Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy and External Dacryocystorhinostomy

ABSTRACT A prospective study on 50 cases of chronic dacryocystitis was done to see outcome of management by endoscopic dacryocystorhinostomy (DCR) in Indian population and to look for its advantages or disadvantages over external-DCR. Effect of mitomycin-C was also evaluated in endoscopic DCR cases. Dacryocystitis was diagnosed on the basis of clinical examination by doing regurgitation test and lacrimal syringing. These patients were divided into two groups: group I consisted of those 25 subjects who were planned for endonasal endoscopic DCR and group II of those 25 subjects who underwent external-DCR in ophthalmology department. Of all the cases, maximum number of cases was in the age group of 21 to 35 years, 27 (54%) cases, 88% were females and 12% were males. External-DCR required a relatively longer surgical duration of an average 65 minutes as compared to 35 minutes for endonasal DCR. Average hospital stay for patient in group I was 3 days and it was 7 days in group II. There were minimal intraoperative complications in endoscopic procedure as compared to external-DCR group. Average follow-up was 6 months. Primary success rate was 96% in both the groups. Thus, it was concluded that both the procedures represent good alternatives for the treatment of primary nasolacrimal sac or duct obstruction or chronic dacryocystitis, endoscopic DCR having advantage of less complications and less traumatic. Mitomycin-C was found to be helpful in reducing fibrosis. How to cite this article Singh H, Mohindroo NK. Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy and External Dacryocystorhinostomy. Clin Rhinol An Int J 2015;8(1):1-4.

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Mitomycin C–Enhanced Revision Endoscopic Dacryocystorhinostomy

Otolaryngology ◽

10.1177/0194599812450280 ◽

2012 ◽

Vol 147 (5) ◽

pp. 937-942 ◽

Cited By ~ 25

Author(s):

Sameh M. Ragab ◽

Hossam S. Elsherif ◽

Emad M. Shehata ◽

Ahmed Younes ◽

Ahmed M. Gamea

Keyword(s):

Mitomycin C ◽

Controlled Study ◽

Safe Procedure ◽

Endoscopic Dacryocystorhinostomy ◽

Randomized Controlled ◽

Group I ◽

Significant Difference ◽

Endoscopic Dcr ◽

Causes Of Failure

Objectives (1) To conduct an adequately powered randomized controlled trial investigating the safety and efficacy of mitomycin C–enhanced revision endoscopic dacryocystorhinostomy (DCR) and (2) to analyze causes of failure after primary endoscopic DCR. Study Design A randomized controlled study. Setting General hospital. Subjects and Methods Seventy-six revision endoscopic DCRs were randomized into 2 groups: endoscopic DCR with mitomycin (group I), where 0.5 mg/mL mitomycin C was applied for 10 minutes, and endoscopic DCR without mitomycin (group II). Follow-up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Results Causes of failure in the original 92 patients included canalicular obstruction (14%), small misplaced bony window (43%), very small nasolacrimal stoma due to development of synechia (23%), and complete closure of nasolacrimal stoma with tough fibrous tissue (63%). There was no significant difference between the 2 groups in subjective and objective success rates and adverse events. Group I demonstrated a significantly longer operative time and a significantly lower number of debridement sessions (mean of 1.2 vs 1.9). Conclusions Recurrent nasolacrimal duct obstruction after primary endoscopic DCR is mainly due to reclosure of the nasolacrimal stoma with synechia and fashioning of the small misplaced bony window. Mitomycin C does not increase the success rate of revision endoscopic DCR. It is a safe procedure and may be of value only in patients inaccessible to strict follow-up because it induces a better healing profile in terms of mucosal recovery, wound healing, and less need for debridement sessions.

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Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1314 ◽

2017 ◽

Vol 10 (2) ◽

pp. 86-90

Author(s):

Aditya Kashyap ◽

Satisg Negi ◽

Prem L Chauhan ◽

Kuldeep Thakur

Keyword(s):

Operative Time ◽

Nasal Endoscopy ◽

Functional Evaluation ◽

Lacrimal Sac ◽

Endoscopic Dacryocystorhinostomy ◽

Group I ◽

Chronic Dacryocystitis ◽

Endoscopic Dcr ◽

Fluorescein Dye

ABSTRACT Objective To compare the results of conventional nasal endoscopic dacryocystorhinostomy (DCR) and inferior nasal endoscopic DCR in Study cases of idiopathic chronic dacryocystitis. Materials and methods Forty patients diagnosed with idiopathic chronic dacryocystitis were divided into two groups alternately. After relevant investigations, they were subjected for endoscopic DCR by two techniques. Twenty patients underwent conventional endoscopic DCR and 20 underwent inferior endoscopic DCR under transoral pterygopalatine block and topical lignocaine (4%) with adrenaline 1:2,000. After 3 months of follow-up in the outpatient department, nasal endoscopy along with fluorescein dye disappearance test (FDDT) at 10 minutes was done. Results Ninety-five percent (19/20) of patients undergoing conventional endoscopic DCR and 90% (18/20) of patients undergoing inferior endoscopic DCR were found to have patent anatomical fistula. On FDDT, nasal endoscopy after 10 minutes revealed 84% (16/19) in group I and 94.4% (17/18) in group II with fluorescein in nasal cavity. Conclusion Present study concludes the importance of bony, tendinous, and muscular support of lacrimal sac in physiological lacrimal pump functioning and advantage of relatively new technique of inferior endoscopic DCR. Inferior endoscopic DCR is associated with less operative time as well as less local complications. How to cite this article Thakur K, Kashyap A, Negi S, Chauhan PL. Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis. Clin Rhinol An Int J 2017;10(2):86-90.

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A Comparative Study between Endoscopic Dacryocystorhinostomy and External Dacryocystorhinostomy – A Hospital-Based Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/522 ◽

2020 ◽

Vol 7 (44) ◽

pp. 2526-2529

Author(s):

Kanishka Chowdhury ◽

Sagar Karmakar ◽

Subhadip Sarkar ◽

Suman Mukhopadhyay

Keyword(s):

Invasive Procedure ◽

External Approach ◽

Medical College ◽

Chronic Dacryocystitis ◽

Group A ◽

Study Population ◽

Endoscopic Dcr ◽

External Dacryocystorhinostomy ◽

Group B ◽

External Dcr

BACKGROUND Dacryocystorhinostomy (DCR) can be performed via two approaches either external approach or endonasally. Earlier, external approach was preferred but with the recent introduction of endoscopy, the focus has shifted to endoscopic DCR as it is a less invasive procedure. This study was conducted to compare both the approaches. METHODS 50 patients were selected from patients attending eye and ENT OPD of a medical college in Kolkata with complaints of watering and / or discharge or with other features of chronic dacryocystitis e.g., mucocele, pyocele etc. They were then allocated in to two groups, group A (patients who will undergo endo DCR) and group B (patients who will undergo external DCR). Results of both were compared. RESULTS The mean age of study population was 34.34 ± 6.65 yrs. Among the study population, 36 patients (72 %) were female and 14 were male (28 %). Mean age of Group A (i.e. patients subjected to endo DCR) was 34.60 ± 5.72, while that of Group B (patients undergone external DCR) was 34.08 ± 7.58 yrs. Patients had a right sided predilection for DCR operation (66 %). Most common presenting symptom was epiphora (66 %) followed by epiphora with discharge. Mean time taken for the operation was significantly (p < 0.0001) more in group B (117 ± 14.43 mins) compared to that in group A (46.60 ± 8.63 mins). Massive intraoperative bleeding was more common in group B (32 %) compared to that in group A (p = 0.0023). Group B had a significantly higher rate of post-operative complications (56 %) compared to that in group A (p = 0.00085). Group B also had a higher success rate compared to group A; but this difference was not significant. (p = 0.22144). CONCLUSIONS Both the approaches have their own merits and demerits; but both are accepted alternatives, so either approach could be performed depending on the situation. KEYWORDS Endoscopic DCR, External DCR, Epiphora

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A Study of Efficacy of Intraoperative Application of Mitomycin-C in Endoscopic Dacryocystorhinostomy

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2018.v26i1.153 ◽

2018 ◽

Vol 26 (1) ◽

pp. 29-34

Author(s):

Harikesh Sharma ◽

Ajay Mallick

Keyword(s):

Success Rate ◽

Mitomycin C ◽

Symptomatic Improvement ◽

Age Group ◽

Female Ratio ◽

Endoscopic Dacryocystorhinostomy ◽

Chronic Dacryocystitis ◽

Group A ◽

Endoscopic Dcr ◽

Group B

Introduction Common cause for failure of endonasal dacryocystorhinostomy is closure of the intranasal ostium usually due to granulation tissue formation. Attempts have been made to improve the success rate of lacrimal surgery by using different methods like using balloon catheters, lasers and antimetabolites. This study aims to see change in success rate with and without the use of using Mitomycin-C in endonasal Dacryocystorhinostomy (DCR) surgery. Materials and Methods Sixty patients of acquired chronic dacryocystitis with nasolacrimal duct blockage, in the age group of 11-50 yrs were taken for study. Patients were alternatively divided into two groups A & B (30 patients in each group). Endoscopic dacryocystorhinostomy with Mitomycin-C application was performed in Group A and without Mitomycin-C application in Group B patients. Subjective assessment for symptomatic improvement and objective analysis obtained from results of syringing. The result data was subjected to Student’s t test and x2analysis. Result Age of patients varied from 11 to 50 yrs. The male to female ratio was 7:8 in group A while 2:3 in group B. The commonest age group was between 21 -30 years in both the groups. After 12 month follow up the success rate was 93% in both the groups. The results between the groups were found to be statistically not significant (p>0.05). Conclusion Mitomycin C was used in this study to assess its efficacy in improving the results of endoscopic DCR. Mitomycin C did not have significant effect on the outcomes of endoscopic DCR surgery for chronic dacryocystitis.

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Efficacy of mitomycin c in endoscopic dacryocystorhinostomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20184355 ◽

2018 ◽

Vol 4 (6) ◽

pp. 1431

Author(s):

Vinod Shinde ◽

Anju Unnikrishnan ◽

Shad Fatma ◽

James Thomas

Keyword(s):

Mitomycin C ◽

Nasolacrimal Duct ◽

Lacrimal Sac ◽

Duct Obstruction ◽

Surgical Success ◽

Endoscopic Dacryocystorhinostomy ◽

Nasal Sprays ◽

Group I ◽

Chronic Dacryocystitis ◽

Cause Of Failure

Background: Endoscopic dacryocystorhinostomy is a procedure done to drain the lacrimal sac due to post saccular lacrimal obstruction. The most common cause of failure of dacryocystorhinostomy is blockage of ostium created in lacrimal sac. Various methods are employed to prevent the blockage such as stenting, mitomycin C and steroidal nasal sprays. In this study we evaluated the efficacy of mitomycin C in reducing the stomal closure following dacryocystorhinostomy.Methods: Fifty patients who were diagnosed with chronic dacryocystitis due to nasolacrimal duct obstruction were chosen for the study. They were randomly divided in to two groups. In group I 25 patients under went endoscopic dacryocystorhinostomy with intraoperative mitomycin C application and in group II 25 patients underwent endoscopic dacryocystorhinostomy without application of mitomycin C. Patients were followed up at the end of one week, three weeks, three months and six months. Surgical success was evaluated objectively at the end of six months. Results: The success rate of endoscopic dacryocystorhinostomy with use of mitomycin c was 86% in group where mitomycin c was used and 62% in group where mitomycin c was not used.Conclusions: Mitomycin C is a safe drug which can keep the stoma created patent and reduces the chance of recurrence following endoscopic dacryocystorhinostomy.

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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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Role of Silicone Stenting in Endoscopic Dacryocystorhinostomy: A Comparative Study

International Journal of Advanced and Integrated Medical Sciences ◽

10.5005/jp-journals-10050-0002 ◽

2016 ◽

Vol 1 (1) ◽

pp. 4-6 ◽

Cited By ~ 2

Author(s):

Shahzad Ahmad ◽

Bhawana Pant

Keyword(s):

Comparative Study ◽

Nasolacrimal Duct ◽

Endoscopic Dacryocystorhinostomy ◽

Medical College ◽

Randomized Design ◽

Silicone Stent ◽

Foreign Body Reactions ◽

Endoscopic Dcr ◽

The Cost

ABSTRACT Objective To evaluate the role of using silicone stent in endoscopic dacryocystorhinostomy (DCR) and compare the results with endoscopic DCR without silicone stenting. Design Prospective study, interventional type, randomized design and comparative analysis. Materials and methods The study was done in Department of Otorhinolaryngology, Government Medical College and Dr Susheela Tiwari Hospital, Haldwani, Uttarakhand. We included 30 patients in the study presenting with epiphora with or without mucocele and congenital cases of dacryocystitis and nasolacrimal duct (NLD) blockage were included in the study. All patients were divided into two groups. First one undergoing endoscopic DCR and silicone stent was used in all cases and second one underwent endoscopic DCR and no stent was used. Postoperative assessment was carried out at the end of 1st, 3rd, 6th and 10th week and the role of silicone stent was subjected to compare. Result Use of silicone stent was not improving the results and risk of failure of the surgery had increased with stent due to granulation formation in the lacrimal sac region. Apart from that, foreign body reactions in the form of irritation, pain were seen with stent. It also added the cost of surgery without giving much benefit to the patient. How to cite this article Ahmad S, Pant B. Role of Silicone Stenting in Endoscopic Dacryocystorhinostomy: A Comparative Study. Int J Adv Integ Med Sci 2016;1(1):4-6.

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Evaluation of idiopathic scoliosis by anterior and posterior arthrodesis

Coluna/Columna ◽

10.1590/s1808-185120151402145201 ◽

2015 ◽

Vol 14 (2) ◽

pp. 88-92 ◽

Cited By ~ 1

Author(s):

Jean Carlo Frigotto Queruz ◽

Allan Kato ◽

Carlos Abreu de Aguiar ◽

Luiz Muller Avila ◽

Luis Eduardo Munhoz da Rocha

Keyword(s):

Idiopathic Scoliosis ◽

Hospital Stay ◽

Posterior Approach ◽

Thoracolumbar Spine ◽

Average Hospital ◽

Icu Stay ◽

Group I ◽

Number Of Patients ◽

Significant Difference ◽

Group Ii

<sec><title>OBJECTIVE:</title> To evaluate comparatively surgical treatment of adolescent idiopathic scoliosis type 5CN by anterior and posterior approach.</sec><sec><title>METHODS:</title> The study consists of a comparative retrospective study of two groups of patients with the thoracolumbar spine arthrodesis technique by anterior and posterior approach. Twenty and two patients were sequentially selected, 11 operated by anterior approach - called Group I - and 11 by posterior approach - Group II. Anamnesis and physical examination were performed, as well as length of hospital stay and ICU stay, degree of correction, comorbidities and pre and postoperative radiographic images data were gathered.</sec><sec><title>RESULTS:</title> The mean age was 13.7 years in Group I and 14 years in Group II. The average hospital stay was 5.81 days for Group I and 5 for Group II. The average ICU stay was 2.81 and 2 days, respectively. Considering the operated levels, Group I presented an average of 4.81 vertebrae (4-6 levels), and Group II presented an average of 6.36 vertebrae (5-11 levels). Complications did not show statistically significant difference.</sec><sec><title>CONCLUSION:</title> Despite the limited number of patients in groups, it was demonstrated that the posterior approach reduces the number of days of hospitalization and ICU stay. However, it was found increased levels included in the arthrodesis.</sec>

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Endoscopic dacryocystorhinostomy with silicon stent: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181872 ◽

2018 ◽

Vol 4 (3) ◽

pp. 785

Author(s):

Neeraj Suri ◽

Bhavya B. M.

Keyword(s):

Cost Effective ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Invasive Technique ◽

Safe Alternative ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy ◽

Endoscopic Dcr ◽

Surgical Modality ◽

External Dcr

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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A Mitomycin C-Sparing Novel Technique for Subscleral Trabeculectomy in Primary Congenital Glaucoma

Journal of Ophthalmology ◽

10.1155/2020/2017158 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Ashraf Bor’i ◽

Salah M. Al-Mosallamy ◽

Tamer G. Elsayed ◽

Wael M. El-Haig

Keyword(s):

Intraocular Pressure ◽

Mitomycin C ◽

Congenital Glaucoma ◽

Surgical Interventions ◽

Primary Congenital Glaucoma ◽

Group I ◽

Significant Difference ◽

The Mean ◽

Group Ii ◽

Contralateral Eye

Purpose. To evaluate the safety and efficacy of a novel modified subscleral trabeculectomy technique in management of primary congenital glaucoma. Methods. This study included 25 infants diagnosed of having bilateral primary congenital glaucoma. For each patient, one eye was assigned to undergo subscleral trabeculectomy with trimming of the edges of the scleral bed (group I), while the contralateral eye underwent subscleral trabeculectomy with application of mitomycin C (0.4 mg/ml for 3 min) (group II). All the patients were followed up for a period of 14 ± 3 months (range 13–22 months). Results. 25 eyes were included in each group. Patients’ mean age was 2.5 ± 0.5 months (range 1.8–6.5 months). The mean preoperative intraocular pressure was 31 ± 4.9 mmHg and 32.1 ± 4.0 mmHg in group I and II, respectively. The mean postoperative intraocular pressure was 9.0 ± 1.0, 11.0 ± 3.2, 12.5 ± 0.9, 13.0 ± 2.9, and 15.5 ± 1.5 mm Hg in group I and was 10.3 ± 1.2, 12.0 ± 2.5, 13.5 ± 1.7, 15.0 ± 1.5, and 17.1 ± 2.8 mm Hg in group II at the first week and 1, 3, 6, and 12 months, respectively. There was no statistically significant difference between the mean intraocular pressure values recorded at both groups preoperatively and at each follow-up visit. Failure necessitating further surgical interventions was recorded in 4 eyes (16%) in group I as compared to 3 eyes (12%) in group II (P>0.05). Postoperative complications included mild hyphema, which occurred in one eye (4%) in group I and 2 eyes (8%) in group II, and shallow anterior chamber in 3 eyes (12%) in group I and in 2 eyes (8%) in group II. One eye (4%) in group I developed drawn-up pupil. Choroidal effusion developed in one eye (4%) at each group. Conclusion. Trimming the edges of the scleral bed adjacent to the sclera flap is a safe and effective surgical step which can be added to the subscleral trabeculectomy procedure to effectively control the intraocular pressure in patients with primary congenital glaucoma, sparing them the hazards associated with mitomycin C application.

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