Success Rate Of Endoscopic Dacryocystorhinostomy Research Articles

Endoscopic Dacryocystorhinostomy: A Comprehensive Review of Surgical Techniques and Clinical Outcomes.

Dacryocystorhinostomy (DCR) stands as an essential surgical procedure for addressing the persistent challenge of dacryocystitis-a condition marked by inflammation of the lacrimal sac due to nasolacrimal duct obstruction. A hospital-based retrospective study was conducted in a tertiary care hospital, spanning the years 2018 to 2023, involving 34 patients who underwent Endoscopic Dacryocystorhinostomy. The study involved the examination of their clinical presentations, surgical techniques employed, and resulting outcomes along with causes of failure. Our study included 34 patients who had presented with persistent watering of eyes. The maximum number of cases was in the age group of 46-60 years (38%), with a minimum age of 7 years and a maximum age of 68 years. Among those 34 patients, 5 underwent a revision DCR. Fifteen patients underwent stenting. Thirteen of the fifteen patients, who underwent stenting came for regular postoperative follow up and stent removal was done 6 to 8 weeks later. The two patients who were lost to follow-up presented after 4 years of their initial surgery with persistent symptoms. The success rate of endoscopic DCR was 94% in our study. Endoscopic Dacryocystorhinostomy has emerged as a practical solution for addressing nasolacrimal duct obstruction. Despite numerous surgical modifications documented over time, the endoscopic DCR technique consistently demonstrates excellent outcomes with minimal patient morbidity. This study underscores the significance of thorough preoperative assessment, making informed decisions regarding stenting during both the preoperative and intraoperative period, employing proper surgical techniques, and recognizing the importance of regular post-operative follow-up.

Effects of Topical Anti-Glaucoma Medications on Outcomes of Endoscopic Dacryocystorhinostomy: Comparison with Age- and Sex-Matched Controls.

This study analyzed the effects of topical anti-glaucoma medications on the surgical outcomes of endoscopic dacryocystorhinostomy (EDCR) in nasolacrimal duct obstruction (NLDO). This retrospective study included patients who underwent EDCR for NLDO between September 2012 and April 2021. Thirty patients with topical anti-glaucoma medications and 90 age- and sex-matched controls were included. The success rate of EDCR was higher in the control group than in the anti-glaucoma group (97.8% vs. 86.7%, p = 0.034). Univariate and multivariate logistic regression analyses identified prostaglandin analogs as the most influential risk factor for EDCR success among anti-glaucoma medication ingredients (p = 0.005). The success rate of the group containing all four anti-glaucoma medication ingredients was statistically significant (p = 0.010). The success rate was significantly different in the group of patients who used anti-glaucoma medication for >24 months (p = 0.019). When multiplying the number of drug ingredients by the duration in months, the group > 69 showed a significantly decreased success rate (p = 0.022). Multivariate logistic regression analysis identified the number of anti-glaucoma medications as the most significant risk factor for EDCR success (odds ratio, 0.437; 95% confidence interval, 0.247 to 0.772; p = 0.004). The authors suggest that the anti-glaucoma medications might cause NLDO and increase the failure rate after EDCR. Therefore, when performing EDCR in patients using topical anti-glaucoma medications, surgeons should consider the possibility of increased recurrence after EDCR in clinical outcomes.

Cost-effectiveness analysis of endoscopic dacryocystorhinostomy using Markov modelling

ObjectifDéterminer le rapport coût-efficacité de la dacryocystorhinostomie (DCR) endoscopique. MéthodesNous avons mis au point un modèle de Markov selon lequel des patients qui présentaient une obstruction du canal nasolacrymal ont été répartis en 2 groupes : DCR endoscopique ou absence de traitement chirurgical. Le rapport coût-efficacité différentiel, l'analyse de sensibilité à un critère et l'analyse de sensibilité probabiliste ont permis d’évaluer la sensibilité du modèle en présence de multiples intrants. RésultatsOn a pu conclure que la DCR endoscopique était rentable, son coût-efficacité différentiel s’établissant à 2162 $US par année de vie ajustée en fonction de la qualité. Le modèle s'est révélé particulièrement sensible à la déduction de l'utilité au chapitre de la santé en lien avec l’épiphora. L'analyse de sensibilité probabiliste a permis de conclure que 93,7 % du temps, la DCR endoscopique offre un bon rapport coût-efficacité comparativement à l'absence de traitement chirurgical. ConclusionsLa DCR endoscopique est un traitement rentable en présence d’épiphora. Le modèle est très sensible à l'effet négatif de l’épiphora sur la qualité de vie. Compte tenu des progrès technologiques et chirurgicaux en matière de soins de santé, les taux de réussite de la DCR endoscopique continuent de s'améliorer, ce qui en fait un traitement encore plus efficace et économique de l'obstruction du canal nasolacrymal.

Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses.

To evaluate the outcome of endoscopic dacryocystorhinostomy (En-DCR) with mucosal anastomosis in chronic dacryocystitis patients, with various categories of ethmoid sinuses. Between July 2015 and September 2019, 1439 adult patients, representing 1623 affected eyes, presented with chronic dacryocystitis and were scheduled for En-DCR. The categories of ethmoid sinuses were preoperatively determined, using computed tomography-dacryocystography (CT-DCG), and were classified as category 1 (C1), category 2 (C2), and category 3 (C3). No sinuses anterior to the posterior lacrimal crest defined as C1. Sinuses found between the anterior edge of the lacrimal bone and the posterior lacrimal crest defined as C2. Sinuses found anterior to the lacrimal bone suture defined as C3. At the end of surgery, the dacryocyst and nasal mucosa were anastomosed in C1, and the dacryocyst mucosa and anterior ethmoid sinus were anastomosed in C2 and C3 ethmoid sinus patients. The surgical success rate and related complications, in patients with 3 categories of ethmoid cells, were monitored and documented. Postoperative data was obtained for 179 C1 affected eyes, 878 C2 affected eyes, and 432 C3 affected eyes. The overall success rate of En-DCR was 93.0% (1385/1489). Additionally, the success rates were comparable among the different ethmoid categories at 12mo post operation. We demonstrated that the major reason for surgical failure was intranasal ostial closure, due to granulation or scar tissue. En-DCR is a feasible and highly effective primary treatment for chronic dacryocystitis. To ensure surgical success, the surgery protocol must be designed in accordance with the category of ethmoid sinuses present in individual patient.

Clinical study on the success rate of endoscopic dacryocystorhinostomy

Background: Endoscopic dacryocystorhinostomy (DCR) has advantages like excellent homeostasis, absence of scar, less post operative pain and edema. However, less literature is available on success rate. Aim and objectives: To evaluate the success rate of endoscopic DCR. After 3 months DCR success rate was estimated based on relief perceived by the patient, free flow of saline on syringing through the lower canaliculus and presence of patent stoma visualized on rigid endoscopy. Materials and methods: 25 Epiphora patients underwent anterior rhinoscopy, nasal endoscopy, syringing, CT scan and DCR. They were evaluated for the relief of symptoms at 2 week and 3 month respectively. Results: Mostly 76% females with mean age (females:54.4/Males:59) were present. Symptoms: watering of eyes (100%), swelling (92%) and mucopurulent discharge (68%). Disease on the right side- 40% and left side -56% only 4% were with bilateral disease. On follow up after 3months 96% patients reported symptomatic relief of complaints and 4% had granulations at the neoostium and synechiae between nasal and lacrimal mucosa which were removed and subsequent relief of symptoms and free flow of saline on syringing were seen. Conclusion: Endoscopic DCR is a safe, minimally invasive, surgical procedure with 96% functional success rate.

Evaluation of the efficacy of postoperative triamcinolone in endoscopic dacryocystorhinostomy using lacrimal symptom questionnaire.

To evaluate the effect of postoperative nasal triamcinolone spray use in primary endoscopic dacryocystorhinostomy using The Lacrimal Symptom Questionnaire. This study included a series of 50 consecutive retrospective cases with primary endoscopic dacryocystorhinostomy and with silicone stent implantation who were followed up for 6months postoperatively. Patients using nasal triamcinolone spray for 3months postoperatively were included in the triamcinolone group. Patients not using triamcinolone were included in the control group. Lacrimal stents were removed 3months postoperatively. The Lacrimal Symptom Questionnaire (Lac-Q) was performed in the preoperative and postoperative 6th month. Anatomical success, functional success, and changes in lacrimal symptom and social impact scores were compared between the two groups 6months after surgery. Results of 48 endoscopic dacryocystorhinostomies performed on 48 patients (23 triamcinolone group, 25 control group) meeting the inclusion criteria were analyzed. The anatomical success rate (95.7% vs. 84.0%, p = 0.350) and the functional success rate (91.3% vs. 76.0%, p = 0.249) were higher in the triamcinolone group, but this difference was not statistically significant. No complications were observed in the triamcinolone group, whereas complications developed in two patients in the control group (p = 0.490). The mean change in total lac-Q score was 11.0 in the triamcinolone group and 9.0 in the control group (p = 0.011). The mean change in social impact score was 4.0 in the triamcinolone group and 3.0 in the control group (p = 0.005). Mean change in lacrimal symptom score was 6.0 in the triamcinolone group and 6.0 in the control group (p = 0.368) CONCLUSIONS: Our study indicated that postoperative use of triamcinolone spray increases the success rate of endoscopic dacryocystorhinostomy and also revealed that triamcinolone may also lead to greater improvement in quality of life scores than the control group using a validated questionnaire.

Possibility of Pseudo-Obstruction in Lacrimal Canalicular Obstruction Diagnosed with Dacryocystography

Introduction: Endoscopic dacryocystorhinostomy (DCR) is the treatment of choice for patients with lacrimal drainage system obstruction. Dacryocystography (DCG) is one of the most common preoperative studies and considered as a useful test demonstrating the anatomy of lacrimal drainage systems. Objective: This study was designed to evaluate the diagnostic efficacy of DCG for canalicular obstruction and to compare surgical outcomes between true-obstruction versus pseudo-obstruction diagnosed with DCG. Methods: A retrospective study was performed on 45 consecutive patients with lacrimal canalicular obstruction who had underwent endoscopic DCR with silicone tube insertion from January 2009 to December 2014 at a single tertiary hospital. A review of medical records included demographic data, preoperative symptoms and signs, results of intraoperative canalicular probing, and surgical outcomes including the postoperative symptom improvement and endoscopic finding. Results: Of 45 patients, 34 patients (75.6%) had true-canalicular obstructions and 11 patients (24.4%) had pseudo-canalicular obstructions. The success rate of endoscopic DCR was 50% (17 of 34) in cases with true-canalicular obstruction while 90.9% (10 of 11) in pseudo-canalicular obstruction (p value <0.05). No intraoperative or postoperative complications including sinusitis or synechia were found. Conclusions: About a quarter of lacrimal canalicular obstruction cases diagnosed with DCG seem to be pseudo-obstruction. The success rate of endoscopic DCR in pseudo-canalicular obstruction is similar to that of saccal and nasolacrimal ductal obstruction.

English

BACKGROUND Dacryocystorhinostomy (DCR) operation is the gold standard treatment for management of chronic dacryocystitis due to nasolacrimal duct block. This operation directs the lacrimal flow into the nasal cavity creating an artificial opening made at the level of lacrimal bone, thus obtaining a low-pressure lacrimal bypass system which will relieve epiphora and dacryocystitis. But the commonest reason for failure of this surgery is closure of the rhinostomy (neo-ostium). To overcome this difficulty, silicone tube catheter stent insertion has been advocated. Here in this study, we wanted to compare the success rate of endoscopic DCR with or without silicone tube catheter (STC) stent. METHODS This study was a prospective study conducted among 50 patients divided in to two equal groups randomly. One group underwent Endoscopic DCR with silicone tube catheter stent and another group underwent DCR without stent. We compared outcomes of both groups subjectively with five-point scale and objectively examined patency of the stoma by syringing with water postoperatively after 3 months and results were compared. RESULTS During subjective evaluation, we used five-point scales to get the grade of epiphora relief. First three grades (grade 1 to grade 3) were considered as success. We got an overall success rate of 92 % in without stent group and we got 88 % success rate in silicone tube catheter stent group. CONCLUSIONS Surgical success for Endoscopic DCR surgery encompassed both anatomical patency and symptom relief. We found overall success rate of 92 % in without stent group and 88 % success rate in silicone tube catheter stent group which were closely comparable to other studies. We also found failure due to granulation tissue formation in STC stent group. So the role of stent is yet to be confirmed and further large scale trials are needed. KEYWORDS Endoscopic DCR, Silicone Tube Catheter (STC) Stent

A Prospective Longitudinal Study to Evaluate the Outcomes of Success of Endoscopic DCR in Pediatric Age Group.

Children with nasolacrimal duct obstruction (NLDO) have different therapeutic approach from that used in adults. Dacryocystorhinostomy (DCR) is the most common procedure in adults but it is less frequently carried out in children, indicated in children which are refractory to probing. The objective of the study is to report a series of 30 cases of paediatric epiphora who underwent endoscopic endonasal dacryocystorhinostomy surgery, for primary obstruction of nasolacrimal duct and results, outcomes of success are evaluated. This is a prospective and non-comparative review of 30 cases of epiphora aged between 3 and 9years from April 2018 to March 2019. The main outcome measures assessed were determined by the resolution of symptoms and the patency of the lacrimal anatomy confirmed by syringing or irrigating the nasolacrimal duct. Secondary outcomes included the presence of such complications as bleeding, scarring, and/or persistent epiphora and infection. In our study 30 patients underwent unilateral DCR surgery in NLDO. Out of 30 patients males were 17 and females were 13. The overall success rate of endoscopic DCR was 90%, and failed cases were mainly due to pre-saccal obstruction. No major complications were reported, minor complications occurred in about 60% of cases. Analysis of the results indicated that EDCR was safe and an effective therapeutic approach for treating nasolacrimal duct obstruction in pediatric age group patients having NLDO. It's considered as an alternative procedure to external dacryocystorhinostomy after a failed conservative treatment.

Role of silicone stenting in endoscopic dacryocystorhinostomy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Dacryocystorhinostomy (DCR) is a surgical procedure performed to relief nasolacrimal duct obstruction, which involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. Closure of the rhinostomy opening was considered a major factor for surgical failure. Use of silicone stent in endoscopic DCR to improve the success rate of the operation have been tried by many surgeons. In this study we assess the success rates of endoscopic DCR with and without silicone stents.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study includes 30 patients were operated in the Department of ENT, Misrata Medical Center, from April 2017 to March 2018. They underwent endonasal endoscopic DCR for primary acquired nasolacrimal duct obstruction.&lt;strong&gt; &lt;/strong&gt;These patients were randomly divided in two groups: A and B with 15 patients in each group. The group A patients underwent endoscopic DCR with silicone stent and group B patients underwent endoscopic DCR without stent. The results were statistically analyzed by chi-square test. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 30 patients were included in this study, their age ranged from 17 to 60 years, complaining of epiphora, 24 (80%) were females and 6 (20%) were males. The success rate was higher in patients with silicone stent (93.33%) as compared to patients without silicone stent (86.67%) but this difference in the results is not statistically significant (As p value is 0.542 which is &amp;gt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopic DCR is safe, successful procedure for treatment of nasolacrimal duct obstruction and there was no significant difference in the success rates of performing endonasal DCR with silicone or without silicone stents.&lt;/p&gt;

Endoscopic Dacryocystorhinostomy: Advantage over External Approach

Introduction &#x0D; Although external DCR was considered to be the Gold Standard treatment for NLD obstruction, endoscopic DCR appears to give comparable results, with the advantage of the absence of external facial scar and no disruption of the medial palpebral ligament or the angular facial vessels. This study aims to evaluate the outcome of endoscopic dacryocystorhinostomy (DCR) and compare with the outcome of external DCR, based on data available on literature search.&#x0D; Materials and Methods &#x0D; In this prospective, longitudinal, interventional study, 67 cases of chronic dacryocystitis were operated endoscopically from January 2017 to December 2018. All patients were documented about detailed medical and operative history, thorough medical check up including ocular and ENT examination. Level of obstruction of nasolacrimal duct (NLD) was diagnosed by lacrimal syringing and probing.&#x0D; Surgery was performed under local anaesthesia except in uncooperative patients where general anaesthesia was used. 0˚ &amp; 30˚ endoscopes were used in surgery. The surgical outcomes and complications were recorded, analyzed and compared to those of external DCR from available literature. &#x0D; Results &#x0D; The overall success rate of endoscopic DCR was 94.7%, which is closely comparable to external DCR.&#x0D; Conclusion &#x0D; Endoscopic DCR is an effective and safe alternative to external DCR, with comparable results and better patient satisfaction.

Efficacy of mitomycin c in endoscopic dacryocystorhinostomy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Endoscopic dacryocystorhinostomy is a procedure done to drain the lacrimal sac due to post saccular lacrimal obstruction. The most common cause of failure of dacryocystorhinostomy is blockage of ostium created in lacrimal sac. Various methods are employed to prevent the blockage such as stenting, mitomycin C and steroidal nasal sprays. In this study we evaluated the efficacy of mitomycin C in reducing the stomal closure following dacryocystorhinostomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Fifty patients who were diagnosed with chronic dacryocystitis due to nasolacrimal duct obstruction were chosen for the study. They were randomly divided in to two groups. In group I 25 patients under went endoscopic dacryocystorhinostomy with intraoperative mitomycin C application and in group II 25 patients underwent endoscopic dacryocystorhinostomy without application of mitomycin C. Patients were followed up at the end of one week, three weeks, three months and six months. Surgical success was evaluated objectively at the end of six months. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The success rate of endoscopic dacryocystorhinostomy with use of mitomycin c was 86% in group where mitomycin c was used and 62% in group where mitomycin c was not used.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Mitomycin C is a safe drug which can keep the stoma created patent and reduces the chance of recurrence following endoscopic dacryocystorhinostomy.&lt;/p&gt;

Does long-term success from endoscopic DCR correlate with early post-operative reduction in tearing?

PurposeThe purpose of the study was to determine the association between early post-operative improvement in tearing and the long-term success rate of endoscopic dacryocystorhinostomy (eDCR). MethodsA retrospective review of consecutive patients who underwent eDCR and were followed up for at least 6 months at our institution from January 2010 to December 2017 was performed. Results47 cases(39 patients) of eDCR met the inclusion and exclusion criteria during this time period.Mean follow up after the surgery was 12.5 ± 8 months. In 45 out of 47 (96%) cases post-operative improvement in epiphora within 2 weeks of surgery, or lack thereof, correlated with long-term success or failure of the procedure.There were only 2 cases in which the patients felt improvement in tearing at the initial post-operative visit and the tearing recurred in the late post-operative period (>6 months). ConclusionsThere is a strong association between the early initial post-operative assessment of tearing resolution and the long-term result of eDCR.

A Systematic Review of Benefit of Silicone Intubation in Endoscopic Dacryocystorhinostomy.

ObjectivesInsertion of a silicone stent during endoscopic dacryocystorhinostomy (DCR) is the most common procedure to prevent rhinostomy closure. It has been claimed that silicone intubation improves the surgical outcomes of endoscopic DCR. However, many reports have documented an equally high success rate for surgery without silicone intubation. Accordingly, we conducted a systematic review and meta-analysis to clarify the outcomes of endoscopic DCR with and without silicone intubation and determine whether silicone intubation is actually beneficial for patients.MethodsPubMed, Embase, and Cochrane Library databases were searched to identify relevant controlled trials evaluating endoscopic DCR with and without silicone intubation. The search was restricted to English articles published between January 2007 and December 2016. Relevant articles were reviewed to obtain information pertaining to interventions and outcomes. We also performed a meta-analysis of the relevant literature.ResultsIn total, 1,216 patients included in 12 randomized controlled trials were pooled. A total of 1,239 endoscopic DCR procedures were performed, and silicone stents were used in 533 procedures. The overall success rate for endoscopic DCR was 91.9% (1,139/1,239), while the success rates with and without silicone intubation were 92.9% (495/533) and 91.2% (644/706), respectively. There was no statistically significant heterogeneity among the included studies. A meta-analysis using a fixed-effects models showed no significant difference in the success rate between endoscopic DCR with silicone intubation and that without silicone intubation (OR, 1.38; 95% CI, 0.89 to 2.12; P=0.148; z=1.45). Furthermore, there were no significant differences with regard to surgical complications such as synechia, granulation, and postoperative bleeding.ConclusionThe findings of our meta-analysis suggest that the success rate and postoperative complication rate for endoscopic DCR is not influenced by the use of silicone intubation during the procedure.

A comparative study of the results of endoscopic dacryocystorhinostomy with and without stent placement

Background: Nasolacrimal duct (NLD) obstruction is a common clinical entity encountered both by ophthalmologists as well as otorhinolaryngologists. Endoscopic dacryocystorhinostomy (DCR) has emerged as a gold standard surgery for treatment of this disorder. Silicone stents are often promoted as agents to maintain patency of surgically created fistula during postoperative period in this surgery. Aim: The aim of this study is to evaluate and compare the outcomes of endoscopic DCR with and without silicone stenting. Materials and Methods: A prospective observational study was conducted. Totally 50 patients with acquired NLD obstruction were enrolled in the study and were randomly assigned to two groups: Group I underwent the surgery with silicone stent placement while the Group II underwent the surgery without stent placement. The patients were evaluated in terms of relief of symptoms and postoperative complications. Results: The overall success rate for endoscopic DCR in this study was 90% which is comparable with the reports in the literature. Success rate for patients with placement of stent was 92% and without stenting was 88%. However, there was no significant statistical difference between the two groups. Conclusion: Use of silicone stents does not influence results of Endoscopic DCR.

Clinicopathological Study of Lacrimal Sac Dacryolith in Patients Treated for Nasolacrimal Duct Obstruction

Purpose: To evaluate the correlation between clinical manifestation of patients with nasolacrimal duct obstruction and pathological characteristics of lacrimal sac and dacryolith found during endoscopic dacryocystorhinostomy. Methods: This retrospective study included 158 patients (189 eyes) who received endoscopic dacryocystorhinostomy. We defined lacrimal dacryolith by gross discovery in the lacrimal sac during surgery or findings during pathological examination as dacryolith or calcification, including size and distribution in pathology slides. We correlated the relationship between the patients’ clinical manifestations, surgical results, lacrimal sac's pathological findings including calcification, inflammation and fibrosis, and pathological findings of lacrimal sac dacryolith. Results: Dacryolith was found in 61 eyes (32.3%) and among them, grossly found in 13 eyes (6.9%). Dacryolith's filling defect on dacryocystography was found in 17 eyes (9.0%) and based on grossly found dacryolith, dacryocystography's sensitivity and specificity were 58.8% and 1.7%, respectively. The average size of dacryolith was 0.3 ± 0.8 mm with an average distribution of 20.1 ± 17.9%. Distribution of dacryolith and the proportions of inflammatory cells and fibrosis in the lacrimal sac were negatively correlated (p < 0.05). The size of dacryolith and the proportions of fibrosis in the lacrimal sac were also negatively correlated (p = 0.008). In cases where the proportion of calcification in pathology slides was over 50%, the duration of symptoms in the calcification-dominant group was shorter than in other groups (p = 0.006). The success rates of endoscopic dacryocystorhinostomy with dacryolith and without dacryolith were 91.8% and 80.5%, respectively (p = 0.046). Conclusions: The patients with lacrimal sac dacryolith in nasolacrimal duct obstruction showed shorter duration of symptoms, lower fibrosis of lacrimal sac, and higher surgical success rates than the other cases. Therefore, additional research may be necessary to determine the mechanism of dacryolith formation and early treatment in nasolacrimal duct obstruction with lacrimal sac dacryolith. J Korean Ophthalmol Soc 2016;57(1):6-13

Successful Endoscopic Dacryocystorhinostomy: What Factors Make Revision Surgery More Likely?

Objectives: Endoscopic dacryocystorhinostomy (DCR) is indicated for treatment of nasolacrimal duct obstruction, which manifests as a watery eye. Endoscopic techniques have gained popularity in recent years compared to open DCR, which leaves a facial scar. Success rates have been reported to be between 65-95%. We report the success rate of endoscopic DCR at our institution and analyze factors leading to revision surgery. Methods: This is a retrospective analysis of endoscopic DCR performed at a district general hospital between August 2010 and December 2013. We perform this as a day case procedure using a DCR burr and leave silastic stents in situ. We do not routinely use anti-mitotic agents. We collected and analyzed demographic data (age, co-morbidity, medications), technical notes, rate of symptom resolution at follow-up, and need for revision surgery. Results: A total of 33 endoscopic DCRs were performed in this time period. The overall success rate (satisfactory resolution of symptoms at minimum 3 months follow up) was 76%. Rate of revision surgery was 15%. In 50% of cases scar tissue obstructing the DCR opening was the cause of surgical failure. Previous surgery (external DCR/punctoplasty) was not associated with a higher rate of endoscopic DCR failure ( P = .616). Conclusions: Endoscopic DCR is a safe technique for treating nasolacrimal duct obstruction with local success rates of 76%. A common reason for failure is scar tissue obstructing the rhinostomy opening and greater attention is being given to surgical techniques that maintain wide patency of the opening, as this may reduce rates of failure.

Comparative Study of Endonasal Endoscopic Dacryorhinostomy with or without Intraoperative Mitomycin C

ABSTRACT Objective Endoscopic dacryocystorhinostomy (DCR) has known advantages over external DCR as a less invasive method without the need of any skin incision. Mitomycin C (MMC), a wound healing inhibitor, was used intraoperatively with the objective of reducing incidence of adhesion and synechiae formation as a postoperative complication leading to failure of the procedure. Materials and methods Endoscopic DCR was performed in 60 patients. MMC (0.5 mg/dl for 5 minutes) was applied to the ostium in 30 patients in comparison with control group. Results The postoperative follow-up was done at 1, 3 weeks and 3 months. The success rate of endoscopic DCR with intraoperative MMC was 90%whereas it was found to be 83.33% in control group. The statistical analysis did not show a difference between the two groups according to success rates. Conclusion Adjunctive use of a wound healing inhibitor may be considered to increase the success rate of endoscopic DCR. Its intraoperative use seems to be easy and safe. This study of limited series needs further extensive evaluation to establish the adjunctive use of MMC in endoscopic DCR in future. How to cite this article Jain NK, Vashistha S, Kaushik S. Comparative Study of Endonasal Endoscopic Dacryorhinostomy with or without Intraoperative Mitomycin C. Clin Rhinol An Int J 2013;6(2):77-79.

Improving Results in Endoscopic DCR

The aim of presenting this article is to highlight the factors causing failure in endoscopic dacryocystorhinostomy (DCR). Understanding these factors will lead to an enhancement in the success rate of endoscopic DCR. Out of 600 cases done in a period of 10years (from 1998 to 2008), 60 were revision cases. 60 patients referred over a period of 10years, were selected. The aim was to study the factors causing failure in each case. The cases included were revised in a period of 10years from 1998 to 2008. These were the cases that were unsuccessful for one or the other reason. The author presents a series of failed DCR cases referred over a period of 10years. Patients had undergone primary surgery elsewhere and were referred due to the persistence of symptoms. Assessment of all the cases was done with the examination of Eyes and lids for any obvious deformity, watering or purulent discharge in the medial canthal area. ROPLAS test was done as a spot diagnosis for NLD block. This was followed by probing and syringing in the outdoor. All the cases were revised and the likely causes leading to failure of the first surgery were analyzed. It was found that the improper selection of cases accounted for 3.3% of total failed cases; Low rhinostomy accounted for 28.3% cases, inadequate sac opening for 38.3% cases, Pre existing canaliculitis for 1.6% of cases, contracture at the rhinostomy site in 10% cases. Laser burn canalicular scarring for 3.3% of total cases and laxity of the lids and atonic sac was responsible for failure in 3.3% cases. Most of the above factors are secondary to the false localization of the sac, inadequate removal of the sac wall, too much of mucosal removal leading to synaechia formation at the surgical site and inability to detect any additional block with NLD (Nasolacrimal duct) block.

UK survey of the present role of ear, nose and throat surgeons in lacrimal surgery

The objective of this study was to evaluate the current involvement of ear, nose and throat (ENT) surgeons in lacrimal surgery. A postal survey was distributed to 796 practicing UK consultant otorhinolaryngologists listed at the drfoster website. Overall, 531 questionnaires were returned, giving a response rate of 66.7%. Of these, 108 (20.6%) respondents indicated they were involved in lacrimal surgery. The majority of otolaryngologists seem to work in collaboration with ophthalmologists. In our survey, 98% (106) perform endoscopic dacryocystorhinostomy (DCR). Most respondents believed lacrimal intubation and dilation to have limited success, endoscopic DCR to have moderate success and external DCR to have high success. Lacrimal surgery is carried out in a spirit of collaboration with ophthalmologists rather than competition. Endoscopic DCR is the favoured surgical procedure of otolaryngologists. The perceived success rate for endoscopic DCR reported in this survey coincides with that reported in the literature.