A new lacrimal bypass tube fixation method to prevent tube displacement in conjunctivodacryocystorhinostomy (CDCR)

Aims: To evaluate the efficacy of a new lacrimal bypass tube fixation technique to the conjunctiva and caruncle, preventing postoperative displacement of the tube in conjunctivodacryocystorhinostomies (CDCRs). Methods: The authors conducted 52 CDCR procedures by a new tube fixation technique using a 6-0 prolene suture encircling the tube neck (encircling group). The suture was not removed during the follow-up period. Over the same period, the authors carried out 51 CDCRs with tube fixation using a 5-0 vicryl suture with the purse string procedure (purse string group) and 71 conventional CDCRs with tube fixation to the skin using a 6-0 nylon suture (control group). Postoperative complications, including dislodgement and tube length problems, were recorded. The three groups were statistically compared. Results: Among the 52 cases using the new fixation technique, tube malpositions, including extrusions, had developed in only four cases (7.7%) at 12 months after the operation. In the purse string and control groups, the same complications developed in 11 (21.6%) and 22 cases (31.0%), respectively. A statistically significant difference between these groups was detected (p=0.008). Other complications, such as conjunctival granulomas and tube obstruction, developed postoperatively in four cases (8.0%) in the encircling group, and this did not differ significantly from that in the other groups (p=0.193). Conclusions: The authors believe that this encircling fixation procedure can help in CDCRs for maintaining the location and orientation of the tube during the early postoperative period.