Comparison of Endonasal Endoscopic Dacryocystorhinostomy with External Dacryocystorhinostomy

Purpose: To compare anatomical and functional success of Endonasal Dacryocystorhinostomy (DCR) with that of External Dacryocystorhinostomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Ophthalmology and Otolaryngology, District Headquarter Teaching Hospital, Sahiwal, from July 2018 to July 2019. Methods: Sixty patients with nasolacrimal duct obstruction were selected by convenient sampling technique and were divided into two groups. Group 1 underwent endonasal DCR while group 2 underwent external DCR. Detailed history with regard to symptoms and duration of the obstruction was taken. Detailed ophthalmological and otolaryngological examination was performed. Patients were followed up for three months. Chi-square test was used to compare the success between two groups. Confidence level of 95% was used and p value of less than 0.05 was considered significant. Results: Male to female ratio was 4:11. The most common presenting symptoms was epiphora that was present in all patients. Regurgitation of lacrimal sac was present in 75%, conjunctivitis was present in 53.33% and dacryocystitis was present in 41.66% patients. Anatomical success rate for endonasal DCR was 25 (83.33%) and for external DCR was 27 (90%). Functional success rate for endonasal DCR was 23 (76.67%) and for external DCR was 22 (73.33%). There was no statistically significant difference in the short term success of surgery between the two groups. Conclusion: Endonasal DCR offers minimal invasive approach with comparable anatomical and functional results to the external DCR. Key Words: Conjunctivitis, Dacryocystorhinostomy, Dacryocystitis, Epiphora.

CROSS SECTIONAL STUDY OF SUCCESS RATE OF EXTERNAL DACRYOCYSTORHINOSTOMY SURGERY WITH AND WITHOUT INTUBATION STENT USAGE IN A TERTIARY CARE HOSPITAL

Dacryocystorhinostomy is widely considered as the standard treatment due to chronic nasolacrimal duct obstruction (NLDO). These procedures include standard external Dacryocystorhinostomy (DCR), non-laser endonasal endoscopic DCR (EN-DCR), and endonasal endoscopic laser DCR (LA-DCR)1. However external DCR is considered as the gold standard surgical method in the treatment of NLDO. Our study describes a comparative study of success rates of external DCR surgery, wherein 30 patients each were included for with and without silicone tube intubation usage respectively. The results showed a higher success rate (90%) in outcome of external DCR surgery using silicone tube intubation as compared to that without its usage (80%). Therefore, this study was aimed to shed further light on EXDCR surgery using intubation stents. The study also helps in shedding light on better post-operative management and obtaining higher success rates in case of EX-DCR surgery.

Post-Operative Nasal Obstruction: Comparison between External and Endoscopic Dacryocystorhinostomy

Objectives: The objectives of this study is to compare between endoscopic and external dacryocystorhinostomy (DCR) procedures with regards to both objective and subjective parameters, i.e., incidence of long term post-operative nasal obstruction and patientreported quality of life. Study Design: Prospective study Setting: Tertiary Care University Hospital Participants: Study population included 24 patients undergoing either endoscopic or external DCR with bicanalicular silicone, at the Department of Otorhinolaryngology and Head and Neck Surgery in (removed for blind peer review 1). Main outcome and measure: Changes in nasal resistance was determined by anterior rhinomanometry, and quality of life was assessed by mini rhinoconjuctivitis quality of life questionnaire (MRLQ). Results: Post-operative nasal resistance was significantly increased upon both endoscopic and external DCR (p=0.04); this outcome was temporary and returned to normal after stent removal. Quality of life (QOL) exhibited a significant bimodal improvement in both groups 3 months after the operation (p=0.03), as well as after stent removal (p=0.01). Conclusions: While endoscopic and external DCR with silicone tube stenting both lead to an improvement in quality of life, a significant temporary objective nasal obstruction occurs, more prominently after the endoscopic procedure. Pending future studies, this observed discrepancy may be an appropriate matter to convey to prospective patients prior to choice of procedure.

Scar Appearance and Patient Satisfaction after the Tear Trough Incision for External Dacryocystorhinostomy

Background: Postoperative scar is the major disadvantage of external dacryocystorhinostomy (DCR). Modified incision should be performed to reduce postoperative scarring. Objective: To evaluate scar appearance and patient satisfaction after the tear trough incision for external DCR. Materials and Methods: The present study was a descriptive study with information collected by telephone survey and retrospective chart review. Patients that underwent external DCR over a period of eight years were enrolled and completed the validated Patient Scar Assessment Questionnaire (PSAQ). Scar appearance, consciousness, symptom, and satisfaction were determined. Patient demographics, surgical information, and postoperative scar evaluation using the Scar Cosmesis Assessment and Rating (SCAR) scale were obtained from the medical records. Results: Fifty-eight patients responded to the telephone interview with 71 DCR surgeries performed. The most common scar characteristic and symptom reported by patients was color mismatch in 11.3% of scars and itching in 15.5%. Scar evaluated by patients was invisible in 57.7% of scars, minimally visible in 40.8%, and moderately visible in 1.4%. Among all patients with noticeable scars, 92% of these made no attempt to conceal the scars. The average patient scar grade was 0.44 (scale 0 to 3). The majority (93.1%) of patients were very satisfied with the scar outcome. Of the 64 scars evaluated by physician using the SCAR scale, common scar characteristics were scar spread (40.6%), hypopigmentation (15.6%), and hypertrophic scar (12.5%). The scar evaluated by physician was invisible in 59.4% of scars, minimally visible in 34.4%, and moderately visible in 6.3%, with an average scar grade of 0.47 (scale 0 to 3). Conclusion: The tear trough incision for external DCR results in minimal postoperative scarring, providing a very high satisfaction rate in most patients. Keywords: External dacryocystorhinostomy, DCR, Scar, Tear trough incision, Patient satisfaction

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

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

Factors Associated and Management of Functional Failure after External Dacryocystorhinostomy at Zonal Tertiary Hospital

Aims: To determine factors associated and management of functional failure after Dacryocystorhinostomy among patients attending the eye department at KCMC hospital Moshi Kilimanjaro, from January 2007 to July 2018. Study Design: A retrospective cross-section hospital-based study. Place and Duration of Study: Conducted at Eye Department Kilimanjaro Christian Medical Centre Hospital, between August 2018 and August 2019. Methodology: We recruited 184 patients who underwent external DCR surgery from January 2007 to July 2018. The analysis was done using STATA version 14. Chi-square was used to establish the difference in proportions across groups, multivariable logistic regression models were used to determine the associated factors for functional failure. The 95% confidence intervals were constructed; associations were considered to be statistically significant when a P-value was less than 0.05. Results: Out of 184 external DCR done, 37 (20.1%) had functional failure, 174 (94.6%) attained anatomical success while147 (79.9%) attained functional success. Fifty-one (27.4%) of cases had a primary function failure, of this 50% was managed by probing and irrigation. Functional failure was associated with postoperative complications (AOR=10.58 (95% CI: 2.24 - 49.88). Conclusion: Functional failure after external Dacryocystorhinostomy was 20.1%, the anatomical success of external DCR was 94.6% and functional success was 79.9% in our study. The strongest associated factors for functional failure were a post-operative complication and increased age. Therefore, careful post-operative follow-up after DCR procedure should be emphasized to lacrimal surgeons. On the other hand, external DCR remains the surgical management options with good success.

Nasolacrimal Obstruction Following the Placement of Maxillofacial Hardware

Purpose: This article reviews cases of nasolacrimal obstruction (NLO) secondary to maxillofacial hardware placement. Methods: A retrospective review was performed at a single institution from 2012 to 2017 of patients with NLO following maxillofacial reconstruction. The study was approved by the Institutional Review Board of the University of California, San Francisco, adhered to the tenets of the Declaration of Helsinki, and was Health Insurance Portability and Accountability Act compliant. Patients were included if external dacryocystorhinostomy (DCR) confirmed previously placed maxillofacial hardware as the primary contributor to lacrimal outflow obstruction and had at least 3 months of follow-up. Results: Of 420 patients who underwent external DCR, 6 cases of implant-related NLO were identified. The mean age was 47.3 ± 9.6 years and 66.7% of patients were male. All patients presented with epiphora and 50% also had chronic dacryocystitis. Patients had prior maxillofacial hardware placement for paranasal sinus tumors (66.7%) or facial fractures (33.3%). In addition to external DCR, all patients had revision or removal of implants that were impeding lacrimal outflow by 2 mechanisms: (1) an orbital implant impinging the lacrimal sac or nasolacrimal duct (NLD) and/or (2) maxillofacial screws placed into the bony NLD or nasolacrimal fossa. Five of the 6 patients (83.3%) had complete resolution of symptoms and patency of the nasolacrimal system at their last follow-up visit (range 3-30 months). Conclusion: NLO secondary to hardware placement, though infrequent, is underreported. Two mechanisms of hardware-induced NLO were encountered in this case series. Specific attention to nasolacrimal anatomy at the time of maxillofacial reconstruction may help minimize implant-induced NLO.

External Dacryocystorhinostomy versus Canalicular Silicone Intubation with Mitomycin C in Primary Acquired Nasolacrimal Duct Obstruction

Purpose To compare external dacryocystorhinostomy versus canalicular silicone intubation with the use of Mitomycin C (MMC) in primary acquired nasolacrimal duct obstruction (NLDO). Methods the study was carried out at the department of Ophthalmology, Menoufia university Hospital, Egypt, between June 2012 to July 2014. Fifty-six patients who were diagnosed with primary acquired NLDO. Patients were randomly allocated into two groups: thirty cases underwent external DCR and twenty-six cases underwent silicone intubation with MMC. Results No significant difference was detected in success and failure rates between external DCR (90%) and silicon intubation with MMC (80.7%) at 6 months follow up. Also, both procedures were associated with low rate of intraoperative adverse events, with no postoperative adverse events were detected, however, intubation was relatively safer than DCR. Conclusion Silicon intubation with MMC is as effective and safe as external DCR and should be considered as a minimally invasive procedure in primary acquired NLDO.

Endoscopic Dacryocystorhinostomy: Advantage over External Approach

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.