A PROSPECTIVE STUDY ON MODIFIED APPROACH TO CLASSICAL DACRYOCYSTORHINOSTOMY

Authors

  • NIKUNJ AMIN Department of Ophthalmology, C.U. Shah Medical College and Hospital, Surendranagar, Gujarat, India.
  • KISHAN MAKWANA Department of Ophthalmology, C.U. Shah Medical College and Hospital, Surendranagar, Gujarat, India.
  • ARUNA GUPTA Department of Ophthalmology, C.U. Shah Medical College and Hospital, Surendranagar, Gujarat, India.

DOI:

https://doi.org/10.22159/ajpcr.2022.v15i12.46176

Keywords:

Dacryocystorhinostomy, Epistaxis, Intraoperative hemorrhage, Nasolacrimal duct

Abstract

Aim and Objective: The present study was done with an aim to present the outcome of the modified technique of external dacryocystorhinostomy (DCR) with anterior flap anastomosis with the excision of posterior flaps.

Methods: Present prospective and observational study was carried out at C.U. Shah Medical College after taking permission from the ethical committee at C.U. Shah Medical College. A total of 100 participants were included in the study. All surgeries were performed by the same surgeon. All routine investigations including thorough rhinological checkup were carried out before DCR surgery. Patients were followed up for period of 1 year. Patency of lacrimal sac was considered as a successful result.

Results: Review of complications demonstrates that only four cases had intraoperative hemorrhage more than 100cc, while 96 experienced less hemorrhage. Two patients had early post-operative hemorrhage in the form of epistaxis which stopped without need for nasal repacking. Another two patients had orbital hemorrhage without seriously elevating the intraocular pressure. There was no case of orbital emphysema, cerebrospinal fluid leakage, or wound sepsis in our study. Six patients had post-operative epiphora in varying degrees.

Conclusion: Although it is simpler and easier to master the surgical technique, anterior single flap DCR shows a success rate comparable to that obtained by the more complex conventional DCR.

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References

Tanenbaum M, McCord CD. The lacrimal drainage system. In: Tasman W, Jaeger EA, editors. Duane’s Clinical Ophthalmology. Vol. 4. Philadelphia PA: Lippincott Williams & Wilkins; 2001. p. 1-34.

Hirschbein MJ, Stasior GO. Lacrimal system. In: Chen WP, editor. Oculoplastic Surgery: The Essentials. 1st ed. New York: Thieme Medical Publishers; 2001. p. 263-88.

Older JJ. Routine use of a silicone stent in a dacryocystorhinostomy. Ophthalmic Surg 1982;13:911-5. doi: 10.3928/1542-8877-19821101-04, PMID 7155512

Elwan S. A randomized study comparing DCR with and without excision of the posterior mucosal flap of the posterior mucosal flap. Orbit 2003;22:7-13. doi: 10.1076/orbi.22.1.7.14011, PMID 12759862

Yu HH, Deng JY, Zheng XN, Lu L, Zeng D. Comparative study of silicone reverse intubation versus dacryocystorhinostomy for nasolacrimal drainage obstruction. Int J Ophthalmol 2007;7:1456-7.

Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology 2005;112:1463-8. doi: 10.1016/j.ophtha.2005.03.015, PMID 15953636

Gonnering RS, Lyon DB, Fisher JC. Endoscopic laser-assisted lacrimal surgery. Am J Ophthalmol 1991;111:152-7. doi: 10.1016/s0002- 9394(14)72252-4, PMID 1899536

Baldeschi L, Nardi M, Hintschich CR, Koornneef L. Anterior suspended flaps: A modified approach for external dacryocystorhinostomy. Br J Ophthalmol 1998;82:790-2. doi: 10.1136/bjo.82.7.790, PMID 9924373

Behnawi KH, Ali NA, Al Sirhy EY, Elias NR. Anterior single flap external dacryocystorhinostomy outcome in 200 Sudanese patients. Int J Ophthalmol 2009;2:162-4.

Dubey A, Jain S, Chandra VL, Tirky ER, Jain SC. A comparative study of single flap versus double flap external dacryocystorhinostomy. Natl J Dent Res 2014;3:8-13.

Hurwitz JJ, Rutherford S. Computerized survey of lacrimal surgery patients. Ophthalmology 1986;93:14-9. doi: 10.1016/s0161- 6420(86)33779-5, PMID 3951812

Becker BB. Tricompartment model of the lacrimal pump mechanism. Ophthalmology 1992;99:1139-45. doi: 10.1016/s0161-6420(92)31839-1, PMID 1495795

Halle M. Zur intranasalen operation am tranensack. Arch Laryngol Rhinol 1914;28:256-66.

Ohm J. Bericht über 70 totische operazionen. Z Augenheilkd 1921;46:37-45.

Dupuy-Dutemps L, Bourguet M. Procede plastique de dacryocystorhinostomie et ses results. Ann Ocul 1921;158:241-61.

Summerskill WH. Dacryocystorhinostomy by intubation. Br J Ophthalmol 1952;36:240-4. doi: 10.1136/bjo.36.5.240, PMID 14925294

West J. Eine neue method zur operation des tranensaches von der nase aus. Arch Laryngol Rhinol 1911;24:62-4.

Rice DH. Endoscopic intranasal dacryocystorhinostomy results in four patients. Arch Otolaryngol Head Neck Surg 1990;116:1061. doi: 10.1001/archotol.1990.01870090077012, PMID 2383391

Steadman MG. Transnasal dacryocystorhinostomy. Otolaryngol Clin North Am 1985;18:107-11. doi: 10.1016/S0030-6665(20)31898-3, PMID 3991199

Jokinen K, Karjä J. Endonasal dacryocystorhinostomy. Arch Otolaryngol 1974;100:41-4. doi: 10.1001/archotol.1974.00780040045009, PMID 4842611

Massaro BM, Gonnering RS, Harris GJ. Endonasal laser dacryocystorhinostomy-a new approach to nasolacrimal ducts obstruction. Arch Ophthalmol 1990;108:1172-6. doi: 10.1001/ archopht.1990.01070100128048, PMID 2383207

Singh DS, Garg RS. Polyethylene intubation of the naso lacrimal duct in chronic dacryocystitis. Br J Ophthalmol 1972;56:914-18. doi: 10.1136/ bjo.56.12.914, PMID 4651985

Von Below H, Rose GE. Adult nasolacrimal duct bypass tubes: Where do they go? Br J Ophthalmol 1993;77:449-50. doi: 10.1136/ bjo.77.7.449, PMID 8343476

Rizzo S, Baldeschi L, Frezzotti P, Torrazza C, Nardi M, Rose GE. A case of a late complication after naso lacrimal duct intubation. Eye (Lond) 1995;9:801-2. doi: 10.1038/eye.1995.199, PMID 8849554

Harris GJ, Sakol PJ, Beatty RL. Relaxed skin tension line incision for dacryocystorhinostomy. Am J Ophthalmol 1989;108:742-3. doi: 10.1016/0002-9394(89)90881-7, PMID 2596564

Mat E, Okumus S, Zorlu F, Kocluk Y, Sozen T. Comparison of the results in external dacryocystorhinostomy with single flap and double flap techniques. Gaziantep Med J 2013;19:40-2. doi: 10.5455/GMJ-30- 2012-106

Dolman PJ. Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy. Ophthalmology 2003;110:78-84. doi: 10.1016/s0161-6420(02)01452-5, PMID 12511350

Hornblass A. Oculoplastic, Orbital and Reconstructive Surgery. Vol. 2. Baltimore: Lippincott Williams and Wilkins; 1990.

Published

07-12-2022

How to Cite

AMIN, N., K. MAKWANA, and A. GUPTA. “A PROSPECTIVE STUDY ON MODIFIED APPROACH TO CLASSICAL DACRYOCYSTORHINOSTOMY”. Asian Journal of Pharmaceutical and Clinical Research, vol. 15, no. 12, Dec. 2022, pp. 58-60, doi:10.22159/ajpcr.2022.v15i12.46176.

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