FP928 : Outcome of Monocanalicular Tear Repair with 24G Cannula.

Dr. Naresh Desinayak, D09017, Dr. Sukhada Mishra, Dr. Mayank Rai

Introduction:

Canalicular lacerations are seen in 16% of eyelid lacerations and 20% of globe injuries(1,2). It can be caused by either penetrating or blunt trauma(3). Canalicular laceration may involve either upper or lower canaliculus or both giving rise to epiphora(4,5). Success rate with mini monoka monocanalicular stent has been good. The cost of mini monoka monocanalicular intubation or its counter parts led our search for economical and effective alternatives. We report retrospective analysis of patients with monocanalicular laceration who refused repair with standard minimonoika stent and underwent repair with 24G IV cannula.

Materials and methods:

A retrospective analysis of all patients who underwent canalicular laceration repair with 24 G IV cannula. The data collected from hospital medical records include demographic profile, type of injury, lag time before repair of laceration, intraoperative and postoperative complicatios and efficiency of procedure. All patients underwent monocanalicular laceration repair with 24 G IV cannula under local anesthesia in adult and general anesthesia in children

In the procedure the distal end of canaliculus identification was difficult. With careful inspection and gentle traction under magnification, in some cases distal cut end of canaliculus identified as pinkish tubular mucosal surface and in other saline mixed with betadine injected through opposite canaliculus while maintaining pressure over lacrimal sac. After identification of canaliculus a 0′ number bowmans probe passed through the canaliculus from proximal to distal end to the sac to see the patency. Later 24 G iv cannula was passed through the canaliculus into the sac. Needle was removed from the cannula and catheter was left in place. Catheter was stabilized by a stitch with 6’0 vicryl. Associated lid tear were repaired with 6′ 0 viacryl interrupted sutures. Post operatively patients were advised systemic and topical antibiotic ointment for 2 weeks.

Patients were revieved on day 1 after surgery. 1 week, 1 month, 3 months and 6 months after surgery. The  stent was removed after 1 month of surgery under topical anesthesia. Lacrimal sac syringing was done to check patency. Complications if any and failures of procedure are noted.

Preoperative and postoperative photo graphs of canalicular laceration with stent insitu

Results:

        7 patients with monocanalicular tear repair with 24G IV cannula were included in study. Of these 4 were females and 3 were males among them one was 2 year old child. Median age of patients was 42years. Associated injury to globe is seen in one patient. Mode of injury was with bamboo stick in one, cow horn in one patient, with stone and iron rod in two patients and RTA in three patients. Mean time lag between injuries to time of repair is 45 hours. Mean follow up was for 6 months. Mean time for stent removal was 6 weeks. Patency of canaliculus was noted in 5 patients. Syringing was not patent in 1 patient and partially patent in 1 patient. Epiphora was seen in two patients. Complications like corneal abrasion noted in one patient and tube extrusion in 1 patient.

Discussion:

canalicular lacerations should be repaired to avoid postinjury epiphora. Different stent materials are available for repair of canalicular lacerartion. Of these medical grade silicon because of its inert nature, flexibility, easy availability emerged as material of choice for lacrimal stenting(6). mini monoka monocanalicular stent is widely used now in monocanalicular tear repairs.

In India because of uneven economy and poor availability of medical facilities, our series aim to offer an economical and effective alternative to standard monocanalicular stenting. In our serie s we report patency of lacrimal passage in 71.4 % of patients, partial patency in 14% of patients and failure in 14 % of patients. In the literature one study reported effectiveness of minimonoka monocanalicular stent(7). Our reports are comparable to that study but small sample size is our limitation. In our series we report complications like tube extrusion and corneal abrasion.

Conclusion:

24 G cannula offers a significant cost advantage compared to standard monocanalicular stents. This may be relevant to developing countries with large underprivileged sector in society and poor access to affordable health care. In our experience 24 G IV cannula was an effective and economical alternative in canalicular lacerations with reasonable success.

References:

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