External Repeat Dacryocystorhinostomy with Modified Silicone Intubation for Failed DCR: Analysis of Efficacy and Patient Tolerability
Delhi Journal of Ophthalmology
External Dacryocystorhinostomy [DCR] is a well proven procedure where success ranges from 85 to 97% in patients with nasolacrimal duct obstruction as published in various journals. 1-3 Inspite of excellent success rate, there are large number of cases with failure typically due to poor surgical technique, intranasal adhesions, fi brous obstruction at the common canaliculus, closure of the osteotomy, and fall of the mucosal fl ap. 1,4 Development of scar tissue at the osteotomy site, seen
... y site, seen endoscopically, is considered to be the main cause of failure. 5 Kao et al 6 have shown that the area of the osteotomy site gets reduced from 65.55 mm2 to 10.83mm2. The application of antifi brotic agents like mitomycin C 7 or the placement of stents 8 at the site of the osteotomy are thought to increase the success of the procedure, although previous studies have not demonstrated these interventions to be statistically signifi cant. Performing repeat surgery in cases of failed DCR is a daunting task owing to its disruption of normal anatomy of lacrimal sac area, fi brous adhesions and inadequate tissue availability for performance of anastomosis. Use of silicone stents in failed DCR is an useful adjunct for maintaining the integrity of anastomosis of nasolacrimal pathway, moreover it is commonly performed technique by oculoplastic surgeons all over the world. Silicone material is tissue friendly and is used in various intraocular and extraocular procedures in varying consistency. Elmorsy et al 9 have shown that fi nal osteotomy size after DCR with silicone stent placement was larger in comparison to that with Aim of the Study : To describe a novel and alterna ve method of stent placement for failed dacryocystorhinistomy(DCR). Methodology : A retrospec ve analysis of 40 non consecu ve cases of failed DCR underwent repeat DCR with modifi ed silicone intuba on. Here each arm of the lacrimal intuba on tube was introduced through the canaliculi, and these arms were anchored to a large bore silicone tube at the level of the internal os um. This large bore silicone tube was freely suspended in the nose through the internal os um. The whole complex was kept in situ for a period of 6 months. Nasal endoscopy was performed a er removal of stent. Results: : The mean age group was 51 years (27-73 years). Sex ra o showed female preponderance (70%). The mean dura on of follow up was 9.30 months (2.8 -18 months), and the mean period of stent removal was 7.08 months (2.5 -12.3 months). The outcome of this procedure showed that 95% of cases had patent lacrimal passage. Two cases had some form of punctal split. There were no cases of epistaxis or granuloma forma on. Mean area of internal os um a er stent removal was 28.67 mm2 (SD 4.65). Conclusion: Re DCR has high risk of osteotomy closure, hence this modifi ed technique can be considered as an alterna ve to standard intuba on technique with op mum results.