Technique Of External Dacryocystorhinostomy Research Articles

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.

Transconjunctival Dacryocystorhinostomy: Scarless Surgery Without Endoscope and Laser Assistance

To evaluate the efficacy of a novel external dacryocystorhinostomy technique with transconjunctival approach to avoid facial scarring without the use of endoscope and/or laser. In this prospective interventional case series, 25 eyes of 22 patients with epiphora due to primary nasolacrimal duct obstruction were included. Lower eyelid conjunctival inferomedial vestibular incision was used to access the lacrimal sac and nasal mucosa. Bone apertures were created with burr and rongeurs, and saccal and nasal flaps were anastomosed. Bicanalicular silicone intubation was done. Conjunctival wound edges were apposed and left unsutured. Intraoperative difficulties and complications are noted. Patients were followed up postoperatively for an average period of 11 months. Criteria for success were relief of epiphora and patency to irrigation. In 12 (48%) eyes, the surgeries were completed without complications with the formation of both the anterior and posterior flaps. Epiphora resolved in 18 of 19 eyes (94.7%) in which transconjunctival dacryocystorhinostomy could be completed. In 7 eyes (28%), only anterior flaps could be sutured. The authors needed to convert to external dacryocystorhinostomy in 6 patients (34%) during whose surgeries the nasal mucosa could not be exposed adequately via the transconjunctival route. Epiphora and failure to irrigation started in one eye (5.3%) at the postoperative fourth month and required reoperation. No complications occurred, except granuloma formation at the conjunctival incision site in 2 eyes (10.6%) and a 1-mm-long lower eyelid margin laceration in one eye (5.3%). Epiphora resolved in the remaining 6 eyes that underwent external DCR. Transconjunctival dacryocystorhinostomy, which is performed without endoscope and/or laser assistance, has a high success rate comparable to external DCR and does not leave a visible facial scar.