Re Vision Endoscopic DCR Surgeries : Our Experience

Abstract

Patients presenting with "Wet eye" after dacryocystorhinostomy are quite challenging, to treat the recurrence and to find an explanation for the failure of surgery. Surgical treatment for lacrimal obstruction is Dacryocystorhinostomy (DCR) which involves marsupialisation of lacrimal sac into nasal cavity. DCR can be performed externally or endoscopically. The results of both the techniques are almost similar ranging between 85 -95% in the literature. A prospective study of 40 cases of recurrent dacryocystitis following both endoscopic and external DCR were analysed for probable causes for recurrence in primary endoscopic DCR and external DCR surgery and results of the revision surgery are evaluated. OBJECTIVES: This study is aimed to determine the probable causes of failure of primary DCR surgery and its subsequent management. The study involves the role and usefulness of the powered instrumentation, silicon stent, Mitomycin C application in the revision DCR surgeries. MATERIALS AND METHODS:A prospective study was conducted on 40 cases of recurrent dacryocystitis of which 10 cases are following primary external DCR surgery and 30 cases following primary endoscopic DCR surgery. All the 10 cases of recurrent dacryocystitis following external approach were referred from Sarojini Devi eye hospital Hyd-Bad and 30 recurrent Dacryocystitis following endoscopic DCR surgery are picked from Govt ENT hospital, Koti and Nightingale hospital, Hyderabad between Jan. 2009 to Jan. 2014. RESULTS: In 62.5% of the cases, the cause for the failure is inadequate exposure of the lacrimal sac. 15% had uncorrected deviated nasal septum which could be the cause for obstruction of neo stoma postoperatively. 12.5% had associated nasal pathology, such as nasal polyps and sinusitis. In 5%, faciomaxillary trauma was the cause. 2.5% had atrophic rhinitis and another 2.5% mibomian cancer as the cause for recurrence.