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Intralacrimal migration of Masterka® stents
B Fayet1, E Racy2, W R Katowitz3
1Ophthalmology Department, hôpitaux universitaires Paris Centre, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Ophthalmology Department, University Hospital Necker-Enfants malades, AP-HP, Paris V René Descartes University, 149, rue de Sèvres, 75015 Paris, France.
Insights
Intralacrimal migration of self-retaining stents, like Masterka®, can occur in nasolacrimal duct obstruction cases. Careful surgical technique and monitoring are crucial for prevention and management.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital nasolacrimal duct obstruction is common in children, often treated with silicone stents.
- Masterka® is a type of self-retaining stent used for this condition, similar to Monoka®.
- Surgical complications, including intralacrimal migration, can occur with these devices.
Observation:
- Two pediatric cases of Masterka® stent intralacrimal migration after nasolacrimal duct obstruction surgery were analyzed.
- Stent disappearance occurred at 7 days and 2 years post-implantation in the two patients.
- One stent fully migrated and externalized through the nose; the other was retrieved via a canalicular approach.
Findings:
- Self-retaining stent disappearance is estimated at 15%, with intralacrimal migration in 0.5% of these cases.
- Successful management of intralacrimal migration was achieved in both reported cases, with no further epiphora.
- Prevention hinges on meticulous surgical technique and post-operative monitoring.
Implications:
- Rigorous surgical technique, focusing on the stent's meatus and fixation head, is vital to prevent migration.
- Scheduled monitoring post-lacrimal intubation is necessary to detect stent disappearance.
- Management strategies include clinical assessment, rhinoscopy, and potentially exploratory canaliculotomy.
Background:
Tearing and conjunctivitis in children are commonly due to lacrimal drainage system obstruction. Congenital nasolacrimal obstruction is a common pathology treated by probing with or without silicone stent insertion, depending upon the age of the child. The silicone stent is self-retaining and placed for at least one month. Masterka® is a recent version of Monoka®, which may lead to the same surgical complications, such as intralacrimal migration.
Subjects And Methods:
The medical records of two patients surgically treated with the Masterka® probe for nasolacrimal duct obstruction, who developed intralacrimal migration of the stent, were retrospectively reviewed and analyzed. A 41-month-old child and an 18-month-old child presented with disappearance of the silicone tube after 7 days and 2 years respectively. In the first case, the tube migrated completely within the lacrimal system and became externalized through the nose at 2 years, while in the second case, the Masterka® was retrieved through a canalicular approach. In both cases, infants had no further tearing.
Discussion:
The frequency self-retaining stent disappearance is estimated at 15%. Among these cases, intralacrimal migration is only reported in 0.5% of cases. To prevent intralacrimal migration, the surgical technique must follow a certain number of rules. Management, based on residual epiphora, is discussed.
Conclusion:
Prevention of intralacrimal migration of self-retaining stents involves a rigorous analysis of the relationship between the meatus and the fixation head at the time of placement. After lacrimal intubation, scheduled monitoring is necessary to screen for stent disappearance. Management is based on clinical findings, anterior rhinoscopy and even exploratory canaliculotomy.
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