Predicting outcomes in repair of canalicular lacerations
Reviewed by Jaya Myneni

This is a retrospective study looking at results of primary canalicular repairs in a tertiary eye centre. Thirty-nine patients were included in the study. The cause of injury was blunt trauma in 51.2%, road traffic accident (RTA) in 30.7%, animal and blast injuries in the remaining. Monocanalicular stenting was done using Mini-Monoka stent with pericanalicular suturing technique. In patients who refused this, segments of 20G silicone rod (which are primarily used in frontalis sling surgery) were used. Bicancalicular lacerations in five patients were repaired using annular stents or separate monostents. Anatomical success, defined as patency on irrigation and hard stop on probing with a Bowman’s probe, was the final outcome measure. Single canalicular lacerations were found in 87.1% patients (69.2% - lower; 20.5% upper, 12.8% - bicanalicular). Median time lag for repair was two days. Tube removal was done after an average of 9.4 weeks. Mini-Monoka stent was used in 48.7%, silicone rod in 35.9% and annular stent in 15.4% of patients. Overall anatomical success was achieved in 74.4% of patients. Best outcomes were achieved with Mini-Monoka in 89.5%, followed by annular stent at 60% and silicone rod at 57.1%. The authors found the mode of injury (RTA) and type of stent-20G silicone rod to be risk factors predicting poor outcome. The authors propose that extensive tissue damage in RTA could cause poor approximation and failure. Higher extrusion rates were seen with the silicone rod (35.71%) when compared to Mini-Monoka (26.31%). Experienced surgeons had better outcomes, although this was not statistically significant. No patient related factors (presence of associated globe injury, involvement of upper or lower canaliculus, time lag in repair) had an effect on surgical outcome. Time of stent removal and type of anaesthesia also did not alter success rate. The limitations are the retrospective nature of this study due to which other risk factors could not be analysed. Though results of this study cannot be widely extrapolated as the 20G silicone rod is not universally used, it provides an interesting insight into use of alternative surgical materials in a setting where cost can be an issue.

Canalicular lacerations: factors predicting outcome at a tertiary eye care centre.
Singh S, Ganguly A, Hardas A, et al.
ORBIT
2017;36(1):13-8.