Reply re: “The Effectiveness and Long-Term Outcome of Conjunctivodacryocystorhinostomy With Frosted Jones Tubes”

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We were pleased to review the commentary and review of Jones tube lacrimal bypass stents by Radke et al.,1 corroborating our findings that frosted Jones tubes are indeed effective when used with conjunctivodacryocystorhinostomy. Their study included 14 frosted and 35 nonfrosted tubes showing no statistical difference between the 2 with regard to initial tube migration, direction of migration(s), number of revision(s) performed, and functional success being complete resolution of epiphora.
Although our study only looked at frosted Jones tubes, of the 42 eyes with an average follow up of about 3 years, only 6 tube were ultimately lost, with 40/42 eyes achieving complete resolution of epiphora. Our main goal was to show that frosted Jones tube were effective in conjunctivodacryocystorhinostomy and could be retained at an acceptable rate, which we believe was well demonstrated. It should also be stressed that the postoperative and follow-up management of these frosted Jones tube are as important as the initial surgery itself. We routinely will resize the frosted Jones tube collar and length to ensure a good fit, occurring in 55% of the eyes in our study.
We agree that a direct comparison of the frosted Jones tube with other types would have been helpful, but our preliminary data collection of the studied time frame, 2006–2014, included mostly frosted Jones tube and too few nonfrosted tubes to power a reasonable comparison. Anecdotally although it is the author’s observation that in those patients having undergone conjunctivodacryocystorhinostomy with only nonfrosted tubes, the rate of complete tube loss was much higher. Furthermore, it seems as though many of the patients with nonfrosted Jones tubes who were switched to frosted Jones tube experienced less tube loss, though perhaps with a higher tendency to migrate into the conjunctivodacryocystorhinostomy tract. Studies specifically looking at these latter points may be helpful in the future, and look forward to further developments to help alleviate the difficult nature of epiphora in the population requiring such therapy.
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