Resultados de 12 años de dacriocistorrinostomía endoscópica

Surgical Outcome of Endoscopic Dacryocystorhinostomy with and Without Prolene Stent in Chronic Dacryocystitis: A Randomized Controlled Trial

Popularity of Endoscopic dacryocystorhinostomy is rising over a conventional external dacryocystorhinostomy. One of the most frequent reasons for procedure failure is the closing of neo-ostium. To compare the surgical results of endoscopic Dacryocystitis operations with and without Prolene stents in terms of procedure success rates and postoperative complications. A randomized controlled trial of 2 years was carried out including 100 patients of chronic dacryocystitis. The cases were randomly split into two groups with 50 cases each in Endoscopic DCR with stent and without stent groups. The results, both the subjective and objective were noted. At the end of 3 months, the overall success rate was 88% and 90% in group with and without stent respectively with no significant statistical difference. 12% subjects had wound infection, 8% had granulations around the rhinostoma, 6% had synechiae, 10% had discomfort from the tube in stent group. In Group B (without stent), 16% had wound infection, 4% had granulations around the rhinostoma. As Endoscopic DCR without stent has equally good results and less complications as compared to with stent, we recommend endoscopic DCR without stent. Use of Stent should be reserved for special conditions like revision cases, common canalicular block, fibrosed lacrimal sac.

Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience

INTRODUCTION

Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure.

PATIENTS AND METHODS

A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months.

RESULTS

Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ± 11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest.

CONCLUSIONS

EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

[Endoscopic dacryocystorhinostomy: role of the ophthalmologist]

OBJECTIVE

To evaluate the results of endoscopic dacryocystorhinostomy (DCR) with or without support of the ophthalmologist.

MATERIAL AND METHODS

A retrospective study of 100 cases of endoscopic DCR surgery conducted by an otolaryngologist between June 2008 and December 2009. Of the 100 cases, 50 were operated with surgical support of the ophthalmologist, who inserted Bowman probes in the upper and lower canaliculi, while in the other 50 cases it was the otolaryngologist who performed this, without support of the ophthalmologist. The evaluation of the results after 2 years included the subjective perception, the lacrimal patency after lacrimal syringing, and lacrimal functional test after modified Jones test.

RESULTS

Of the 100 DCR reviewed, more than 50% required complementary treatment by the otolaryngologist, mainly septoplasty. As for the resolution of epiphora, without support of the ophthalmologist, 75% the patients reported an overall subjective improvement, but this reached 92% in the surgical group with support of the ophthalmologist, which was a statistically significant difference.

CONCLUSIONS

Endoscopic DCR is effective in the treatment of epiphora, but its results improve when the ophthalmologist inserts the probes in the lacrimal canaliculi during the surgical procedure.