Conventional DCR Research Articles

Lacrimal Plasty with Dacryocystorhinostomy-Anastomosis Using Microsurgery.

In DCR, the lateral aspect of the dacryocyst and the nasal mucosa are incised, and the mucosal valves are sutured together. In DCR-A, the occluded section of the dacryocyst or nasolacrimal duct was trimmed and anastomosed by circumferential suturing through a hole in the nasal mucosa. The success rate and the requirement for postoperative therapy were compared between 21 sides of DCR patients and 11 sides of nasal DCR-A patients. DCR-A was significantly better than conventional DCR. No additional postoperative therapy was required for DCR-A. DCR-A improves symptoms of nasolacrimal duct obstruction to a greater extent than conventional DCR and does not require additional postoperative treatment.

Efficacy of Dacryocystorhinostomy with Fibrin Glue (FibDCR)―Comparison of 122 Cases of Conventional DCR with 119 Cases of FibDCR―

Efficacy of Dacryocystorhinostomy with Fibrin Glue (FibDCR)―Comparison of 122 Cases of Conventional DCR with 119 Cases of FibDCR―

A study to evaluate the effectiveness of conventional DCR and DCR implant method in chronic dacryocystitis

Background: Dacryocystitis is inflammation of the lacrimal sac and nasolacrimal duct. It is a common clinical entity causing troublesome and conspicuous symptoms. It has tendency to recur and persist until definitive surgical treatment is performed. The present study was conducted to evaluate the effectiveness of conventional DCR and DCR implant method in chronic dacryocystitis. Material and methods: The present comparative study was conducted among 160 patients over a period of 1 year. A detailed history was noted. Depends on the investigations and fitness patient was operated by conventional D.C.R or D.C.R implants. The 50 cases were divide into two groups; Group A consisting of 80 cases which underwent conventional DCR technique whereas Group B consisting of 80 cases those were underwent Pawar’s implant DCR. Data regarding post-operative complications were analyzed. Results were expressed in percentage and p value less than 0.05 was considered as statistically significant. Results: In the present study total patients included were 160 in which 64.37% were males and 35.62% were females. Maximum patients were of age group 31-40 years (57.5%). In group A i.e. Conventional DCR the post-operative complications were Lip odema in 7.5% patients, incisionl odema in 10% patients, haemorrhage from nasal mucosa in 5% patients, wound gape in 2.5% patients, obstruction of passage in 7.5% patients, Hypertrophic scar in 12.5% patients, Sac infection in 0% patients. In group B i.e. Implant DCR the post-operative complications were Lip odema in 0% patients, incisionl odema in 5% patients, haemorrhage from nasal mucosa in 0% patients, wound gape in 0% patients, obstruction of passage in 8.75% patients, Hypertrophic scar in 3.75% patients, Sac infection in 3.75% patients. Post complications were less with Implant DCR.Conclusion: This study concluded that post complications were less with Implant DCR than conventional DCR.

Lacrimal trephine vs punch in external dacryocystorhinostomy: The surgeon’s choice

Aim: A prospective comparative study to describe the surgical outcomes of external DCR using Kerrisons punch vs Lacrimal trephine. Materials and Methods: A prospective comparative study involving 56 consecutive patients of age group 30-70 years over a period of 3 years who were randomly divided into two Groups. Group 1(n=28) underwent external conventional DCR using kerrisons punch as against group 2 (n=28) where trephine was used for osteotomy. Result: Procedure success rate among Kerrisons group was 92.85% (26) vs 89.28% (25) in lacrimal Trephine group which is found to be comparable. Overall success rate was 91.07% (51). Need of general anaesthesia, more bleeding, longer operative time in group 1versus higher chance of nasal mucosal damage in group 2 was noticed. Patients were followed up for six months after surgery. Conclusion: Kerrison punch showed almost comparable success rate to lacrimal trephine group but higher operating time for external DCR. Lacrimal trephine is relatively easier to perform, requiring shorter duration at skilled hands. Keywords: DCR, Trephine, Lacrimal, Punch.

A Comparative study of conventional external dacryocystorhinostomy with dacryocystorhinostomy using intracystic implant

Dacryocystitis is a common manifestation in ophthalmology practice. external DCR is the definitive gold standard management. however many modifications in external DCR are proposed now a days, out of which dcr using intracystic implant is one. This study aiims at comparing the surgical outcome of external conventional DCR with that of DCR using intracystic implant. After a follow up period of 6 months it was observed that the success rate in connventional DCR is significantly better(97%) than DCR using intracystic implant(85%). However intraoperative blood loss and surgical time is significantly less in DCR using intracystic implant than the conventional external DCR. Keywords: Dacryocystorhinostomy, Intracystic Implant, Syringing, Nldo –Nasolacrimal Duct Obstruction.

English

AIM OF THE STUDY: To determine the role of the endonasal Dacryocystorhinostomy in the treatment of acute dacryocystitis and to assess the success rate of the procedure. MATERIALS AND METHODS: A prospective study was carried out on 30 patients at Orbit and Oculoplasty clinic, RIO-GOH, Chennai during the period of from October 2013 to August 2014. SELECTION CRITERIA: 30 patients who presented with acute dacryocystitis were included in this study. Out of 30 patients 26 were female patients and 4 were male patients. They were in the age group of 20-58 years and there was no history of major systemic illness like diabetes or hypertension among them. All the patients underwent primary endonasal DCR. Inclusion Criteria: All the cases of acute Dacryocystitis with abscess with established nasolacrimal duct obstruction were included in the study. Exclusion Criteria: 1. Cases with canalicular and punctal obstruction. 2. Cases with ectropion or entropion. 3. Cases with noticeable lower lid laxity. 4. Cases of congenital malformations of lacrimal apparatus and craniofacial anomalies. 5. Cases of tumours of the lacrimal apparatus and nasal cavity. 6. Cases with lacrimal fistulae and chronic dacryocystitis. 7. All recurrent cases due to failed external dacryocystorhinostomy. 8. Cases with deviated nasal septum on the same side. DISCUSSION AND RESULTS: Acute dacryocystitis is more common on the right side Acute dacryocystitis is more common among females. This is because of the narrow lumen in the bony canal which leads to partial or complete closure of the NLD. Acute dacryocystitis is more common in 5th decade. Acute dacryocystitis presents with complaints of pain, watering, discharge, swelling in the lacrimal sac region and occasionally with pre septal cellulitis and lacrimal abscess. ROPLAS test and lacrimal syringing are contra indicated in the acute phase of the disease. The diagnosis is made exclusively on clinical signs and symptoms. The conventional treatment for a case of acute dacryocystitis includes warm compresses, use of systemic antibiotic therapy, percutaneous route of drainage of the abscess and plan for external DCR after complete resolution of infection. This however may result in formation of cutaneous fistula formation, risk of incidence of recurrent infection before external DCR, prolong the illness and intake of antibiotic therapy. The procedure of external DCR is contraindicated in acute dacryocystitis. Because it spreads the infection via the tissue planes, exacerbates inflammation and causes septicemia. An endonasal approach reduces these complications since the lacrimal sac abscess is approached via the noninfected and less inflamed tissue areas. Endonasal drainage of the abscess causes rapid resolution of symptoms and signs. If the acute dacryocystitis is left unattended it may lead to the formation of lacrimal abscess which may burst open and leads to the formation of lacrimal fistula. These complications can be avoided by timely intervention by endonasal DCR. Endonasal DCR is associated with less intra operative and early postoperative complications like injury to neighbouring structures. CONCLUSION: Endonasal dacryocystorhinostomy is proved to be the treatment of choice in cases of acute dacryocystitis, compared to previous conventional external DCR. Endonasal DCR is a real boon in this world of upcoming cosmetic surgeries. As capsule endoscopies in gastroenterology and micro incision phacoemulsification in cataract surgery, endonasal DCR is now dominating the field of lacrimal surgery. It gives less pain, edema, bleeding, fistula formation. Being aesthetically more acceptable it causes no scar, no adhesions. It lessens the hospital stay, and provides an additional economic benefits for the patient by avoiding readmission for external DCR and prevents fistula formation. The overall success rate of this procedure in this study is 90%.

Aesthetic External Dacryocystorhinostomy

Background: acquired obstruction of the lacrimal excretory outflow system whether functional, structural or both will produce the symptoms of epiphora, mucopurulent discharge, pain, dacryocystitis and even cellulitis, promoting the patient to seek the ophthalmologist for evaluation and treatment. Objective: comparative study between conventional external DCR with postoperative scar modulating treatment, external DCR via subciliary incision and DCR via transconjunctival approach evaluating their functional outcome and final cosmetic scar. Patients and Methods: study cases were non-randomized 30 eyes in patients who inclusion and exclusion criteria are applied for them and dacryocystorhinostomy operation was done. Transconjunctival approach was done for 10 eyes, subciliary approach was done for 10 eyes while conventional approach with scar modulating treatment was done for last 10 eyes. Results: Aesthetic outcome of our study showed improvement in postoperative conventional approach scar with using scar modulatory treatment postoperatively and the results were 30% invisible, 50% minimally visible and 20% moderately visible after three months follow up. Also, subciliary approach study showed a significant improvement in scar outcome which was 60% invisible and 40% minimally visible. Conclusion: in spite of all the new innovations and competition, external DCR remains the gold standard and the most successful surgery in the management of complete NLDO.

A new approach to endoscopic DCR

AimTo compare a composite technique of Endoscopic Dacrocystorhinostomy with the conventional technique. MethodsA randomised prospective study was carried in the department of Otolaryngology Maulana Azad Medical College. Thirty patient selected for Endoscopic DCR were divided into two groups, one of which underwent conventional Endoscopic DCR and the other group were treated with a newer technique using cautery, cold instrumentation and laser at different steps of Endoscopic DCR. The patients were followed up for Nine months. Results/ConclusionBy using cautery, cold instrumentation and laser at different steps of Endoscopic DCR we were able to achieve a success rate of around 94% with this composite technique as compared to 83.3% in conventional Endoscopic DCR surgery.

Endoscopic endonasal dacryocystorhinostomy

Abstract Methods: With the advances of the endonasal endoscopic surgery, DCR performed through the nose becomes with the time a viable and highly effective alternative to the conventional DCR performed through an external approach.The optimal indication is low obstruction of the lacrimal pathway. This requires a precise preoperative assessment of the lacrimal pathway including a complete ophthalmological examination, seringing and probing of the lacrimal pathway and an imaging (dacryocystography and in some cases, a scintigraphy of the lacrimal pathway).The authors present the technique using the powered instrumentation. They emphasize the importance of the resection of the vertical part of the uncinate process and a large drilling of the frontal process of the maxilla in order to expose widely the nasolacrimal duct and the inferior part of the lacrimal sac. Stenting is not routinely necessary except when the epithelium of the canalicular system is damaged by the probing or when a high obstruction of the lacrimal pathway is associated to the low obstruction or in case of functional obstruction.A review of their results and those published in the worldwide literature is exposed. Results: With good selection of patient the success rate is around 90%.

A study of 272 cases of endoscopic dacryocystorhinostomy

272 Patients with obstruction in nasolacrimal duct were treated by endoscopic nacryocystorhinostomy (DCR). The results were compared with that of external DCR and Endoscopic DCR without stent. In our study Endoscopic DCR with stening had better results. Endoscopic DCR with stenting has several advantages over the more conventional external approach and Endoscopic DCR without stenting. Results at 4 years of follow up have been good that is 98.6% patients were relieved of symptoms completely.

Endoskopische Behandlung von Tränenwegsstenosen mit Hilfe eines KTP-Lasers - erster Erfahrungsbericht

Background Since four years, endoscopes with which the mucosa and disorders of the lacrimal drainage system can be examined directly, are available. The wish to treat lacrimal disorders with endoscopes and laser have remained. Patients and Methods Between January 1996 and February 1997, 12 patients with acquired lacrimal stenosis were treated with an Hyb:Erbium-YAG-laser and 32 patients were treated with a KTP-laser (quasi-cw mode. wavelength 532 nm and 1 0 W power). Five patients were treated for lower canaliculus stenosis and seven patients for postsaccal stenosis with the Hyb:Erbium-YAG-laser. 32 patients with postsaccal stenosis were treated with the KTP-laser to perform a bony window of 5 x 5 mm. Bicanalicular intubation into the nose was performed and was left for at least three months. Results The longest follow up period was 30 months while the shortest was 13 months in the Hyb:Erbium-YAG-laser group. Treatment was successful in four cases with a canalicular stenosis, but restenosis occurred in all cases of postsaccal stenosis and in one case of canalicular stenosis and required a conventional DCR. In the KTP-laser group 25 patients are patent and have no symptoms, 4 patients have watering cold weather and patients had a restenosis. Foliow-up range between 2 months and 12 months. Conclusions The Hyb:Erbium-YAG-laser is succesful in thin membranes and small restenosis. With the KTP-laser a successfull transcanalicular laser assisted DCR is possible.

Quality of life outcomes following dacryocystorhinostomy: external and endonasal laser techniques compared

AIMS/BACKGROUND . Endonasal laser dacryocystorhinostomy (ELDCR) has recently become established as an alternative technique to conventional external DCR (EXDCR) for relief of epiphora. The aim of this study was to compare quality of life and symptomatic outcomes in patients treated by these two methods. METHODS . A postal questionnaire was sent to 204 ELDCR and 78 EXDCR patients who had undergone surgery under our care more than 6 months previously. The questionnaire included the validated 18-item Glasgow Benefit Inventory (GBI) and 5 further questions addressing ocular symptomatology. RESULTS . Fully completed questionnaires were received from 156 ELDCR and 50 EXDCR patients. Mean GBI scores of +16.8 (ELDCR) and +23.2 (EXDCR) were obtained (Mann-Whitney U test = NS). Ocular symptom scores were +33 (ELDCR) and +54 (EXDCR) (p=0.005). CONCLUSION . Patients undergoing either ELDCR or EXDCR experience significant benefit in their healthcare status as detected by the GBI. There is no significant difference between the scores obtained by the two groups of patients. There were improvements in ocular symptom scores in both groups, with patients who had EXDCR scoring significantly better than the ELDCR group.

Endonasal laser dacryocystorhinostomy—medium term results

BACKGROUND/AIMSEndonasal laser dacryocystorhinostomy (ELDCR) has many potential advantages over conventional external DCR. Although the short term results of this technique have been reported, little is yet known of the long...