvanç SA. Prevalence and associated factors of external punctal stenosis among elderly patients in Turkey. Arq Bras Oftalmol. 2017 Sep-Oct;80(5):296-99. doi: 10.5935/0004-2749.20170072.
  • 2. Soiberman U, Kakizaki H, Selva D, Leibovitch I. Punctal stenosis: definition, diagnosis, and treatment. Clin Ophthalmol. 2012;6:1011. doi: 10.2147/opth.S31904.
  • 3. Kashkouli MB, Beigi B, Murthy R, Astbury N. Acquired external punctal stenosis: etiology and associated findings. Am J Ophthalmol. 2003;136.6:1079-84. doi: 10.1016/S0002-9394(03)00664-0
  • 4. Tabbara KF, Bobb AA. Lacrimal system complications in trachoma. Ophthalmology. 1980;198787(4); 298-301.
  • 5. Jager GV, Bijsterveld OPV. Canalicular stenosis in the course of primary herpes simplex infection. Br J Ophthalmol. 1997;81(4):332.
  • 6. Bowman W. Methode de traitement applicable a l'epiphora dependent du renversement en dehors ou de l'obliteration des points lacrymaux. Ann Oculist. 1853;29:52–5.
  • 7. Graves B. Making a new lacrimal punctum. Am J Ophthalmol. 1926;9:675–7.
  • 8. Thomas JBT. A modification of Graves' operation for epiphora due to stenosis of the lacrimal punctum. Br J Ophthalmol. 1951;35:306.
  • 9. Viers ER. Disorders of the canaliculus in the lacrimal system, New York: Grune and Stratton.1955);46-7.
  • 10. Jones LT. The cure of epiphora due to canalicular disorders, trauma and surgical failures on the lacrimal passages. Trans Am Acad Ophthalmol Otolaryngol. 1962;66:506–24.
  • 11. Caesar R, McNab A. A brief history of punctoplasty: the 3-snip revisited. Eye (Lond). 2005;19(1):16. doi:10.1038/sj.eye.6701415
  • 12. Chak M, Irvine F. Rectangular 3-snip punctoplasty outcomes: preservation of the lacrimal pump in punctoplasty surgery. Ophthalmic Plast Reconstr Surg. 2009;25(2):134-5. doi: 10.1097/IOP.0b013e3181994062.
  • 13. Munk PL, Lin DT, Morris DC. Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology. 1990;177(3):687–90.
  • 14. Dolin SL, Hecht SD. The punctum pucker procedure for stenosis of the lacrimal punctum. Arch Ophthalmol. 1986;104(7):1086-7.
  • 15. Lam S, Tessler H. Mitomycin as adjunct therapy in correcting iatrogenic punctal stenosis. Ophthalmic Surg. 1993;24(2):123-4.
  • 16. Cowen D. Stenotic puncta: microsurgical punctoplasty. Ophthalmic Plast Reconstr Surg. 1993;9(3):201-5.
  • 17. Shahid H, Sandhu A, Keenan T, Pearson A. Factors affecting outcome of punctoplasty surgery: a review of 205 cases. Br J Ophthalmol. 2008;92(12):1689-92. doi: 10.1136/bjo.2008.140681.
There are 17 citations in total.

Details

Primary Language English
Subjects Ophthalmology
Journal Section Research article
Authors

Onur Temizsoylu 0000-0001-5950-9790

Gözde Şahin 0000-0001-9954-1525

Alev Koçkar This is me 0000-0002-1457-8511

Alper Şengül This is me 0000-0003-1313-6970

Erdal Yüzbaşıoğlu

Publication Date March 15, 2019
Published in Issue Year 2019 Volume: 3 Issue: 3

Cite

APA Temizsoylu, O., Şahin, G., Koçkar, A., Şengül, A., et al. (2019). A modified method for punctoplasty: “Excisional punctoplasty with the guidance of a 27 G Rycroft cannula”. Journal of Surgery and Medicine, 3(3), 258-261. https://doi.org/10.28982/josam.537361
AMA Temizsoylu O, Şahin G, Koçkar A, Şengül A, Yüzbaşıoğlu E.A modified method for punctoplasty: “Excisional punctoplasty with the guidance of a 27 G Rycroft cannula.” J Surg Med. March 2019;3(3):258-261. doi:10.28982/josam.537361
Chicago Temizsoylu, Onur, Gözde Şahin, Alev Koçkar, Alper Şengül, and Erdal Yüzbaşıoğlu. “A Modified Method for Punctoplasty: ‘Excisional Punctoplasty With the Guidance of a 27 G Rycroft cannula’”. Journal of Surgery and Medicine 3, no. 3 (March 2019): 258-61. https://doi.org/10.28982/josam.537361.
EndNote Temizsoylu O, Şahin G, Koçkar A, Şengül A, Yüzbaşıoğlu E (March 1, 2019) A modified method for punctoplasty: “Excisional punctoplasty with the guidance of a 27 G Rycroft cannula”. Journal of Surgery and Medicine 3 3 258–261.
IEEE O. Temizsoylu, G. Şahin, A. Koçkar, A. Şengül, and E. Yüzbaşıoğlu, “A modified method for punctoplasty: ‘Excisional punctoplasty with the guidance of a 27 G Rycroft cannula’”, J Surg Med, vol. 3, no. 3, pp. 258–261, 2019, doi: 10.28982/josam.537361.
ISNAD Temizsoylu, Onur et al. “A Modified Method for Punctoplasty: ‘Excisional Punctoplasty With the Guidance of a 27 G Rycroft cannula’”. Journal of Surgery and Medicine 3/3 (March 2019), 258-261. https://doi.org/10.28982/josam.537361.
JAMA Temizsoylu O, Şahin G, Koçkar A, Şengül A, Yüzbaşıoğlu E. A modified method for punctoplasty: “Excisional punctoplasty with the guidance of a 27 G Rycroft cannula”. J Surg Med. 2019;3:258–261.
MLA Temizsoylu, Onur et al. “A Modified Method for Punctoplasty: ‘Excisional Punctoplasty With the Guidance of a 27 G Rycroft cannula’”. Journal of Surgery and Medicine, vol. 3, no. 3, 2019, pp. 258-61, doi:10.28982/josam.537361.
Vancouver Temizsoylu O, Şahin G, Koçkar A, Şengül A, Yüzbaşıoğlu E. A modified method for punctoplasty: “Excisional punctoplasty with the guidance of a 27 G Rycroft cannula”. J Surg Med. 2019;3(3):258-61.