title: Early loss of monocanalicular silicone tubes in congenital nasolacrimal duct obstruction: incidence, predictors, and effect on outcome.
abstract: OBJECTIVE
  To study predictors and implications on outcome of premature silicone tube-loss, a post-operative complication of monocanalicular intubation (MCI) performed for treatment of congenital nasolacrimal duct obstruction (CNLDO).
  
  
  METHODS
  We conducted a retrospective analysis of cases of post-operative loss of monocanalicular silicone tubes occurring at one medical center from January 2007 to December 2013.
  
  
  RESULTS
  During the study period monocanclicular silicone tubes were lost in 24/54 eyes (44%) of 19/46 children. Multivariate regression analysis identified bilateral intubation as an important predictor of early tube-loss (r=0.54, P=0.006). Seven of eight (88%) children who had both eyes intubated prematurely lost their tubes compared to 12/38 (32%) children who had unilateral intubation (P=0.005). Treatment success was lower in eyes with early tube-loss (17/24 eyes, 71%) compared to eyes with full tube retention (25/30 eyes, 83%), however this difference was not statistically significant (P=0.333). In our study, treatment outcome correlated with duration of intubation (r=0.51, P=0.002). Surgical success was achieved in 33/39 eyes (85%) in which the tubes were retained at least 2 months compared to 7/15 eyes (47%) with shorter period of intubation (P=0.012).
  
  
  CONCLUSIONS
  Spontaneous tube-loss is a post-operative complication of monocanalicular silicone intubation that can occur more frequently than previously reported in certain populations. Tube-loss occurring soon after surgery is often associated with persistent symptoms and increased need of reoperation.
authors.affiliation: Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabi Healthcare Services, Ramat Hasharon, Israel. Electronic address: gaddotan@hotmail.com.
authors.forename: Gad
authors.initials: G
authors.lastname: Dotan
authors.affiliation: Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Oded
authors.initials: O
authors.lastname: Ohana
authors.affiliation: Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Igal
authors.initials: I
authors.lastname: Leibovitch
authors.affiliation: Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Chaim
authors.initials: C
authors.lastname: Stolovitch
mesh_terms: D002675:Child, Preschool; D003608:Dacryocystorhinostomy / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D007440:Intubation / Q000009:adverse effects / Q000295:instrumentation*; D007767:Lacrimal Duct Obstruction / Q000151:congenital* / Q000628:therapy*; D008297:Male; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012828:Silicones; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012828:Silicones
keywords: Congenital nasolacrimal duct obstruction; Monocanalicular silicone tube intubation