Modified Jones' lacrimal bypass surgery with an angled extended Jones' tube

Purpose: To analyze the outcome of modified Jones' lacrimal bypass surgery with an angled extended tube. Design: Retrospective, noncomparative, interventional case series. Participants: Patients with epiphora due to severe canalicular obstruction or dysfunction. Seventy-one Caucasian patients (90 tubes), operated between 1995 and 2005, were followed over a mean period of 3.2 years, ranging from 2 months to 10.4 years after surgery. Intervention: A modified Jones' tube, with a 130-degree angled middle and extended length, was inserted using a transcaruncular technique without a dacryocystorhinostomy. In 6 tubes, an additional external dacryo-cystorhinostomy was performed for reasons of concurrent dacryomucocele. Main Outcome Measures: Patency and anatomic position of the tube and subjective relief of epiphora. Results: The tube complications included nasal displacement in 12% of the tubes, lateral displacement in 11%, and nonpatency in 4%. The conjunctival complications were conjunctival overgrowth and caruncular granuloma, observed in 6% of the tubes. In all but 4 eyes, complications occurred within 2.7 months after the first tube implantation. After secondary surgery for a complication, 40% of the eyes needed a third intervention or more. The patients reported a comfortable relief of epiphora in 89% of the well-positioned patent tubes. Conclusion: The modified Jones' tube offers a good long-term outcome, with a tube displacement rate of 23%, mainly occurring within the first 3 months after surgery.