A novel technique to improve the results of conventional dacryocystorhinostomy

Abstract

Purpose The objective of this study was to evaluate the results of the use of dried lyophilized amniotic membrane to increase the survival of external dacryocystorhinostomy (EX-DCR) with respect to the efficacy and complications. Patients and methods This was a prospective controlled study that included 22 eyes of 20 patients. All had nasolacrimal duct obstruction and were selected from the outpatient clinic; they were classified into two groups, 11 patients each. The first group patients were treated by EX-DCR using dried lyophilized amniotic membrane (group I) that was wrapped around the silicon tube after its implantation in the lacrimal passage (between the lacrimal passage and nasal cavity). The second group (II) patients were treated by the standard EX-DCR only, which served as the control group. Results The study included 22 eyes of 20 patients: 13 were female patients (65%) and seven (35%) were male patients, with mean age of 50.8 ± 6.5 and 48.2 ± 7.1 for groups I and II, respectively. Demographic characteristics showed insignificant difference between both groups. With respect to the success rate, all patients in both groups showed 100% subjective (symptomatic relief) and objective success rate (on examination) at 3-month follow-up (at the time of removal of silicon tube), but at the end of follow-up (8 months) the success rate decreased to 90.9% in the first group and 72.7% in the second group, and this difference was statistically significant ( P = 0.0288). One of the complications encountered in this study was epistaxis in five patients (45.4%) in group I and in six patients (54.5%) in group II. Other complication was periorbital ecchymosis in two patients in each group. In one patient in group I, the lower punctum was slit and opened (cheese wiring) using a silicon tube. The complication rate was statistically insignificant between the two groups ( P = 0.897). Conclusion The use of amniotic membrane with EX-DCR was effective in improving the results and increasing the survival of the ostium between the sac and the nasal cavity, with no added complications. However, larger multicenter studies with longer follow-up are needed before establishment of this treatment strategy.