Powered endoscopic dacryocystorhinostomy (DCR), raising the bars

Abstract

Abstract Introduction: This study is done to assess the efficacy of powered endoscopic dacryocystorhinostomy (DCR) with large bony ostium exposing of fundus of sac and primary mucosal anastomosis. The study involved prospective interventional case series with short perioperative follow up. Materials and Methods: Operative and postoperative data were prospectively collected on 42 patients (15 men and 27women; mean age, 62.4 y; range 14–91 y) who presented to a lacrimal clinic with epiphora and obstruction of the nasolacrimal system and who consecutively underwent either primary or revision powered endoscopic DCR. All surgeries done by the same surgeon by standardized surgical technique. Follow?up evaluations included symptom evaluation and endoscopic assessment of the newly created ostium with fluorescein testing at each postoperative visit. Results: The only surgical complication was one case of sub cutaneous emphysema. 39 of the 42 DCRs had anatomically patent naso lacrimal duct after a mean follow?up of 12 months (standard deviation = 5 months), yielding a success rate of 95.7%. Out of three failures two had closed ostium because of improper use of medications, one patient had granulation tissue at the ostium. Two patients with a patent ostium had functional block and continued to have some symptoms. Conclusion: Powered endoscopic DCR which meets the with full sac exposure and primary mucosal apposition has a success rate comparable to that achieved with external DCR. Keywords: Endonasal DCR, Powered DCR, Dacryocystorhinostomy. Introduction Dacryocystorhinostomy (DCR) is surgical procedure done for epiphora due to nasolacrimal duct obstruction (NLDO), which involves creating a fistulous opening between lacrimal sac and nasal cavity at the level of middle meatus. There are various procedures to create this ostium that is external DCR, endoscopic nasal DCR, laser DCR. The most accepted are external and endonasal DCR. Endonasal DCR in