External Repeat Dacryocystorhinostomy with Modified Silicone Intubation for Failed DCR: Analysis of Efficacy and Patient Tolerability

Abstract

Aim of the Study : To describe a novel and alternative method of stent placement for failed dacryocystorhinistomy(DCR). Methodology : A retrospective analysis of 40 non consecutive cases of failed DCR underwent repeat DCR with modified silicone intubation. Here each arm of the lacrimal intubation tube was introduced through the canaliculi, and these arms were anchored to a large bore silicone tube at the level of the internal ostium. This large bore silicone tube was freely suspended in the nose through the internal ostium. The whole complex was kept in situ for a period of 6 months. Nasal endoscopy was performed after removal of stent. Results: The mean age group was 51 years (27-73 years). Sex ratio showed female preponderance (70%). The mean duration of follow up was 9.30 months (2.8 -18 months), and the mean period of stent removal was 7.08 months (2.5 -12.3 months). The outcome of this procedure showed that 95% of cases had patent lacrimal passage. Two cases had some form of punctal split. There were no cases of epistaxis or granuloma formation. Mean area of internal ostium after stent removal was 28.67 mm2 (SD 4.65). Conclusion: Re DCR has high risk of osteotomy closure, hence this modified technique can be considered as an alternative to standard intubation technique with optimum results.