Modified Jones' lacrimal bypass surgery with an angled extended Jones' tube.

PURPOSE: To analyze the outcome of modified Jones' lacrimal bypass surgery with an angled extended tube.

DESIGN

Retrospective, noncomparative, interventional case series.

PARTICIPANTS

Patients with epiphora due to severe canalicular obstruction or dysfunction. Seventy-one Caucasian patients (90 tubes), operated between 1995 and 2005, were followed over a mean period of 3.2 years, ranging from 2 months to 10.4 years after surgery.

INTERVENTION: A modified Jones' tube, with a 130-degree angled middle and extended length, was inserted using a transcaruncular technique without a dacryocystorhinostomy. In 6 tubes, an additional external dacryocystorhinostomy was performed for reasons of concurrent dacryomucocele.

MAIN OUTCOME MEASURES: Patency and anatomic position of the tube and subjective relief of epiphora.

RESULTS

The tube complications included nasal displacement in 12% of the tubes, lateral displacement in 11%, and nonpatency in 4%. The conjunctival complications were conjunctival overgrowth and caruncular granuloma, observed in 6% of the tubes. In all but 4 eyes, complications occurred within 2.7 months after the first tube implantation. After secondary surgery for a complication, 40% of the eyes needed a third intervention or more. The patients reported a comfortable relief of epiphora in 89% of the well-positioned patent tubes.

CONCLUSION

The modified Jones' tube offers a good long-term outcome, with a tube displacement rate of 23%, mainly occurring within the first 3 months after surgery.