Step by step

SURGICAL TECHNIQUE

OF THE MASTERKA

 

 

-I- ANESTHESIA :

. The constraints associated with anaesthesia are the same as for late and very late probing.

. Nasolacrimal duct intubation using the Masterka is technically comparable to a lacrimal stenting done at any age and requires the usual medical and anesthetic precautions.

 

 

VIDEO

. Facial Mask.

 

-II- TECHNIQUE :

 

- a) Polyvidone iodée.

- b) Remove the stent from the package and holt it between two fingers. Mobilize the guide inside the silicone by rotating the sleeve gently, much like winding a watch. These alternating rotations allow the guide inside the Masterka to exit easily.

- c) The upper lacrimal punctum is carefully dilated. The MASTERKA  is pushed through the upper canaliculus all the way to the “hard stop” or bony contact.

 

 THE FREE END OF THE MASTERKA STENT MUST EXTEND BEYOND THE NASOLACRIMAL OBSTRUCTION.

While maintaining bony contact, the Masterka is rotated inferiorly to catheterize the lacrimal sac and the nasolacrimal duct (during vertical stenting, one should try whenever possible to feel the stent as it penetrates through the mucosal obstruction)., just as done in routine probing, until the nasal floor is reached.  

 

At this moment, the plug may be a little bit close to the punctum.

There is no problem since the metallic guide remain inside the masterka (See : ''Slightly too long'' ). It will be still possible to assess the Masterka to progress inside the lacrymal pathways ; Three or for precedures can be necessary until the plug reach the punctum.

 

THE MOST IMPORTANT :

THE FREE END OF THE MASTERKA STENT MUST EXTEND BEYOND THE NASOLACRIMAL OBSTRUCTION. This correspond pratically to a Masterka length's at least superior to the distance between the lacrymal punctum and the nasal floor.

 
 

 

d) METAL-TO-METAL CONTACT IS SEARCHED at the nasal fossa floor

                            . Using a larger, blunt probe

                            . Exploration of the inferior meatus (lateral)

                            . Positive metal-to-metal contact confirms proper placement (no submucosal and/or or false passage).

 

e) Removal of the guide/introducer is carried out very carefully.

The anchoring plug is held secure against the peyelid while the guide/introducer is carefully removed.

The guide/introducer is removed by gently pulling it from the external section of the tube, millimeter by millimeter, while rotating it (like winding a watch) to help slide it out from the tube.

Vidéo Endoscopic view

Throughout this phase, the anchoring plug is held in firm contact with the Eyelid (or the lacrymal puctum).

 

If the anchoring plug tends to come back out, the Masterka is then pushed back in until the anchoring plug comes back in contact with the punctal meatus.

 

Removal of the guide is then continued.

Once the introducer is completely removed,

the anchoring plug is inserted into the vertical canaliculus with a disposable plug inserter (S1-3090) as is done for routine punctal plug insertions.

      

       - Verify that the collarette of the plug/fixation head is flush against the lid margin.

       - At the end of the procedure : remove the Polyvidin polyvidone; anesthesic eyedrops (1 drop);

     

 

-III- POST-OPERATIVE CARE :

Post-op care is limited to topical antibiotic ointment for approximately one week.

                                                                 ***
The duration of intubation varies according to the surgical indication and the nature ofthe obstruction.
For congenital nasolacrimal duct obstruction, leaving the Masterka in place for three weeks is sufficient in most cases, particularlyif clearance of Fluorescein dye can be documented.
The stent is removed as an office procedure with a forceps instrument by pulling on the collarette.

This removal is painless and does not require a general anesthetic.                      

   

-IV- VIDEO MASTERKA

 

 

 

DON'T FORGET :

1°) Careful initial probing in the operating room is paramount for a proper use of the Masterka.

 

2°) Optimum results and the prevention of complications depend directly on two elements : appropriate selection of the stent length and expert technique.

 

- Vidéo (English)

- Vidéo (French)

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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