CDCR with buccal mucosal graft: Comparative and histopathological study

BACKGROUND AND OBJECTIVE: Conjunctivodacryocystorhinostomy (CDCR) is a proc edure with a high functional success rate, on the other hand post-operative complications are frequent and tube replacement is often required. Therefo re, new investigations were undertaken in order to relieve the undesired ef fects of the tube. Implantation of the Jones tube circumscribed with a bucc al mucosal graft and subsequent removal of the tube when an epithelium line d track was formed has been reported in the literature in recent years. In this study efficacy and safety of this alternative technique was evaluated, PATIENTS AND METHODS: CDCR with insertion of Jones tube surrounded with a b uccal mucosal graft was performed on 14 patients (14 eyes) between Septembe r 1995 and March 1997 and results were evaluated. Results were compared wit h our previous series of traditional CDCR involving 22 patients (22 eyes). RESULTS: Functional success mas obtained in all cases with relief of epipho ra after a mean follow-up of 13.7 +/- 5.7 months. In 11 cases, tubes were r emoved at the sixth post-operative month and passage was blocked in 9 cases . Subsequent surgical tube reinsertion was performed in those patients. Bio psy specimens were obtained in two cases during tube replacement and were e xamined histologically. Disarrangement of the basal epithelial cells and in filtration of the surrounding connective tissue with round cells were obser ved. These histopathological findings suggested a significant graft degener ation threatening the continuity of the passage, Tube displacement existed in two patients, and partial mucosal graft extrusion was apparent in one ca se during the period with the tube still inserted, Surgical tube replacemen t was required in only two cases to correct lateral migration of the tube, Incidence of complications and need for surgical tube replacement were foun d to be less than our previous series of 22 CDCR patients without buccal mu cosa grafting. CONCLUSION: These findings suggest that CDCR with buccal mucosal graft is a promising new method for the treatment of epiphora because of its low inci dence of complications during the period with the tube, However, tube remov al at the sixth post-operative month is probably not indicated. Therefore, studies with larger series and longer follow-up should be undertaken to con firm the advantages of the technique.