Javate microendoscope: Putting tears to stop

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NENITA Sanchez, 27, had a problem. She was not suffering from emotional or physical pain (or watching a heartbreaking soap opera), but tears would perennially flow down her face.

She finally found an answer last July, thanks to UST ophthalmologist and inventor Dr. Reynaldo Javate.

Javate, a professor at the Faculty of Medicine and Surgery, devised a way to stop the overproduction of tears without incision. He modified a painless instrument, which he named “Javate microendoscope.”

“Excessive tearing is the overproduction of tears because of a problem in the eyes,” Javate explained. “Overproduction of tears can be caused by over-exposure to light, inward rubbing of the eyelids, or defective tear drainage.”

According to him, when eyes produce tears, they go through the eyes and stay in the cornea. The cornea, the transparent portion of the eye, is cleansed and provided nutrients.

However, the infection blocks the lacrimal excretory (tear sac), where the tears are supposed to be drained. Because the tears accumulate in the corner of the eye, they lead to excessive tearing.

“If there is an obstruction in the lacrimal excretory, tears would flow continuously,” said Javate.

Women are prone to this problem because they have narrower tear ducts compared to men, he said.

“There are ways to remedy this,” Javate said. “It’s either we give eyedrops, which are temporary, open another pathway, or do a less invasive operation to the patient.”

Treating the tear ducts

The operation, which was performed to Sanchez last July, is called Endoscopic Lacrimal Duct Recanalization (ELDR).

“When there is an obstruction in the passageway, what I do is ‘recanalize’ it with the instrument I’ve designed,” Javate said, adding that 93 to 94 percent of ELDR operations were successful.

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According to him, the procedure is called “recanalization” because re-rooting or making another pathway for tears would not be necessary.

“The microendoscope helps the whole procedure to remove the obstruction from the tear ducts to perform normal again,” he said.

The microendoscope is an instrument used to visualize the internal canals of the body. With the assistance of German company Karl Storz, Javate devised a microendoscope specially made for the tear passage called lacrimal duct.

“I have also redesigned the microendoscope with a smaller outside diameter for Asian patients,” he said. “Asians have smaller body parts compared to others.”

A high definition camera head is built in the lacrimal microendoscope and connected to the computer control unit. The microendoscope transfers information that shows condition of the tear passageway to the digital archiving system. It is documented after showing the “stenosis” or obstruction of the passageway.

Lacrimal trephine, the instrument that is used to remove the obstruction, is pierced through the passageway and removes the obstruction in the duct after the endoscopic procedure. A smaller trephine was also designed for Asians.

The ELDR is performed under anesthesia. A stent, a temporary instrument that keeps the passageway open, is used to avoid entering the wrong passageway and is removed after six months to prevent the closure of the duct.

Although the endoscopic instrument is pierced through the corner of the eyes, near the nasal pathway, Javate said it would not widen the eye opening.

“In microendoscopy, the treatment is scarless and painless,” he said.

Javate pointed out that besides scars, there are other disadvantages in incisional dacryocystorhinostomy or the traditional operation for excessive tearing. These are prolonged recovery, uneasiness on the nasal pathway, blood loss, and difficulty in putting on eyeglasses and nosepad. The ELDR does not require making a new opening near the nasal pathway of the patient.

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“Recanalization is less invasive than the incisional technique,” Javate said.

The ELDR, according to Javate, is safe because there would be minimal bleeding and less discomfort for the patient. It is especially safe to older patients because it would not complicate their illness.

However, if the tear duct is already broken, endoscopy will not be possible because the canal is already dysfunctional, so another pathway must be made.

“You can’t remove the obstruction since the duct is already damaged,” Javate clarified.

Javate’s research, which was co-authored by Dr. Ferdinand Pamintuan and Dr. Raul Cruz, started in November 2003 at the Javate Lacrimal, Orbit and Olcufacial Plastic Surgery Clinic. It was titled “Efficacy of Endoscopic Lacrimal Duct Recanalization Using Microendoscope” and published in the international journal Ophthalmic Plastic & Reconstructive Surgery in September 2010.

Javate is the only ophthalmologist in the Asia-Pacific who performs this kind of operation. He has garnered awards and recognitions all over the country and was listed as one of the Outstanding Thomasian Alumni (TOTAL) in the University in 2005 and hall of famer of the Dangal ng UST faculty award.

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