title: Endoscopically guided minimally invasive bypass tube intubation without DCR: evaluation of drainage and objective outcomes assessment.
abstract: OBJECTIVE
  To report a series of 15 consecutive patients with complete proximal bicanalicular obstructions managed with endoscopically guided minimally invasive placement of bypass tubes without a dacryocystorhinostomy (DCR), their indications, interventions, complications and objective and uniform assessment of outcomes.
  
  
  METHODS
  Fifteen consecutive patients presenting with complete proximal bicanalicular obstructions were included in a retrospective, non-comparative case series. Medical records were reviewed for demographic data, etiology, symptoms at presentation, type of bypass tube used, length of the tubes, duration of follow-up, class of lacrimal drainage, patency of the tube, resolution of symptoms, complications and their outcomes.
  
  
  RESULTS
  The mean age at presentation was 18.7 years (range: 10-32 years). The most common indication was punctal agenesis (46.6%) followed by complete proximal bicanalicular block secondary to trauma (26.6%). All patients presented with epiphora. The most common bypass tube was a straight Jones variety (60%). The mean length of the bypass tubes was 21 mm (range 19-24 mm). All patients were followed up for a mean duration of 9.6 months following surgery (range 7-13 months). The majority of the patients were post-operatively objectively classified into type I lacrimal drainage (66.6%). At the last follow-up, the success rate was 86.6%. None of the tubes extruded but were removed in two patients due to peritubal soft tissue infection and conjunctival pressure necrosis.
  
  
  CONCLUSIONS
  Endoscopically guided minimally invasive placement of a bypass tube without DCR is an easier and effective alternative to the traditional conjunctivodacryocystorhinostomy and is likely to help in avoiding major complications of tube extrusion and malpositions seen with the latter procedure. Objective evaluation of lacrimal drainage helps in typifying and uniformly assessing the outcomes.
authors.affiliation: Dacryology Service, Ophthalmic Plastics Surgery, LV Prasad Eye Institute, Hyderabad, India. drjaved007@gmail.com
authors.forename: Mohammad Javed
authors.initials: MJ
authors.lastname: Ali
authors.forename: Santosh G
authors.initials: SG
authors.lastname: Honavar
authors.forename: Milind
authors.initials: M
authors.lastname: Naik
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003608:Dacryocystorhinostomy; D020878:Device Removal; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007440:Intubation / Q000379:methods*; D007766:Lacrimal Apparatus Diseases / Q000473:pathology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult