Comparison of external dacryocystorhinostomy with endoscopic surgical dacryocystorhinostomy

Tamilarasi, S (2007) Comparison of external dacryocystorhinostomy with endoscopic surgical dacryocystorhinostomy. Masters thesis, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai.


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INTRODUCTION: Epiphora is a relatively frequent problem encountered in ophthalmology. It may be due to nasolacrimal sac obstruction following an acute or chronic inflammation, trauma, tumour, or congenital malformation. It may be associated with purulent secretion and swelling of the sac region. Although medical treatment including antibiotic therapy, may address the symptoms, definitive management of this problem consists of surgical procedure in which patency of the lacrimal system is restored. The standard surgery for the blockage of the lacrimal outflow is dacryocystorhinostomy, in which the lacrimal sac is connected directly to the nose by removing the layer of bone and mucosa that separate these two structures. The aim of the surgery is at draining the tears freely into the nose with sac mucosa forming part of the lateral nasal wall. AIMS AND OBJECTIVES: To compare the external dacryocystorhinostomy with endoscopic endonasal surgical dacryocystorhinostomy. To evaluate the outcomes of the two procedure on subjective and anatomical basis. MATERIALS AND METHODS: A prospective non randomised clinical interventional study was undertaken at Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai; in the department of Orbit and Oculoplasty. The duration of the study was from May 2004 to June 2006. Fifty three patients with Primary nasolacrimal duct obstruction with chronic dacryocystitis were taken up for this study. Patients underwent either external or endoscopic endonasal surgical DCR depending on their preference after explaining the two procedures in detail. Consent of the patient was obtained before including in the study. The ethical committee in the hospital approved the study. INCLUSION CRITERIA: 1. Patients with nasolacrimal duct obstruction. 2. Patent canaliculi. 3. Normal eyelid function. 4. No lacrimal sac pathology. EXCLUSION CRITERIA: 1. Previous lacrimal surgery. 2. Functional nasolacrimal duct obstruction and canalicular obstruction. 3. Suspicion of malignancy. 4. Post traumatic bony deformity. DISCUSSION: Epiphora is an annoying symptom embarrassing the patient both socially and functionally. Lacrimal surgeries continue to evolve with new technical developments. There has been renewed interest in performing dacryocystorhinostomy through an intranasal approach using modern surgical tools such as endoscope and laser. The two widely accepted modalities of treatment for epiphora resulting from obstruction of the nasolacrimal ducts are external and endonasal dacryocystorhinostomy. The current study was carried out for a period of two years on 53 cases who had nasolacrimal duct obstruction of which 26 cases underwent external DCR and 27 cases underwent endonasal DCR. Both the groups were operated by single surgeon. The purpose of the study is to compare the success rates and complications of these two procedures. In our study we have defined success as full success, partial success and failure based on symptomatic relief of epiphora and patency of nasolacrimal duct post operatively. In external dacryocystorhinostomy group, 92.3% (24 cases) had full success and 7.7% (2 cases) had partial success. There was no failure reported in this group. In endonasal dacryocystorhinostomy group, 74.1 % (20 cases) had full success, 7.4 % (2 cases) had partial success and 18.5% (5 cases) had failure. The difference in overall success rate (p value - 0.06) was not statistically significant. The success rate in our study was comparable to that of Hartikainen et al86 ‘s who reported a success of 95% in external dacryocystorhinostomy and 71 % in endonasal dacryocystorhinostomy. CONCLUSION: In our study, The age distribution of patients were such that maximum number (35.8%) of patients were in the age group of 31 – 40 years. Females constituted 69.8% while males constituted only 30.2%. 62.3% of cases presented with nasolacrimal obstruction on left side External dacryocystorhinostomy had higher success rate of 100% while endonasal surgical DCR had a success rate of 81.5%, but the difference is statistically insignificant. In external Dacryocystorhinostomy the only complication seen in our study was prominent scar (15.4%). In endonasal dacryocystorhinostomy the complications seen in our study were pyogenic granuloma (3.7%), cheese wiring of canaliculi (7.4%), tube displacement (7.4%), and failure (14.8%). One patient had both pyogenic granuloma and failure accounting for 3.7%. External dacryocystorhinostomy is a standard surgical procedure for the treatment of nasolacrimal duct obstruction for successful outcome with minimal risk of disturbing scar. It allows for the inspection of the lacrimal sac for pathology like tumors and dacryoliths and easy suturing of the mucosal flaps. Endonasal dacryocystorhinostomy may be a viable option for the treatment of nasolacrimal duct obstruction. Disadvantage of this procedure include the preferred use of general anesthesia by many surgeons, the need for expensive equipment and instrumentation, and the relatively steep learning curve for this procedure. Both the advantages and disadvantages of endonasal DCR relative to external DCR should be carefully discussed with patients contemplating endonasal surgery. 8. Future studies comparing DCR techniques should measure the size of the created soft tissue and bony ostium, and the end point should include not only improvement in symptoms but more importantly static and dynamic observation and analysis of the healed ostium.

Item Type: Thesis (Masters)
Uncontrolled Keywords: external dacryocystorhinostomy; endoscopic surgical dacryocystorhinostomy
Subjects: MEDICAL > Ophthalmology
Depositing User: Devi S
Date Deposited: 15 Feb 2018 11:09
Last Modified: 15 Feb 2018 11:09

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