A COMPARATIVE STUDY IN DACRYOCYSTORHINOSTOMY WITH VERSUS WITHOUT SILICON TUBE INTUBATION IN NASOLACRIMAL DUCT OBSTRUCTION IN ADULTS

Abstract

Background: Dacryocystorhinostomy (DCR) has been touted as the standard procedure fortreatment of acquired nasolacrimal duct obstruction; it can be performed through a cutaneousincision referred to as external DCR, or via a transnasal approach. Intubation with silicone tubes hasbeen widely used in lacrimal duct surgery. Objective: Toevaluate the role of silicon tube intubation inthe clinical outcomes of external and endonasal dacryocystorhinostomy in nasolacrimal ductobstruction in adults. Patients and Methods: This is a prospective, randomized; comparative studyincluded 80 cases of 74 patients who were diagnosed with postsaccal obstruction of the lacrimalpathway. The studied sample was randomly grouped into two main groups (n=40), group (I)undergoneexternal dacryocystorhinostomy (EX_DCR) and group (I) undergoneendonasaldacryocystorhinostomy (EN_DCR), then each group was subdivided into two subgroups (n=20)according to with or without silicon tube intubation. From all patients, full history was taken andthey received a complete ophthalmologic examination, ENT and systemic assessment. Afterundergoing the surgical procedure, patients were followed up at1stpostoperative day, 1week, 1, 3 &6 months, complications and outcome were assessed. Results: The overall success rate in externalDCR was 82.5% (33 cases), however, the overall success rate in endonasal DCR was 77.5% (31cases) with no significant difference between groups. The success rate was 85% for external DCRwith intubation, 80% for external DCR without intubation, 80% forendonasal DCR with intubation andwas 75% for endonasal DCR without intubation, with non significant differences among thesesubgroups (P=0.89). The results showed that DCRs without intubation recorded significantly loweroperative time compared to with indubation DCRs. Conclusion: The results of endoscopic andexternal DCR with silicone intubation were comparable to these result without intubation with nonsignificant differences. Using of silicone tube has no significant beneficial effect in the surgicalsuccess of primary DCR, while, it is associated with increasing cost, operative time and complicationrate, there is no need for its routine use. Further studies with larger sample size are warranted.