Re-establishing Lacrimal drainage by Canaliculorhinostomy, after dacryocystectomy - A viable option in symptomatic patients

Purpose

To evaluate the outcome and efficacy of a modified technique of canaliculo-dacryocystorhinostomy (canaliculoDCR) in the complete absence of lacrimal sac, as a means to re-establish lacrimal drainage in post dacryocystectomy(DCT) patients.

Methods

A retrospective, non-randomised interventional study including 15 proven and established post DCT patients with intact canaliculi of at least 7- 8mm. The patients presented with bothersome tearing to the Oculoplasty clinic from January 2017 to January 2018. Patients were operated by a single surgeon (ST). Procedure involved creating a bony ostium of optimum size, internal membranectomy and the nasal mucosal flap anchored appropriately to create a passage in line with the common canaliculus(CC). Adjunctively bicanalicular intubation and mitomycin- C (MMC) were used.

Results

Of the 15 patients who were operated,10 females and 5 males, 14 (93.33%) had functionally and anatomically patent lacrimal passage after the modified canaliculoDCR, 1 (6.66%) was symptomatically better with partial regurgitation of clear fluid. 3(20%) had tube prolapse after first month post operatively, which although significant, was not related to the technique. They were repositioned as an office procedure and retained thereafter till removal, no other tube related or MMC related sequelae was seen. No intra operative complication was encountered.

Conclusion

With a success rate of 93.33% and a resultant patent lacrimal tear drainage passage and trivial complication such as tube prolapse, we can conclude, this technique of modified canaliculoDCR in post DCT patients is a safe and effective procedure with promising results, thereby avoiding cumbersome methods and maintenance of Jones tube while at the same time providing symptomatic relief to the patients.

Severe focal stromal degeneration up to Descemet membrane after corneal collagen cross-linking

Corneal collagen cross-linking (CXL) is an effective treatment for arresting progression in keratoconus cases. It is considered safe despite a few complications that have been recorded earlier. In this case series, we report a rare and late complication caused due to severe stromal thinning up to Descemet's membrane in three patients who underwent CXL 3 to 6 years back for keratoconus. Deep anterior lamellar keratoplasty (DALK) was then done for the affected eye with good outcomes. This case series highlights the possible late effects of UVA irradiation post CXL.