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Journal Français d'Ophtalmologie
Volume 34, n° 9
pages 597-607 (novembre 2011)
Doi : 10.1016/j.jfo.2011.02.008
Received : 15 November 2010 ;  accepted : 18 February 2011
Pushed monocanalicular intubation. Pitfalls, deleterious side effects, and complications
Étudier les complications d’une intubation monocanaliculo-nasale « poussée »
 

Figure 1




Figure 1 : 

Instrumentation: The Masterka™ with the guide in place and withdrawn.


Figure 2




Figure 2 : 

Pushed monocanalicular intubation. A. Technique: bony contact, rotation, vertical catheterization. B. The two lengths that are sought: “lacrimal punctum to the floor of the nasal cavity” and “punctum to the site of stenosis”. C. Objective: at the end of the catheterization the anchoring plug should be in contact with the lacrimal punctum. The free end should clearly extend beyond the nasolacrimal stenosis and stops when in contact with the floor of the nasal cavity or just before.


Figure 3




Figure 3 : 

Removal of the guide: A. The guide is withdrawn along the axis of the lacrimal sac. Throughout this phase the anchoring plug is pressed against the lacrimal punctum. B. In the middle of the removal the anchoring plug is always maintained in contact with the lacrimal punctum and the guide is withdrawn halfway out. C. At the end of the removal the anchoring plug remains himself in contact with the punctum without tending to be too deeply inserted. The silicone stent is fully implanted. D. The anchoring plug was inserted into the vertical canaliculus with a single use plug introducer.


Figure 4




Figure 4 : 

Selection by lacrimal probing: A. Simple or extensive nasolacrimal duct impatency. B. Selection of the proper Stent. The length of the stent should be greater than the distance between the lacrimal punctum and the location of nasolacrimal obstruction and also be inferior or equal to the distance between the lacrimal punctum and the floor of the nasal cavity. C. Confirmation of proper location of guide in nasolacrimal duct: a second blunt probe is guided beneath the inferior turbinate achieving metal-to-metal contact.


Figure 5




Figure 5 : 

Technical errors. A. Stents that are too short. The estimated distance between the punctum and the nasolacrimal stenosis is longer than the length of the stent. B. Stents that are too long. The free end of the stent rubs against the floor of the nasal cavity while at the same time the anchoring plug remains above the punctum. C. Poorly positioned stent and punctual plug: the guide is fully withdrawn and the anchoring plug remains 2 or 3mm above the punctum. One should not try to in force push the stent by means of the applicator. One should check the length of the stent and begin the procedure again from the beginning. D. Complex stenosis: the guide may pass through the nasolacrimal stenosis but the silicone usually bunches up without passing through. E. False passages: No metal-to-metal contact is encountered using a second probe that has been introduced in the lower nasal meatus.

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