External Dacryocystorhinostomy Surgery Research Articles

Results of Single and Double Flap Anastomosis in External Dacryocystorhinostomy Surgery

Background: Dacryocystorhinostomy (DCR) is one of the most common oculoplastic surgeries. In this study, we aimed to compare single and double flap anastomosis results in external dacryocystorhinostomy surgery. Materials and Methods: Between January 2016 and November 2017, 156 patients who underwent external DCR were evaluated retrospectively. All cases were performed under general anesthesia. In the first group, 86 patients (52 female, 34 male) had a double flap external DCR. In the second group, 70 patients (40 female, 30 male) had a single flap external DCR. Results: The mean follow-up period was 18.2±8.6 months in the double flap group and 16.4±5.4 months in the single flap group. The mean age was 48.2±16 in the double flap group and 46.3±17 in the single flap group. The success rate was 96.6% in the double flap group and 95.8% in the single flap group. Conclusion: In our study, there was no difference in surgical success in patients undergoing single and double flap external DCR surgery.

Oral versus single intravenous bolus dose antibiotic prophylaxis against postoperative surgical site infection in external dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction - A randomized study.

Purpose:To compare the efficacy of a single perioperative bolus dose of intravenous antibiotic versus postoperative oral antibiotic prophylaxis for prevention of surgical site infection (SSI) in external dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO).Methods:This was a prospective randomized controlled study with a noninferiority design. Patients undergoing external DCR surgery were randomized into two groups A and B. Patients in group A received a single bolus dose of intravenous cefazolin 1 g at surgery, whereas those in group B received oral cephalexin 500 mg postoperatively twice a day for 5 days. Allocation concealment was ensured by sequentially numbered opaque sealed envelopes (SNOSEs). Both groups were advised identical postoperative local wound care regimens. Any clinical evidence of SSI at 4 weeks of follow-up in either group was the main outcome measure.Results:In all, 338 patients randomized into two groups of 169 patients each participated in this study. At follow-up of 4 weeks, only one patient in group B developed postoperative SSI. None in group A developed postoperative SSI. Other potential risk factors for postoperative SSI were also analyzed by univariate and multivariate analyses but none achieved statistical significance in either group.Conclusion:Our results demonstrate that a single bolus dose of perioperative intravenous antibiotic offers adequate prophylaxis against postoperative SSI and compares favorably with the more commonly used oral antibiotic prophylaxis in external DCR for PANDO in our population and our practice scenario.

External dacryocystorhinostomy for isolated lacrimal sac rhinosporidiosis - A suitable alternative to dacryocystectomy.

Purpose:To describe the outcome of external dacryocystorhinostomy (DCR) as a suitable alternative to dacryocystectomy (DCT) in cases of isolated lacrimal sac rhinosporidiosis.Methods:This was a retrospective, interventional case series. Institutional review board approval was obtained for the study. The chart review of 13 patients who underwent external DCR surgery for isolated lacrimal sac rhinosporidiosis between July 2012 and May 2018 was performed. Demographic details, clinical presentation, preoperative and intraoperative findings, surgical technique used, postoperative management, surgical outcome and duration of follow up were reviewed for each patient.Results:Thirteen patients were included in the study. Nine (69.2%) were male and four (30.8%) were female. The mean age was 22.1 years (range: 8–46 years). Involvement was unilateral in all cases. The commonest presenting complaint was epiphora with discharge seen in 10 cases (76.9%). An intrasac granuloma was grossly identified intraoperatively in 12 out of the 13 patients. Mean follow up was 26.9 months (range: 1.5–68 months). Till the last follow up, all cases were symptom free and did not have any evidence of recurrence of infection.Conclusion:From this series of cases reported by the authors, external DCR with appropriate precautions to prevent recurrence appears to be a suitable alternative to conventional DCT with excellent long-term outcomes without disease recurrence.

Application of biodegradable collagen matrix (Ologen\u2122) implants in Dacryocystorhinostomy surgeries, a randomized clinical study

BackgroundTo introduce and evaluate the application of Ologen implants in external Dacryocystorhinostomy (DCR) Surgeries.MethodsProspective comparative randomized study was carried out on 60 patients coming to ophthalmology department, Menoufia University Hospitals. Patients included were suffering from primary acquired nasolacrimal duct obstruction with positive regurge test. Patients were randomly enrolled into two groups using alternating choice technique. Group A included 30 patients who had DCR surgery to treat the obstruction with Silicone tubes. Group B included 30 patients had a Dacryocystorhinostomy with Silicone tubes and Ologen implants.ResultsSuccess rates as regard to relief of symptomatic epiphora were 86.7% in group A and 96.7% in group B and time of dye clearance test was 4.5 ± 0.6 min in group A and 3.9 ± 0.4 min in group B with p value 0.353 &0.001 consecutively. Apart from immediate mild post operative hemorrhage that was encountered in 2 cases in group B and 1 case in group A, there were no significant complications in both groups.ConclusionThe current study shows that application of Ologen implants in external DCR surgeries may improve symptomatic epiphora without exposing the patients to more intra-operative or post-operative complications. To the best of our knowledge, the current study is the first one to use Ologen implants in external DCR surgeries. However, the follow-up period was relatively short and the sample size is relatively small and further work is required to verify the effect of Ologen in external DCR surgeries.Trial registrationCurrent Controlled Trials PACTR201711002809215, and the date of registration is 29 November 2017. The trial is Retrospectively registered.

Safety Comparison of Laryngeal Mask Use With Endotracheal Intubation in Patients Undergoing Dacryocystorhinostomy Surgery.

This study will determine the safety of laryngeal mask airway (LMA) compared with endotracheal tube (ETT) in patients undergoing general anesthesia for dacryocystorhinostomy (DCR) surgery. In this retrospective cohort study, intraoperative and postoperative outcomes of patients who underwent DCR at UAB Callahan Eye Hospital using either LMA or ETT were compared. Over a period of 52 months, 429 patients underwent external DCR surgery. An ETT was used in 37 patients and LMA in 392 patients. Baseline patient characteristics and anesthetic management were similar. No documented cases of blood or gastric aspiration occurred in the total cohort. Our study confirmed the findings of others that there is less cardiovascular lability on LMA placement than with ETT intubation. A 30% increase in heart rate from baseline after intubation (ETT 10.8%, LMA 1.8%; p = 0.010) and after incision (ETT 8.1%, LMA 1.8%; p = 0.047) occurred more frequently in the ETT group. Airway management with an LMA was also less difficult compared with an ETT (ETT 5.7%, LMA 0.5%; p = 0.035). The use of an LMA for airway control is safe and effective in patients undergoing general anesthesia for DCR surgery. No events of aspiration occurred with LMA use. Heart rate increase was significantly less in the LMA group. In our opinion, use of an LMA for airway control during DCR surgery is superior to use of an ETT. Airway protection, improved hemodynamics, and less difficulty in placement of the laryngeal airway device are all validated by this study.

Собственный опыт профилактики рецидивов дакриоцистита при наружной дакриоцисториностомии

Purpose: to evaluate the effectiveness of integrated methods of prevention dacryocystitis recurrences in external dacryocystorhinostomy. Materials and methods. 120 patients (120 eyes) with dacryocystitis, 85 women and 35 men, aged 21 to 75, were divided into 2 groups. The main group of 60 patients (60 eyes, 40 women and 20 men) whose mean age was 65 ± 12.5 years were subjected to external dacryocystorhinostomy with the use of a specially modified device, trepanation fraise, for the formation of the bone window and a binary stent to ensure the tamponade of a formed anastomosis. The control group was formed by the remaining 60 patients (60 eyes, 45 women and 15 men) with a mean age of 69 ± 16.2 years, who underwent regular operations according to Addeo Toti. Results. In the main group, recuperation was noted in 49 cases (82 %) and improvement in 10 cases (17 %). 1 case (1.6 %) showed a recurrent dacryocystitis. In the control group, recuperation was achieved in 38 cases (63.3 %), improvement in 17 cases (28.3 %) and the recurrence of the condition occurred in 5 cases (8.3 %). Conclusion. The proposed method enables an effectiveness increase of external dacryocystorhinostomy surgeries. For citation: Shikhunov D.Sh., Aliev A-G.D., Aliev A.A.-G., Abdulaev A.B.. The experience of prevention of dacryocystitis recurrences in external dacryocystorhinostomy. Russian ophthalmological journal. 2018; 11 (1): 30-4. doi: 10.21516/2072-0076-2018-11-1-30-34 (In Russian).

Factors Affecting the Success Rate of External Dacryocystorhinostomy at B. P. Koirala Institute of Health Sciences, Dharan, Nepal

IntroductionAny disturbance to the normal ouVlow of tears through the nasolacrimal passage causes overflow known as epiphora. The clinical symptoms of epiphora range from mild dribble to the continuous ouVlow of tears. Watering of eyes caused by the nasolacrimal drainage obstruction is managed by surgery. One of the many surgeries to treat this is external dacryocystorhinostomy.ObjectiveThe objective of this study was to evaluate the success rate of external dacryocystorhinostomy as well as factors affecting it.MethodologyThis is a retrospective cross-sectional study, conducted in the Department of Ophthalmology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan with the approval of Institutional Review Committee, BPKIHS. The medical records of patients who underwent external Dacryocystorhinostomy surgery from April 2011 to April 2016 at BPKIHS were retrospectively reviewed. Statistical analysis was performed using SPSS for windows, version 11.5 (SPSS Inc., Chicago, IL). Binary logistic regression models were used to investigate the association of the surgical outcome with various predicting variables.ResultsThe success rate of the external dacryocystorhinostomy was 78.09%. Factors studied were: age, with a range of 2-81 years; duration of symptoms with a range of 1-84 months; and gender of the patients. The intra-operative factors studied were use of silastic tube, types of flap, and osteotomy size. Among these factors, the duration of symptoms and osteotomy size had significant association with the outcome of the surgery p<0.05.ConclusionOur study yielded high success rate in patients with shorter duration of watering of eyes and larger osteotomy size during surgery. Hence, a larger osteotomy size and early intervention is recommended for better surgical outcome. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 196-200

External Dacryocystorhinostomy; Success Rate and Causes of Failure in Endoscopic and Pathologic Evaluations

External dacryocystorhinostomy (DCR) is the method of choice to treat nasolacrimal duct (NLD) obstruction and the other approaches are compared with it, with a failure rate of 4% to 13%. The current study aimed to assess the causes of failure in external DCR by postoperative endoscopic and pathological evaluation. The current retrospective cross sectional study followed-up113 patients with external DCR and silicone intubation for three months. Silicone tubes were removed after the third months. Failure was confirmed based on the clinical findings and irrigation test. Paranasal sinus computed tomography (CT) scanning, and endoscopic and pathological evaluations were performed in the failed cases. Totally, 113 patients underwentexternal DCR. The patients included 71 females and 42 males. The mean age of the patients was 55.91 years; ranged from 18 to 86. Epiphora was the most common complaint before surgery (90.3%). Clinically, epiphora continued in 17 cases (15%), of which 94.11% had at least one sinus CT abnormality and 82.35% had at least one endoscopic abnormality. The most common endoscopic findings were deviated septum (70.6%), scar tissue (52.94%), concha bullosa (46.9%), septal adhesion (47.05%), enlarged middle turbinate (41.2%), and sump syndrome (11.7%). The failure was significantly associated with the chronicity of the initial symptoms (P-value=0.00). Pathologically, there were significant relationship amongst the failure rate, scar formation, and allergic rhinitis (P-values =0.00 and <0.05, respectively). Preoperative endonasal evaluation and consultation with an otolaryngologist can improve surgical outcomes and help to have a better conscious to intranasal abnormalities before external DCR surgery.

Functional Outcome in Primary Nasolacrimal Duct Obstruction after Successful External Dacryocystorhinostomy Surgery

Aim: To assess the functional outcomes of external dacryocystorhinostomy(DCR) surgery in symptomatic patient with primary nasolacrimal duct obstruction .Settings and Design: Prospective, clinical interventional studyMethods: This study was conducted in 50 consecutive (50 eyes) patients of Primary Acquired Nasolacrimal Duct Obstruction admitted in a tertiary eye care centre. Functional outcome comprises of symptom improvement which include absence of epiphora, improvement in vision, routine work, occupational work, mood, embarrassment. Assessment was done by pre and post-operative questionnaires at 2 ,6 and 12 months postoperatively.. Anatomic success was assessed by Lacrimal syringing , Fluorescein dye disappearance test(FDDT) and endoscopic view of osteotomy. Statistical significance between preoperative and postoperative symptoms (Functional outcome assessment) was analysed using McNemars testResults: Postoperatively, marked improvement in subjective symptoms i.e. difficulty in vision (93.5%), routine work (95.6%),occupational work (95.8%),mood(95%) and embarrassment (94%) was seen with anatomic success of 96%.Conclusions: In PANDO population, symptoms bother patient significantly. However, successful DCR surgery has a beneficial effect on the patient physical and social health thus changing the quality of life of patients markedly.

Long-term outcome of primary external dacryocystorhinostomy.

To assess the long-term functional outcome of external dacryocystorhinostomy (DCR) in terms of epiphora. Single-group cohort study. Section of Ophthalmology, The Aga Khan University Hospital, Karachi, from January 2000 to June 2010. This study included adults who underwent external DCR surgery at the AKUH during January 2000 to June 2010. The main outcome measure was the proportion of patients reporting to have developed epiphora after surgery. During the telephonic interviews participants were asked if they had a recurrence (symptoms such as watering or discharge) after surgery. Individuals answering in affirmative were asked when the symptoms started. Data on age at surgery, gender and pre-operative symptoms were collected from medical records. Recurrence-free curves were calculated according to the Kaplan-Meier method. A total of 44 persons who underwent DCR surgery were contactable by telephone in 2011 and all agreed to participate in the study. The mean age of the patients at the time of surgery was 48.0 ± 15.8 years. Overall, 38.6% (17/44) participants reported having developed epiphora after surgery. The overall median recurrence-free time was 1.7 years; there was no statistically significant difference in the median recurrence-free time between men and women. The long-term functional outcome of external DCR surgery does not appear to be optimal and, in fact, far worse than the short-term results reported in the international literature.

Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy.

PurposeTo analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes.MethodsWe reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomy for primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location and extent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimal duct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimal sac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significant inflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical success rate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups.ResultsOf 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases (56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%) showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis of the lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and the other 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success rate was 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, the functional success rate was lower in cases with significant lacrimal sac change (p = 0.044).ConclusionsEven in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sac changes, and those changes were associated with lower functional success rate.

Comparison of the effect of W-shaped and linear skin incisions on scar visibility in bilateral external dacryocystorhinostomy.

Dear editor The article entitled “Comparison of the effect of W-shaped and linear skin incisions on scar visibility in bilateral external dacryocystorhinostomy” by Ekinci et al1 was published in Clinical Ophthalmology; I reviewed this paper for another journal (Journal of Ophthalmology) several months ago before it appeared in your journal. It seems that the authors submitted their rejected paper to your journal, after making some unethical, methodological changes. The major differences between the two versions of the same manuscript are as follows: The rejected manuscript states that the study was conducted “between January 2009 and June 2012” (42 months). However, the published manuscript states that the study was conducted “between June 2011 and June 2012” (12 months). The rejected manuscript states that “The mean follow-up time was 14.1±5.84 (7–25) months for the WS incision group and 29.4±5.08 (24–40) months for the LS incision group”. These periods and follow up times show that the dacryocystorhinostomy (DCR) surgeries with linear shape (LS) incision were performed about 15 months before the DCR surgeries with W-shaped (WS) incisions. These follow up times, however, are removed from the published version of the manuscript. Another significant issue arises when the scar assessments times are compared in the rejected and published versions. In the rejected version, the scar assessment time was reported as “6 months after the second surgery”, “Scars were scored 6 months after the second surgery […]” (in the Abstract) and “The skin incisions were assessed 6 months after the second procedure by […]” (in the Materials and methods). Taking into account the mean follow-up times reported in the rejected manuscript, the scar assessment must take place about 15 months apart for each group. However, the published paper reports that the scar assessment took place “6 months after each procedure”. See the Materials and methods section paragraph 1 and 3 stating: “The skin incisions were assessed 6 months after each procedure by […]” and “The surgeries were not simultaneous, so assessment of scar visibility on each side was done at the 6-month postoperative visit to prevent one side being more healed than the other at evaluation.”1 This last sentence is like a response to one of the reviewer’s comments on the rejected manuscript and explains the motivation of the authors for this change in the published version. Given that both the rejected manuscript and the published paper derived results from the same cohort of patients, a serious question arises with regard to the truthfulness of the method and data in the published paper. Another potential issue involves a schematic drawing of the WS incision included in the rejected version of the manuscript. This drawing shows that the arms of the WS incision are unequal: the two inner arms toward the nasal dorsum are 8 mm in length (two times longer than the outer arms). However, in the methods section of the text (in the both rejected and published versions), the W shape was described as follows: “The W shape was formed by three consecutive equilateral triangles having sides 4 mm in length with two tips and one base that showed the medial canthus”. Another paper written by these authors, which was previously published in the journal Orbit, also included the similar discrepancy between the drawing and text.2 This discrepancy becomes unnoticeable when the authors removed the drawing from the published version. In addition to these discrepancies, another issue I have with this paper is that the idea of a W-shaped incision is presented as original. This idea appeared first in our department in the form of a specialization thesis, in which equal W-shaped and linear incisions were compared.3 This technique represents a significant advancement in external dacryocystorhinostomy surgery. I have discussed this technique and performed live surgeries at several national meetings in Turkey over the past 8 years. Although Ekinci et al knew about these presentations and the thesis, they presented this method as original research. It is disappointing when fellow academicians adopt such strategies for academic promotion.

A Possible Cause of Nasolacrimal Duct Obstruction: Narrow Angle Between Inferior Turbinate and Upper Part of the Medial Wall of the Maxillary Sinus

Background: To search the relationships between the primary nasolacrimal duct obstruction and the angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus.Design: Retrospective study.Participants and methods: Computed tomography findings of 35 patients with primary nasolacrimal duct obstruction and 100 sides of 50 individuals were reviewed. While the study group was composed of patients who had external dacryocystorhinostomy surgery, the control group was composed of patients who had CT scans due to headache, sinusitis and smell dysfunction. Epiphora complaint was evaluated with the lacrimal syringing. The exclusion criteria were: age less than 20 years, previous nose, sinus, turbinate or lacrimal surgery, prior history of maxillofacial fracture, nasopharyngeal malignancy, reflex hypersecretion, and associated pathology of the lacrimal canaliculi.Main outcome measures: The angle of inferior turbinate.Results: The mean angles were 53.2° (range, 37.9–82.9°) for affected side of the study group, 58.6° (range, 32–85.3°) for the unaffected side of the study group and 56.8° (range, 41.2–76.9°) in the control group. The difference between the angles was statistically significant between the study and the control groups (p < 0.05). The difference between the operated and non-operated sides of the study group was also statistically significant (p < 0.05).Conclusion: Although this study was performed in a small group, we thought that the narrow angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus might be a possible causative factor in primary acquired nasolacrimal duct obstructions.

Assessment of anterior suspended flaps modification for external dacryocystorhinostomy.

The aim of this study was to evaluate the functional and/or anatomic success rate as well as complications of anterior suspended flaps modification for external dacryocystorhinostomy (DCR). This is a retrospective study that included 50 eyes of 47 patients who underwent anterior suspended flap external DCR surgery for nasolacrimal duct obstruction. Diagnosis of nasolacrimal duct obstruction was made through irrigation of the nasolacrimal drainage system. Anterior flaps of lacrimal sac and nasal mucosa, as large as possible, were created in all patients. Posterior flaps of lacrimal sac and exposed nasal mucosa were excised. After suturing the anterior flaps with two 6-0 Vicryl sutures, the third suture was passed through the orbicularis oculi at the subcutaneous level on 1 edge of incision, then from the middle of the anterior flaps and the other edge of the incision to the suspended anterior flaps. The success rate of 50 surgeries was 96%. In 37 eyes, no problems were reported during the surgery and the modified external DCR was performed successfully. The success rate of the modified external DCR was 100% in those patients. The average operation time was 34 ± 8.2 minutes. These results suggest that anterior suspended flap external DCR is a simple, safe technique with a very high success rate and a satisfactory surgical time.

N-butyl-2-cyanoacrylate tissue adhesive versus subcuticular skin closure in external dacryocystorhinostomy

Purpose The aim of this study was to compare the surgical efficacy and aesthetic outcome of using tissue adhesive N-butyl-2-cyanoacrylate 'Histoacryl' with subcuticular suture closure of skin incision in external dacryocystorhinostomy (DCR). Design The present study was conducted as an interventional study. Patients and methods A total of 60 chronic dacryocystitis patients undergoing DCR procedures at the Research Institute of Ophthalmology were included. The patients were randomly selected, irrespective of age, sex or race, and were divided into two groups of 30 patients each. A classic external DCR was done for all the patients. At the completion of the surgery, the skin incisions in group 'A' were closed with vicryl 6/0 subcuticular suture, whereas in group 'B' N-butyl-2-cyanoacrylate 'Histoacryl' (FDA approved) tissue adhesive was used to close the skin incisions. No subcutaneous sutures were placed to approximate the wound edges. After 20 s of drying time the adhesive was applied for the second time. All the patients were followed up on the first day, fourth day, first week, second week, first month, and then monthly thereafter for 6 months. The time of suturing the wound and the time of application of the tissue adhesive was recorded for all the patients in both groups. During follow-up the wound was examined for evidence of infection, pain and discharge, and an inquiry was carried out for patient satisfaction. Photographs of the wounds were taken at every visit. The photographs were then shown to a senior surgeon, who was oblivious of the method of closing the wound, and rated the quality of skin incision according to 'WES scale'. Results No intraoperative wound complications were encountered in any patient. Statistical analysis of the data available, at 1 month, showed no statistically significant differences between the two groups as regards duration of healing, inflammation or final incision appearance as rated by the senior surgeon. Skin closure time averaged 61 s in subcuticular suture and 52 s in N-butyl-2-cyanoacrylate skin glue, which was statistically insignificant. Conclusion Using N-butyl-2-cyanoacrylate glue is an effective and a reliable method for skin closure, yielding similar aesthetic results as skin closure with subcuticular sutures in clean incision for external DCR surgery. It is safe, quick, does not compromise wound integrity, is adequately tolerated by the patients and could be considered an excellent alternative and an improvement on the traditional method of wound closure, providing high level of satisfaction for both patient and surgeon.

The Outcomes of Transcanalicular Multidiode and External Dacryocystorhinostomy Surgeries

The Outcomes of Transcanalicular Multidiode and External Dacryocystorhinostomy Surgeries

External versus endonasal dacryocystorhinostomy in a specialized lacrimal surgery center

PurposeTo study the duration of surgery, outcomes, adverse events and success rates of external versus endonasal dacryocystorhinostomy (DCR) surgery in a specialized lacrimal surgery center. MethodsProspective, interventional case series. Standard external DCR technique was performed. Mechanical endonasal DCR was performed with enlargement of the ostium and full length opening of the lacrimal sac. Surgical time, duration of intubation, incidence of hemorrhage, infection, wound dehiscence; follow-up duration and functional success at the end of follow up were recorded. ResultsFunctional success and symptomatic relief were equivalent in both procedures. Endonasal DCR surgery was found to be quicker to perform than external DCR surgery. The follow-up duration was comparable in both groups (mean 9months). Patient satisfaction was significantly higher in the endonasal DCR group (9.3 versus 8.6). ConclusionEndonasal DCR surgery offers a very attractive alternative to the well established technique of external DCR surgery for the treatment of primary acquired nasolacrimal duct obstruction with equivalent success rates, shorter surgical time and higher patient satisfaction.

External Dacryocystorhinostomy: Do We Really Need to Repair the Posterior Flap?

Purpose: This study aims to compare a simplified technique of external dacryocystorhinostomy (DCR), where the posterior flap is excised, with the more traditional approach of double flap repair.Methods: A prospective, comparative, single surgeon, single centre clinical trial was conducted of eighty-three patients who received external DCR, with either anterior and posterior flap anastomosis (Group A), or anterior flap anastomosis and excision of the posterior flap (Group B), in a tertiary referral hospital in Nepal. Patients with nasolacrimal duct obstruction and epiphora were assigned to one of two groups. Follow up was a minimum of 6 months for inclusion in the study. Success was defined objectively by irrigation of the puncta without regurgitation and subjectively by the absence of epiphora or discharge.Results: The overall success rate of external DCR was 89.2%, after a mean follow up of 13.5 ± 2.2 months. There was no difference in success between the two groups (p-value = 0.73), with 90.7% success in Group A and 87.5% in Group B. The frequency of complications was not statistically different between Groups A and B (p-value = 0.79).Conclusions: Excision of the posterior flap and anastomosis of only the anterior flap is not disadvantageous to the outcomes of external DCR surgery when compared with the more traditional approach of anastomosis of both flaps. We believe this simplified procedure can be implemented as the standard technique for external DCR, particularly in developing nations such as Nepal.

Eksternal dakriyosistorinostomi: Tek veya çift flep anastomozu

Objective: To compare the the results of external dacryocystorhinostomy using double flaps anastomosis and single flaps anastomosis Methods: Fifty-one eyes of 48 consecutive patients with complain epiphora and chronic dacryocystitis who had undergone external dacryocystorhinostomy from October 2009 to January 2012 were included. Single flap anastomosis were performed on 26 eyes of 26 patients and double flaps anastomosis were performed on 25 eyes of 22 patients and reviewed surgical success rate. Results: Silicon tube intubations were performed on 13 eyes with single flaps anastomosis and 20 eyes with double flaps anastomosis. The mean length of follow-up was 16.2p1.3 months for single flaps anastomosis group and 18.1p2.1 months for double flaps anastomosis group. Success rates in single flap anastomosis group and double flaps anastomosis group were 92.4% and 96%, respectively. There was no statistically significant difference in success rate between the groups (p=0.088). Conclusion: Single flap and double flap anastomosis gave similar outcome in external dacryocystorhinostomy surgery.

External Dacryocystorhinostomy Surgery in Patients With Wegener Granulomatosis

To determine surgical outcomes after external dacryocystorhinostomy (DCR) surgery in patients with Wegener granulomatosis (WG). The authors retrospectively reviewed the charts of consecutive patients with WG who underwent primary or secondary external DCR surgery between January 2001 and January 2010. Clinical data reviewed included patient demographics, systemic disease involvement and immunosuppression therapy, intraoperative biopsy findings, and postoperative outcomes and complications. Success was defined as resolution of epiphora. Sixteen primary external DCRs were performed on 9 patients with WG, and 2 secondary external DCRs were performed on 2 patients. At the time of surgery, all patients with WG were on systemic immunosuppressive agents including methotrexate, rapamycin, sirolimus, tacrolimus, azathioprine, cyclophosphamide, rituximab, and prednisone, and no patients received increased corticosteroids after surgery. Intraoperative biopsy in patients with WG revealed chronic inflammation (4 patients) and fibrosis (1 patient). Silicone stents were removed at an average of 5.8 months (range, 3-12 months). All surgeries were successful in resolving epiphora with an average follow up of 3.5 years (range, 10 months-6 years) and no complications. Primary and secondary external DCR surgery successfully treats nasolacrimal duct obstruction in patients with WG on systemic immunosuppression.