Articles

ARTICLES

 

1) ''Pushed'' monocanalicular intubation. A preliminary report. Jfo 2010.
B. Fayet, E. Racy, G. Renard.

 

2) ‘‘Pushed’’ monocanalicular intubation in children under general anesthesia with spontaneous ventilation. A preliminary report. Jfo 2010.
B. Fayet, E. Racy, J.-M. Ruban, J. Katowitz..
 

3) Pushed monocanalicular intubation. Pitfalls, deleterious side effects, and complications.  Jfo 2011
B. Fayet, E. Racy, J.-M. Ruban, J. Katowitz..
 

4) Stent offers alternative to probing in nasolacrimal duct obstruction. Ocular Surgery News U.S.

B. Fayet, E. Racy, J. Katowitz,  J-M Ruban, W.. Katowitz.

 

5)   Pushed Monocanalicular intubation: an alternative stenting system for management of congenital nasolacrimal obstructions. 

2012,  JAAPOS.

B. Fayet, W. Katowitz, E. Racy,  J-M Ruban, .J. Katowitz.

 

6) Pushed" stent intubation for treatment of complex congenital nasolacrimal duct obstruction.

Eur J Ophthalmol. 2014.

Eshraghi B, Aghajani A, Kasaei A, Tabatabaei Z, Akbari M, Fard MA.

 

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8 ) 陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援9熏晕燥援5熏May 18, 圆园16 www. ijo. cn
栽藻造押8629原愿圆圆源缘员苑圆8629-82210956 耘皂葬蚤造押ijopress岳员远猿援糟燥皂
1Hotel de Ophthalmology, Place Du Parvis N觝tre D覾me, Paris
75004, France
2Department of Ophthalmology 34th and Civic Center
Boulevard, the Children's Hospital of Philadelphia,
Pennsylvania 19104, USA
3Clinique Saint-Jean-de-Dieu-ENT, 19 Rue Oudinot, Paris
75007, France
4Edouard Herriot Hospital Place D'arsonval, Lyon 69003,
France
Correspondence to: William R Katowitz. Department of
Ophthalmology 34th and Civic Center Boulevard, the
Children's Hospital of Philadelphia, Pennsylvania 19104,
USA. billkat@gmail.com
Received: 2015-06-18 Accepted: 2016-01-07
DOI:10.18240/ijo.2016.05.29
Fayet B, Katowitz WR, Racy E, Ruban JM, Katowitz JA. An update to
monocanalicular stent surgery. 2016;9(5):797-798
Dear Sir,
I n their article, "A comparison between monocanalicular
and pushed monocanalicular silicone intubation in the
treatment of congenital nasolacrimal duct obstruction",
Andalib [1] present the results of a prospective study on
congenital nasolacrimal duct obstruction treated either with a
Monoka stent (using a Crawford hook for nasal retrieval) or a
Masterka pushed technique for insertion of the Masterka
stent. The success rates were respectively 90% and 50%. In
this publication the authors did not document the severity of
ductal stenosis and treated patients with either the Monoka or
Masterka. It should be stressed, however, that Masterka stent
is not designed to be effective in cases of moderate to severe
ductal stenosis. Thus, the poorer results for the 20 cases of
Masterka may be attributed either to a Masterka that
remained nestled inside the lacrimal sac, because it could not
be pushed beyond the area of ductal stenosis, or due to an
insufficient time of stent retention as demonstrated by an
early Masterka stent loss rate of 30%.
We would like to present our perspective regarding the
relationship between failure with a Masterka stent retained
for the usual planned postop period of time and the rate seen
with early loss of the Masterka stent.
Since our first case in 2008, the analysis of complications had
led to our recommending the following precautions: 1) we
prefer to place the Masterka in the upper canaliculus as it is
more difficult for the child to scratch the superior punctum
than the inferior punctum. We try to avoid stenting the lower
canaliculus, since the lower eyelid punctum is usually more
lateral and the collarette of the stent can thus come into
contact with the cornea more easily; 2) for cases of ductal
stricturotomy (congenital or iatrogenic), it would appear
preferable to switch canaliculus or choose another method of
intubation. With dilation of the punctum, it is important to
protect the integrity of the meatic ring at the punctal opening
to reduce the potential for extrusion of either type of stent; 3)
our initial surgical technique[2-5] has been changed: currently,
our recommendation is that, the length of the Masterka
should always be greater than the distance between the
superior punctum and the floor of the nasal fossa in order to
eliminate the risk of the probe being too short. When the
guide reaches the floor, the plug portion should be a few
milimeters above the punctum. As the guide is removed, the
plug must then be held flush to the punctum causing the
distal portion of the stent to bend on the floor much like seen
with a pulled Monoka stent. After intubating with the
Masterka, the collarette must be apposed to the punctum
while removing the introducer rod. If not, the stent will likely
not remain bent along the nasal floor and if the surgeon
attempts to push the stent in further it will simply fold within
the nasolacrimal system. In this scenario there is an upward
force that will make stent loss more likely due to the
tendency for the stent to straighten and thus unseat the
collarette. This is not the case if the stent is long enough and
has bent to sit along the nasal floor (as in the case with the
Monoka stent). A video of this technique can be found on
YouTube[6].
Table 1 lists our unpublished data of 71 cases using this
modified technique for the Masterka in comparison to other
published data comparing the pushed and pulled
monocanalicular stent. The loss of stent rate is only 4%
(down from11.8%).
Andalib [1] are correct that there is a paucity of
publications with the Masterka. Ala觡佼n [7] reported a
97.5% in 40 patients treated for congenital nasolacrmial duct
obstruction (CNLDO) with the Masterka. In addition, there
have been posters and presentations at international meetings
comparing the Masterka and Monoka. Katowitz [8]
An update to monocanalicular stent surgery
窑Letter to the Editor窑
797
compared the success rates of the Monoka 86.8% (125/144)
to the Masterka 88.3% (53/60). Nazemzadeh reported a
success rate of 81.6% (62/76 eyes) for the Masterka when
used in all cases of CNLDO except severe ductal stenosis[5,9].
That the overall success rate for Andailb [1] was
significantly lower compared to these other reports brings to
light the challenge for proper patient selection and choice of
surgical technique when using the Masterka.
We think our modified technique for inserting the Masterka
offers improved surgical outcomes and should be employed
when using this pushed monocanalicular device.
ACKNOWLEDGEMENTS
Conflicts of Interest: Fayet B, FCI Ophthalmics; Katowitz
WR, None; Racy E, None; Ruban, JM, None; Katowitz J,
None.
REFERENCES
1 Andalib D, Gharabaghi D, Nabai R, Abbaszadeh M. Monocanalicular
versus bicanalicular silicone intubation for congenital nasolacrimal duct
obstruction. 2010;14(5):421-424.
2 Fayet B, Katowitz WR, Racy E, Ruban JM, Katowitz JA. Pushed
monocanalicular intubation: an alternative stenting system for the
management of congenital nasolacrimal duct obstructions. 2012;
16(5):468-472.
3 Fayet B, Racy E, Ruban JM, Katowitz J. Pushed monocanalicular
intubation. Pitfalls, deleterious side effects, and complications.
2011;34(9):597-607.
4 Fayet B, Racy E, Ruban JM, Katowitz J. "Pushed" monocanalicular
intubation in children under general anesthesia with spontaneous
ventilation. A preliminary report. 2010;33(7):455-464.
5 Fayet B, Racy E, Renard G. Pushed monocanalicular intubation: a
preliminary report. 2010;33(3):145-151.
6 Youtube Video, Masterka 2014 jan, Jan 2014. Available at https://www.
youtube.com/watch?v=Ecsz-HkyQrw&feature=youtu.be
7 Ala觡佼n FJ, Ala觡佼n MA, Mar侏n-Gonz佗lez B, L佼pez-Mar侏n I, Olmo N,
Mart侏nez A, C佗rdenas M, Alarc佼n S. Self-adjusting monocanalicular
intubation for congenital lacrimal obstruction.
2015;90(5):206-211.
8 Katowitz WR, Fayet B, Racy E, Ruban JM, Katowitz J.
. Fall ASOPRS 2011.
9 Nazemzadeh M, Katowitz W, Katowitz J.
.
ESOPRS Meeting; Budapest 2014.
Table 1 A comparison of our unpublished data with previous studies of the monocanalicular stent
Complications
Authors Stent Year Intubations Stent lost in
canaliculus
Stent unseated
from punctum Stent loss
Lacrimal duct
findings Success
Fayet et al[5] Monoka 2010 1028 0.005 0.007 12.5% N/A 90.6%
Fayet et al[2] Masterka 2012 110 0 0.036 12% Hasner membrane only 85%
Current study Masterka 2015 71 0.014 0.028 4% Hasner membran only 90%
The Masterka and Monoka
798

 



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