Comparative Study Of External And Endoscopic Endonasal Dacryocystorhinostomy For The Treatment Of Chronic Dacryocystitis

Introduction: Dacryocystorhinostomy (DCR) is the treatment of choice for Chronic Dacryocystitis. Although external DCR is still regarded as gold standard for acquired naso-lacrimal duct obstruction, endoscopic DCR is evolving as an equally effective alternative in the recent past. Objective: The study was carried out to compare the surgical outcome of external DCR and endoscopic endonasal DCR for the treatment of Chronic Dacryocystitis. Method: This observational study was carried out in the Department of Ophthalmology, Combined Military Hospital, Dhaka from November 2008 to May 2009. A total of 30 consecutive patients were selected for DCR surgery. Among those 15 patients underwent endoscopic endonasal DCR and 15 under went patients external DCR. Data regarding ocular examination, lacrimal drainage system, per-operative and postoperative complications and ultimate surgical outcome were collected and analyzed. Surgical success was defined by patient's resolution of symptoms with patency of lacrimal drainage system. Failure was defined as no symptomatic reduction in epiphora and/or inability to irrigate the lacrimal drainage system postoperatively. Results: Mean age of the patients was 35.0±11.3 years. Fifty three percent of the study subject was male and 43% of the study subject was female. Accumulated result showed that both surgical approaches had almost similar success rate (endoscopic DCR 73.3% versus external DCR 80%; p=0.666). Complication rate was low and no appreciable difference in complication was marked in both types of surgery. Twenty percent in endoscopic DCR group and 13.3% in external DCR group had moderate bleeding. Two patients (13.3%) of endoscopic surgery required septoplasty. All the complications were managed by conservative treatment. Post operative complication particularly nonpatent lacrimal drainage system occurred to 26.7% of endoscopic group and 20% of those with external DCR surgery. Silicon tube was in situ up to 3 months in all the cases. Ultimate failure occurred in 26.7% for endoscopic DCR and 20% for external DCR. Conclusions: Surgical outcome of both endoscopic and external DCR for Chronic Dacryocystitis was quite satisfactory. Overall complication rate was low. Endoscopic surgery might have an advantage of not having any external scar but it requires high equipment cost and long learning curve. DOI: http://dx.doi.org/10.3329/jafmc.v7i2.10389 JAFMC 2011; 7(2): 15-17

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Endoscopic Endonasal Approach to the Lower Lacrimal Drainage System

Lacrimal Drainage Surgery ◽

10.5005/jp/books/12184_8 ◽

2014 ◽

pp. 37-37

Author(s):

P Das ◽

Harini Das ◽

V Venkatraman

Keyword(s):

Drainage System ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Lacrimal Drainage System ◽

Lacrimal Drainage

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Endoscopic Surgery of the Lacrimal Drainage System

10.1007/978-3-319-20633-2 ◽

2016 ◽

Keyword(s):

Endoscopic Surgery ◽

Drainage System ◽

Lacrimal Drainage System ◽

Lacrimal Drainage

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The effect of lacrimal drainage abnormality on the surgical outcomes of congenital lacrimal fistula and vice versa

European Journal of Ophthalmology ◽

10.1177/1120672121994721 ◽

2021 ◽

pp. 112067212199472

Author(s):

Yong Min Choi ◽

Yeonji Jang ◽

Namju Kim ◽

Ho-Kyung Choung ◽

Sang In Khwarg

Keyword(s):

Surgical Outcomes ◽

Surgical Outcome ◽

Drainage System ◽

Mutual Effect ◽

Symptom Improvement ◽

Lacrimal Drainage System ◽

Surgical Methods ◽

The Mean ◽

Lacrimal Fistula ◽

Lacrimal Drainage

Purpose: To evaluate the various surgical modalities of congenital lacrimal fistula and assess the mutual effect of lacrimal fistula and lacrimal drainage abnormality on the individual surgical outcomes. Methods: In this retrospective cohort and case-control study, 74 eyes from 63 patients with lacrimal fistula who underwent surgical management between 2000 and 2015 at three medical centers were enrolled. The data collected included sex, age, preoperative symptoms, presence of concurrent lacrimal drainage abnormality, surgical methods, and surgical outcomes. The main outcome measures were treatment outcomes based on lacrimal drainage patency and symptom improvement, surgical outcome of fistulectomy according to the presence of lacrimal drainage abnormality, and surgical outcome of lacrimal drainage abnormality according to the presence of fistula. Results: The mean age at the time of surgery was 9.2 (SD, ±8.8) years and the mean follow-up duration was 14.4 (SD, ±19.5) months. All eyes (37/37) with fistula without lacrimal drainage abnormality demonstrated surgical success after simple fistulectomy. Patients with concurrent lacrimal drainage abnormalities showed more frequent surgical failure than those with fistula alone ( p = 0.009). However, the presence of fistula did not affect the outcomes of surgery for lacrimal drainage abnormality ( p = 0.179). Conclusion: Simple fistulectomy is sufficient for sole asymptomatic or pauci-symptomatic lacrimal fistula. Symptomatic fistula as well as those accompanied with lacrimal drainage abnormality underwent fistulectomy and lacrimal drainage system surgery. Patients with accompanying lacrimal drainage system abnormalities showed less favorable outcomes. Meticulous preoperative examination of the lacrimal drainage system is critical for surgical planning and prognosis prediction.

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Endoscopic DCR with and without prolene stent in rural area: a prospective randomized study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182718 ◽

2018 ◽

Vol 4 (4) ◽

pp. 1081

Author(s):

Abhay Kumar ◽

Prateek Kumar Porwal ◽

Kailash Prasad Dubey ◽

Harshita Singh

Keyword(s):

Randomized Study ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Successful Outcome ◽

Endoscopic Endonasal ◽

Female Ratio ◽

Duct Obstruction ◽

Chronic Dacryocystitis ◽

Endonasal Dcr ◽

Endoscopic Dcr

Background: The objective of the study was to compare the results of endoscopic DCR with and without prolene stenting and to assess subjective and anatomical success in patients undergoing prolene stenting.Methods: The surgical outcomes of endoscopic endonasal DCR was compared in 100 patients of chronic dacryocystitis with nasolacrimal duct obstruction from June 2013 to May 2018. The successful outcome of surgery was defined by subjective improvement of symptoms and anatomical patency of the neo-ostium on syringing by nasal endoscopy. Results: In our study females were predominant in both groups with around 60% being females in group with stenting and 64% in group without stenting. Male to female ratio was 1:1.5 and 1:1.77 in group with stenting and without stenting. The symptomatic success rate of the surgery at the end of 3 months was 92% in group without stenting and 88% in group with stenting. There was no statistical difference in the results of two groups.Conclusions: We recommend that stenting is not routinely required for endoscopic DCR surgeries. A selective stenting approach may be advocated using prolene 3-0, using stenting for specific indications. With proper surgical technique and good follow up, endoscopic DCR without stenting is treatment of choice for chronic nasolacrimal duct obstruction.

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Outcome of primary endoscopic dacrocystorhinostomy with and without stent: a randomised prospective study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175614 ◽

2017 ◽

Vol 4 (1) ◽

pp. 137

Author(s):

Rajesh Pandey ◽

Pramod Kumar Yadav ◽

Amit Kumar Patel ◽

Poonam Rani

Keyword(s):

Success Rate ◽

Surgical Outcome ◽

Nasolacrimal Duct ◽

Sinus Surgery ◽

P Value ◽

Chi Square ◽

Endoscopic Endonasal ◽

Significant Difference ◽

Endonasal Dcr ◽

Endoscopic Dcr

Background: The introduction of endoscopes with different degrees of angulation for endoscopic sinus surgery led to widespread use of endoscopic endonasal DCR (EDCR). The results of EDCR are not only encouraging, but are associated with many other additional advantages. Many modifications like LASER assisted endoscopic DCR, use of silicon tube for stenting, mitomycin-C application etc. have been described. However, insertion of silicon stent in endonasal DCR is most commonly used procedure. Many surgeons claim that use of silicon stent improves success rate of endoscopic DCR. On the other hand, some studies indicate that silicon stent itself is a reason for surgical failure. The present study was done to compare surgical outcome and complication of endoscopic DCR with and without silicon stent. Methods: 70 cases (total 90 EDCR) randomly taken for study. In 35 EDCR cases lacrimal stent were used and in 55 EDCR cases stent were not used. Success rate in both group was analysed using chi-square test. P value <0.05 was considered as significant. Results: We found a success rate of 90.9% and 85.7% for group A (stent not used) and group B (stent used) respectively. The statistic evaluation among these groups does not show any significant difference (p=0.445) which means that insertion of stent in cases of primary EDCR does not significantly change the surgical outcome. Conclusions: Endonasal DCR without silicon stent is considering as effective, safe and minimally invasive primary procedure for treatment of nasolacrimal duct obstruction. Role of using stent in primary EDCR is not very promising because it is not improving the outcome of surgery.

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