Endoscopic dacryocystorhinostomy with silicon stent: our experience

Background: Dacryocystorhinostomy is the current surgical modality of treatment preferred for patients with nasolacrimal duct obstruction. Both external and endonasal endoscopic approaches have been in practice with their own merits and demerits. Since the invention of endoscopes, endoscopic DCR is preferred for its scarless, minimally invasive technique and many modifications have been done over years like placement of silicon stents to reduce recurrence.Methods: In our study we evaluated 70 patients with epiphora with obstruction in nasolacrimal duct, Fresh cases and revision cases who had undergone either external and/ endoscopic DCR without stent were included. All patients underwent endoscopic dacryocystorhinostomy (DCR) with silicon stent placement. Patients were followed postoperatively for a period of 6 months to 3 years. Results: The results were compared with that of external DCR and endoscopic DCR without stent. In our study we found that, endoscopic DCR with silicon stent had less chances of recurrence and synechiae formation. Results at 3 years follow up have been good with 95.7% patients relieved of symptoms completely.Conclusions: Endoscopic DCR is a cost effective and a safe alternative for External DCR in patients with nasolacrimal duct obstruction. We found that endoscopic DCR with stenting had several advantages over more conventional external approach.

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Successes rate of endoscopic dacryocystorhinostomy at KMC

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i2.3557 ◽

1970 ◽

Vol 8 (2) ◽

pp. 195-198 ◽

Cited By ~ 2

Author(s):

S Shrestha ◽

PK Kafle ◽

S Pokhrel ◽

M Maharjan ◽

KC Toran

Keyword(s):

Success Rate ◽

Symptomatic Relief ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Sinus Surgery ◽

Duct Obstruction ◽

Complete Cure ◽

Endoscopic Dacryocystorhinostomy ◽

Endoscopic Dcr ◽

Sac Syringing

Background: Nasolacrimal duct obstruction is a common problem which can be corrected by dacryocystorhinostomy (DCR). The gold standard treatment for this is DCR operation through an external approach. Development of endoscopic sinus surgery and endoscopic DCR performed through intranasal route is a major recent development in this field. Objectives: The aim of this study is to find out the success rate of endoscopic dacryocystorhinostomy without silicon stent intubation within the period of six month following surgery. Materials and methods: A prospective study was done on 26 patients with obstruction of the nasolacrimal duct referred from eye out-patient department to ENT OPD during one year period from 2008 to 2009. All the cases had undergone endoscopic DCR operation which was regularly followed up for a period of six months. Postoperative patency of ostium was checked by sac syringing and endoscopic visualisation of ostium in the nasal cavity. The success of surgery was categorised as: complete cure, partial cure and no improvement depending upon symptomatic relief and clinical examination such as sac syringing and endoscopic examination following surgery. Result: In six months' follow-up, 22 (84.5%) out of 26 patients had achieved the complete cure and 4 patients (15.5%) continued to have persistent epiphora. Conclusion: Endoscopic DCR is a beneficial procedure for nasolacrimal duct obstruction with no external scar on face and less bleeding. The success rate is as good as external DCR. Key words: Nasolacrimal duct; Epiphora; Rigid nasal endoscope; Endoscopic Dacryocystorhinostomy DOI: 10.3126/kumj.v8i2.3557 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 195-198

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Trans Canalicular Diode LASER DCR with ‘Bari Device’ in Pediatric Cases

Journal of Medical Science & Research ◽

10.47648/jmsr.2018.v2902.02 ◽

2018 ◽

Vol 29 (Number 2) ◽

pp. 8-10

Author(s):

Md. B B Bhuiyan ◽

A Akber ◽

M S Islam ◽

K U Chowdhury ◽

M Choudhury

Keyword(s):

Success Rate ◽

Pediatric Patients ◽

Middle Turbinate ◽

Surgical Techniques ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

Endoscopic Dcr ◽

External Dcr

Epiphora due to Nasolacrimal duct obstruction (NLDO) is common in chidren. About 5% to 20% infants show evidence of congenital Nasolacrimal duct obstruction with symptoms 1,2. Most of them (95%) cured by conservative management. Majority of the remaining symptomatic patients are cured by probing, repeat probing, probing with incubation and Baloonplasty procedures. About 4% of the patients need surgical intervention. Conventional Dacryocystorhinostomy (DCR) is the main treatment of choice in these cases till to date. DCR means creation of an alternate pathway between lacrimal sac and nasal cavity to drain tear when nasolacrimal duct (NLD) is blocked. There are different surgical techniques available for DCR. These includes conventional or external DCR, endoscopic DCR, endoscopic Laser DCR, transcanalicular or endocanalicular Laser DCR. In adult DCR can be carried out comfortably by the conventional or newly developed endoscopic approach. Narrow space, inadequate development of anatomical landmark makes both the conventional & endoscopic DCR difficult in children. Long term success rate of External DCR in pediatric patients is less in comparison to adult due to vigorous growth of tissue in a child. Laser DCR has been tried but long term success rate is not up to the mark. Several observations like- primary osteum closure, cicatrix formation with middle turbinate and nasal septum, granulation tissue formation- all are more in children due to marked fibroblastic response. So Laser DCR is a challenge in pediatric patients.

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Endonasal endoscopic dacryocystorhinostomy in Misrata central hospital, Libya

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180692 ◽

2018 ◽

Vol 4 (2) ◽

pp. 317

Author(s):

Abdussalam M. Jahan ◽

Yousef M. Eldanfur ◽

Abdulhakim Ben Ghuzi

Keyword(s):

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Success Rates ◽

Central Hospital ◽

Endoscopic Endonasal ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy ◽

Endoscopic Dcr ◽

One Year ◽

The Right

Background: Dacryocystorhinostomy (DCR) is a surgical procedure performed for the relief of nasolacrimal duct obstruction (NLDO). This procedure involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. It can be performed externally or endoscopically. The aim of this study is to evaluate the success rates and complications of endoscopic dacryocystorhinostomy in Misurata Central Hospital. Methods: Prospective study includes 30 patients admitted to the ENT-Department, Misrata Central Hospital over a period of one year, starting from April 2016 to March 2017. They underwent endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction. Results: Thirty patients were included in the study. Their age ranged from 11-60 years, with mean age of 33 years. Most of the patients were in the age range of 31 to 50 years. There were 24 (80%) females and 6 (20%) males. The most common complaint of patients before surgery was epiphora. There was more obstruction on left side -21 (70%) than on the right side-9 (30%). Bilateral involvement was not seen. Three patients (10%) were required septoplasty during the endoscopic DCR procedure. Twenty four out of thirty (80%) patients had complete resolution. There were no any significant major complications observed in any patient in our study. Conclusions: Endoscopic DCR is safe, successful procedure for the treatment of nasolacrimal duct obstruction and has several advantages over conventional external approach.

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Endoscopic Dacryocystorhinostomy: Advantage over External Approach

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i2.244 ◽

2019 ◽

Vol 27 (2) ◽

pp. 161-166

Author(s):

Bijan Basak ◽

Kaustuv Das Biswas ◽

Subhradev Biswas ◽

Ankit Choudhary

Keyword(s):

Standard Treatment ◽

Nasolacrimal Duct ◽

External Approach ◽

Interventional Study ◽

Safe Alternative ◽

Endoscopic Dacryocystorhinostomy ◽

Chronic Dacryocystitis ◽

Endoscopic Dcr ◽

Prospective Longitudinal ◽

External Dcr

Introduction 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. Materials and Methods 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. Surgery was performed under local anaesthesia except in uncooperative patients where general anaesthesia was used. 0˚ & 30˚ endoscopes were used in surgery. The surgical outcomes and complications were recorded, analyzed and compared to those of external DCR from available literature. Results The overall success rate of endoscopic DCR was 94.7%, which is closely comparable to external DCR. Conclusion Endoscopic DCR is an effective and safe alternative to external DCR, with comparable results and better patient satisfaction.

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External dacryocystorhinostomy

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v16i3.510 ◽

2019 ◽

Vol 16 (3) ◽

pp. 179-185

Author(s):

Li Ying Long ◽

Safinaz Mohd Khialdin ◽

Nazila Binti Ahmad Azli

Keyword(s):

Surgical Technique ◽

Success Rate ◽

Case Series ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Retrospective Case ◽

Duct Obstruction ◽

Posterior Flap ◽

External Dacryocystorhinostomy ◽

External Dcr

Aim: To analyse the epidemiological data, surgical technique, success rate, and complications of patients who underwent external DCR in Hospital Selayang from January 2015 to December 2016. Method: Retrospective case series. Results: A total of 21 eyes of 20 patients who underwent external DCR from January 2015 to December 2016 were identified and reviewed. There were 15 females (75%) and 5 males (25%). Age ranged from 5 to 75 years old, with a median age of 56 years old (IQR 23). Twelve patients presented with epiphora while eight patients presented with symptoms of dacryocystitis. One case was congenital, two were secondary nasolacrimal duct obstruction and the rest were primary nasolacrimal duct obstruction. All patients underwent external DCR under general anaesthesia. Silicone tube were inserted in 21 eyes, of which all were removed 3 months after the surgery except one patient whom had his tube dislodged accidentally. The overall success rate was 90.5% (n = 19), which was defined as no or minimal intermittent epiphora or no reflux on lacrimal irrigation at 12 months postoperative. There was one patient who had a cerebrospinal fluid leak treated successfully with intravenous antibiotics. Conclusion: The surgical success rate for external dacryocystorhinostomy was comparable to that of the global success rate of external DCR. This is attributed to the application of surgical technique such as anterior suspended flap modification and posterior flap excision.

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Usefulness of the dacryoscintigraphy in patients with nasolacrimal duct obstruction prior to endoscopic dacryocystorhinostomy

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-019-04303-4 ◽

2019 ◽

Vol 257 (7) ◽

pp. 1535-1540 ◽

Cited By ~ 1

Author(s):

Dong Ju Kim ◽

Sehyun Baek ◽

Minwook Chang

Keyword(s):

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy

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A Case of Endoscopic Dacryocystorhinostomy for Nasolacrimal Duct Obstruction Secondary to Sarcoidosis

Practica oto-rhino-laryngologica Suppl ◽

10.5631/jibirinsuppl.141.38 ◽

2015 ◽

Vol 141 (0) ◽

pp. 38-39

Author(s):

Koji Otsuka ◽

Masaaki Shimizu ◽

Motoko Shibata ◽

Yohei Okayoshi ◽

Susumu Araki ◽

...

Keyword(s):

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy

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Comparison between Endoscopic and External Dacryocystorhinostomy by Using the Lacrimal Symptom Questionnaire: A Pilot Study

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2018.32.4494 ◽

2018 ◽

Vol 32 (1) ◽

pp. 46-51 ◽

Cited By ~ 1

Author(s):

Wai Keat Wong ◽

Simon Dean ◽

Salii Nair

Keyword(s):

Quality Of Life ◽

Social Impact ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

External Group ◽

Validated Questionnaire ◽

Endoscopic Group ◽

External Dcr

Background Epiphora has a significant impact on the patient's quality of life and is commonly caused by nasolacrimal duct obstruction. Dacryocystorhinostomy (DCR) has traditionally been performed via an external approach, which involves a skin incision. With the advent of endoscopes, the endonasal approach to DCR has gained significant popularity. Method To prospectively compare the quality of life of adult patients who underwent either an endonasal or an external DCR for acquired nasolacrimal duct obstruction, the Lacrimal Symptom Questionnaire (Lac-Q) was administered before and after surgery. The treatment group assignment was nonrandom and performed based on patient preference. The Lac-Q is a validated questionnaire that assesses the subjective perception of one's well-being from an eye-specific symptom and social impact standpoint. Total scores range from 0 (no concerns) to 33 (maximal degree of ocular symptoms and social impact). Results Sixty patients (22 in the endonasal group, 38 in the external group) were recruited between January 1, 2014, and January 1, 2016. Postoperative assessment was performed at 3 and 6 months. Patients who underwent external DCR reported a median 7.0–point improvement (interquartile range [IQR], 3.0–11.0) in total Lac-Q scores. A 12.0–point improvement (IQR, 10.0–18.5) was seen in the endonasal group (p = 0.005). The median change in the social impact score was 3.0 and 4.0 in the external group and the endoscopic group, respectively (p = 0.029). Changes in the median lacrimal symptom score were 4.0 in the external group and 8.0 in the endoscopic group (p = 0.014). The anatomic patency rate was lower in the external group (60.0%) when compared with the endonasal group (90.4%). Patients in the external DCR group were significantly older (median age, 51 versus 41 years). Conclusion Our study indicated that both endonasal and external DCR can lead to improvement in quality of life by using a validated questionnaire. Although there are differences in age and anatomic success rates between the two groups, subgroup analyses indicated that the differences in the Lac-Q scores persisted when age and anatomic patency were removed as potential confounding factors. Further larger, randomized studies would be helpful.

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Outcomes of external dacryocystorhinostomy and endoscopic endonasal dacryocystorhinostomy in the management of nasolacrimal duct obstruction

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v7i1.13165 ◽

2015 ◽

Vol 7 (1) ◽

pp. 39-46 ◽

Cited By ~ 3

Author(s):

S Duwal ◽

R Saiju

Keyword(s):

Success Rate ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Endoscopic Endonasal ◽

Duct Obstruction ◽

Dence Interval ◽

External Dacryocystorhinostomy ◽

Group 2 ◽

External Dcr ◽

Group 1

Introduction: Dacryocystorhinostomy (DCR) is the treatment of choice for nasolacrimal duct obstruction. Although external DCR is regarded as the gold standard, endoscopic DCR is evolving as an equally-effective alternative. Objectives To compare the success rate of treating nasolacrimal duct obstruction by endoscopic endonasal method compared to the conventional DCR surgery.Materials and methods This prospective, comparative, non-randomised study was conducted in 2009 - 2010. Thirty consecutive patients undergoing endoscopic endonasal DCR (Group 1) and 30 consecutive patients undergoing external DCR (Group 2) between July 2009 and September 2010 at the oculoplasty unit of the Tilganga institute of ophthalmology were included in this study. A patent lacrimal passage on syringing and symptomatic improvement at six months after surgery was de¿ned as a successful outcome. The intraoperative and postoperative complications were also compared. Results Our study included 31 eyes of 30 patients in Group 1 and 34 eyes of 30 patients in Group 2. The success rate for endoscopic endonasal dacryocystorhinostomy was 90.3 % (95 % con¿dence interval 80 - 100) and external dacryocystorhinostomy was 94.1 % (95 % con¿dence interval 80 - 100). The difference of surgical success among the two methods was not statistically significant (p = 0.7). The rate of intra-operative and post-operative complications was similar in the two methods (p = 0.5). Conclusion: The short term outcomes and complication rates of endoscopic endonasal dacryocystorhinostomy and external dacryocystorhinostomy were similar.

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Role of silicone stenting in endoscopic dacryocystorhinostomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200136 ◽

2020 ◽

Vol 6 (2) ◽

pp. 248

Author(s):

Abdussalam M. Jahan ◽

Yousef M. Eldanfur ◽

Abdulhakim B. Ghuzi

Keyword(s):

Success Rate ◽

Medical Center ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

P Value ◽

Success Rates ◽

Duct Obstruction ◽

Significant Difference ◽

Silicone Stent ◽

Endoscopic Dcr

Background: 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.Methods: 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. 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. Results: 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 >0.05).Conclusions: 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.

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