Purpose

To introduce use of a vascular graft to construct punctum and canaliculi in Congenital Puncto canalicular Atresia (CPCA).

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Methods

Introduction: CPCA has limited options for restoring tear drainage. Conjunctivo-dacryocystorhynostomy with Lester Jones tube gives no physiological drainage and associate with long-term maintenance issues. Creating a passage with Mini Monoka stent (MMS) alone also has limited success as formation of true canalicular structures with epithelium, lamina propria and smooth lumen is uncertain. These challenges can be overcome by using a vascular graft which provides a smooth surface epithelial lining and supportive wall.

Methods: This technique was used in selected patients with absent puncta. First, non-ciliary lid margins were explored via gray-line incision to confirm absence of canalicular. The medial canthal tendon (MCT) and lacrimal sac were exposed transcutaneously. After dividing MCT, the sac was opened laterally and irrigated with Trypan blue under endoscopic visualization to verify naso lacrimal duct patency. Two tracts were created from the sac to upper and lower lid exploration sites. Two venous grafts were harvested from the angular vein through the same incision. Each graft was loaded onto an MMS or similar substitute and passed through each tract. Proximal ends were sutured to the sac wall openings, and distal ends secured at the lid margins creating new puncta. The MMS heads were anchored to the lid, and all the incision were repaired.

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Results

Stents were removed after 4 months. Syringing confirmed patent new canaliculi and periodic irrigation was done.

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Conclusion

Venous grafting appears to be a novel and viable option for establishing tear drainage in Congenital Puncto canalicular Atresia. Further cases and follow up needed to evaluate long term outcome and to refine the technique.

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Additional Authors

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