Twelve-Year Experience of Lester Jones Tubes - Results and Comparison of 3 Different Tube Types

Purpose: Conjunctivodacryorhinostomy with insertion of a bypass Lester Jones tube is effective in treating epiphora due to canalicular failure. There is little information in the literature that directly compares different types of tubes. We report our results of Jones tube placements over a 12-year period with comparison of 3 tube types: plain, frosted, and a new tube with an additional flexible internal silicone flange (StopLoss Jones tube). Methods: Case notes review of a single surgeon consecutive series of patients having Jones tube placement. Results: One hundred twenty-seven tubes were inserted in 81 eyes of 65 patients. Information on 121 tubes was available for comparison (67 plain, 25 frosted, 29 StopLoos Jones Tube [SLJT]), with flange sizes 3.5 and 4.0 mm. There were 31 males, 34 females, mean age 59 years. After mean follow up of 20 months (range 0.5-108), there were no complications in 50% of tube insertions. Forty-three percentage of tubes needed replacing. The overall rate of complications was higher with a 3.5-mm flange tube than with a 4.0-mm flange (67% vs. 43%). There were no cases of extrusion in the SLJT group after follow up to a maximum of 25 months. The risk of extrusion for both frosted and plain tubes was significantly higher than for SLJT (p = 0.0040). There was no significant difference in the risk of extrusion between frosted and plain tubes. Overall, the risk of complications requiring tube replacement was not significantly different between frosted and plain tubes; however, the risk was significantly higher with both frosted and plain tubes compared with the SLJT (p = 0.036 and p = 0.042, respectively). Patient satisfaction was full in 86% and moderate in a further 5% of patients. Conclusions: Although patient satisfaction with LJT surgery is high, complications occur frequently, although seem to be less common with the larger 4.0 mm flange. Frosted tubes do not protect against tube displacement. The addition of the internal silicone flange on the SLJT seems to prevent the previously common problem of extrusion.