Online ISSN: 2515-8260

Keywords : External DCR

A Prospective Study to Compare the Outcome of Endoscopic (Endonasal) DCR with Conventional (External) DCR in a Tertiary Care Center

Jairaj Vaishnav, Amrit Debbarma, Umesh Chandolia, Rajni Gaur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3405-3411

Background: Epiphoracan be extremely troublesome and a source of social embarrassment. There are various methods of performing dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction. Present study is planned to evaluate the results of Endoscopic Endonasal DCR without silicon stent in patients with nasolacrimal duct obstruction at tertiary level health care center.
Materials & Methods: A hospital based prospective study done on 40 patients diagnosed as nasolacrimal duct obstruction or chronic dacryocystitis at department of ENT, at RVRS Medical College, Bhilwara Rajasthan, India during one year period.Patients were divided into two groups:Group I for Endonasal Endoscopic DCRwithout silicone stent (N=20)and Group II for conventional (external) DCR (N=20).Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire was given and symptom score were calculated.Lacrimal syringing was performed in all the cases.Subsequent follow up done post-operatively at fourweek, 12 week & 6 month.
Results: The mean age was 45.51±11.43 years (range 15 to 77 years). The demographic variables such as age, sex, laterality, associated nasal pathology and additional procedure was statistically non significant. The mean surgical duration in group I was 40.23±9.45 minutes & in group II was 41.2±8.76 minutes, which was statistical non significant (P>0.05).The success rate of En DCR is 95%. Complete objective & symptomatic relief was seen in 19 (95%) cases, & 1(5%) reported no symptomatic relief after one month and 90% success rate after 6 month in both groups.
Conclusion: We concluded that endonasal DCR is a procedure that has recently gained by otorhinolaryngologists due to its minimal invasive nature, high patient satisfaction, and high success rates.

A Hospital Based Prospective Study to Evaluate the Functional/ Anatomic Success for Endoscopic Versus External Dacrocystorhinostomy (DCR) Surgeries in Naso Lacrimal Duct Obstruction (NLDO) at Newly Established Tertiary Care Centre

Vipul Kumar Nagar, Gaurav Kataria, Rameshwar Lal Suthar, Devhuti Dhawan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2278-2284

Background: Dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction. The purpose of the current study was to evaluate functional/ anatomic success for endoscopic versus external dacrocystorhinostomy (DCR) surgeries in nasolacrimal duct obstruction (NLDO) at newly established tertiary care centre.
Materials& Methods: A hospital based prospective study done on 100 patients with complaining of excessive tear formation in department of ophthalmology & Otorhinolaryngology at Government Medical College Pali, Rajasthan, India during one year period. Documented obstruction on syringing and probing or obstruction on lacrimal scintigraphy were used in the diagnosis of NLDO. Patients with previous DCR surgery to the same eye were excluded from the study. Success was defined as full resolution of symptoms and no postoperative dacryocystitis without additional postoperative lacrimal duct surgery. Regarding the analysis of long-term outcome, only the first side was included in bilateral cases. Patients were also asked to rate their satisfaction on a scale of 1 to 10 (1 = extremely dissatisfied to 10 = extremely satisfied).
Results: Demographics between the two surgical groups were similar. There was no statistically significant difference in comorbidities, previous sinus disease or surgery, ocular history, or presenting symptoms. 94 had unilateral DCR (right side, 48 (51.06%); left side, 46 (48.93%)), and 6 patients had bilateral DCR. The complication incidence was low and similar in both operations. Two patients had postoperative hemorrhage (one who had endonasal DCR surgery and one having external DCR surgery). Seven patients who underwent DCR surgery had tubes that fell out before the 2-month assessment, of which three were in the endonasal group and four in the external group. There was no statistical significance between the external DCR group and the endoscopic endonasal group (P >0.05). The success rate of external DCR for patients with previous episodes of dacryocystitis was 82.8%, compared to 83.5% for patients without previous episodes of dacryocystitis. The difference was not statistically significant (P>0.05). The success rate in patients without previous lacrimal duct surgery was 88.6% compared to 74.4% for patients with previous lacrimal duct surgery. The difference was also not statistically significant (P>0.05).
Conclusion: The advantage of endoscopic surgery is that it leaves no scar and preserves the lacrimal pump system, unlike external DCR. Choice in regards to surgical techniques should depend on patient preference, with consideration given on the availability of resources amongst health care systems.