Re: “The Effectiveness and Long-Term Outcome of Conjunctivodacryocystorhinostomy With Frosted Jones Tube”

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We read with interest the recent manuscript by Ahn et al.1 regarding long-term outcomes of use of frosted Jones tubes in conjunctivodacryocystorhinostomy for treatment of proximal lacrimal outflow obstructions. They described in detail their experience with frosted Jones tubes over an 8-year period focusing on surgical history, etiology of tearing, surgical method and procedures, conjunctivodacryocystorhinostomy outcomes, and tube sizing. Forty-two eyes were included in their study. Of those 42 eyes examined 40 (95.3%) found symptomatic functional success, 42 (100%) found anatomical functional success, and 6 frosted tubes were lost at an average of 972 days. Of those 6 tubes lost, 1 was noted to have migrated out of the eye, and 5 into the nose. They conclude that use of a frosted Jones tube is a highly efficacious option to be used in conjunctivodacryocystorhinostomy with minimal complications.
Similarly, we retrospectively reviewed our cases of all patients who underwent a Jones tube lacrimal stent bypass from 2006 to 2014 performed by a single surgeon (A.R.H.) utilizing both frosted and nonfrosted Jones tubes, and the minimally invasive conjunctivodacryocystorhinostomy technique described by Devoto et al.2. Our study was institutional review board approved, Health Insurance Portability and Accountability Act compliant, and adherent to the declaration of Helsinki. Data collected included etiology of tearing, rate of migration for both initial and revised tube placement, direction of tube migration, and functional success. Fourteen frosted and 35 nonfrosted tubes were initially placed. Of the information collected in regards to initial migration, migration of the revised tubes, direction of tube migration, and functional success, there was no statistical significance found when comparing frosted and nonfrosted Jones tubes (Table 1). Respective follow-up time and time until migration (initially and revised) is displayed in Table 2.
Comparable with the study by Ahn et al.,1 we found low rates of migration and higher rates of functional success for the frosted Jones tubes; however, we found no statistical differences when we compared it with the nonfrosted tubes. This is an unbiased mirror to the group Bagdonaite and Pearson3 as they reported similar findings in their manuscript introducing the StopLoss Jones tube in 2014. We would agree with the authors that with surgical expertise and comfort of specific tube use, one can attain low complication rates and high rates of functional success; however, we equally express the importance of the current lack of strong evidence-based support of one tubes’ superiority over others. While Bagdonaite and Pearson3 did find a statistically significant difference between its StopLoss tube and the nonfrosted and frosted varieties, the findings have not been replicated by a group unassociated with the StopLoss tube. Yet, we too shared limitations of small sample size and being a retrospective analysis. Overall, we agree there are strengths and weaknesses with each type of Jones tube. It is therefore important that knowledge regarding current comparisons be emphasized, and future randomized, prospective comparative studies be encouraged to help appropriately guide tube selection.
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