Efficacy Of Modified Annular Silicone Stent Intubation In Deep Lacrimal Canaliculus Laceration

Objective:To evaluate the clinical efficacy of modified annular silicone stent intubation for the treatment of deep lacrimal canaliculus laceration.Methods:The clinical data of 58 eyes of 58 patients with deep lacrimal canaliculus laceration from Jan.2008 to Jun.2019 in our hospital were retrospectively analyzed.All patients underwent modified annular silicone stent intubation,which combined retrograde lacrimal canaliculus intubation with distal suture fixation.Under a topical anesthesia,the end of the silicone stent was inserted into the nasal broken end and pulled out from the nasal cavity through the lacrimal duct,dacryocyst and nasolacrimal duct.The another silicone stent end was inserted into temporal broken end and pulled out from lacrimal punctum,and inserted into another lacrimal punctum,and pulled out of the nasal cavity through the lacrimal duct,dacryocyst and nasolacrimal duct.Then we preset suture between two broken ends and strain the stent ends.Two broken ends were aligned with decreased tension.Then we tight preset suture,and sutured the orbicularis oculi muscle and skin tissues.The lacrimal was irrigated with gentamicin every 2 weeks for 1 month after operation,and the stent was removed after 3 months.Data analyzed included patients’ demographic characteristics,causes,lacrimal canaliculus involved,time from trauma to surgery,surgical success rate,and the incidence of complications such as eyelid deformity,stent prolapse,lacrimal punctum or canaliculus tear,granuloma,etc.Postoperative anatomic and functional success rates were assessed by lacrimal irrigation and by asking patients(or their guardians)about epiphora.Results:Those patients aged 9-76 years,with an average of 44.78±15.54 years.Of the 58 patients,41 were males(70.69%).There were 52 cases(89.66%)with inferior deep canaliculus laceration,5 cases with superior deep canaliculus laceration,and 1 case with inferior and superior canaliculus laceration.The patients were followed up for 3-91 months,with an average of 53.37±27.20 months.The success rate was 100%.The most common causes were traffic accidents(62.07%)and fighting(22.41%).The mean time from the injury to surgery was 23.04±26.19 hours,and the time was less than 7 days in all of the 58 cases.The follow-up time ranged from 3 to 91(53.37±27.20)months.The success rate was 100%.There were no complications such as eyelid deformity,granuloma,lacrimal punctum or canaliculus tear.All patients had eyelid well reestablished with good appearance and no obvious postoperative scar formation or persistent epiphora were found.Conclusion:It is safe and effective for the treatment of deep lacrimal canaliculus laceration with retrograde lacrimal canaliculus intubation combined with distal suture fixation.The tissue trauma is moderate with few complications and the stent is not easy to fall off.Therefore,this method has clinical application value.