Clinical Experience of Lacrimal Surgery

The success rate of endonasal lacrimal surgery have been reported inferior to that of external lacrimal surgery. But nowadays, owing to developement of surgical instrument, such as endoscope, and improvement of surgical skill, better success rates have been reported. We have performed endonasal lacrimal surgery in 36 eyes of 34 patients and external lacrimal surgery in 41 eyes of 36 patients who have had lacriaml pathway obstruction confirmed by dacryocystography. Endonasal lacrimal surgery has been performed with endoscope, fiberoptic light pipe, and conventional lacrimal surgery instruments. Primary success rates are 84.0% in endonasal dacryocystorhinostomy (DCR), 89.5% in external DCR, 81.8% in endonasal conjunctivodacryocystorhinostomy(CDCR), and 90.9% in external CDCR. The rate of postoperative complications are 32.0% in endonasal DCR, 47.4%, in external DCR, 27.3% in endonasal CDCR, and 40.9% in external CDCR. Therefore, in order to increase the success rate of endonasal lacrimal surgery, improvement of surgical technique, use of adequate surgical instrument and careful followup examination for proper management of postoperative complicaitons are considered essential.

Clinical Effecd of Endonasal Lacrimal Surgery

This study was carried out to compare the clinical effect of the endonasal lacrimal surgery done in 75 eyes of the 62 patients with that of the conventional lacrimal surgery done by the same operator in 72 eyes of the 57 patients. The diameter of intranasal ostium was 1.9 +/- 0.4 mm in endonasal approach and 2.6 +/- 1.4 mm in skin approach (p<0.05), respectively. Postoperative hospitalization were 1.7 - 2.5 days shorter in endonasal lacrimal surgery than those of conventional lacrimal surgery (p<0.001). Satisfactory tear drainge was observed in 29 eyes (90.6%) after endonasal dacryocystorhinostomy and in 28 eyes (90.3%) after conventional dacryocystorhinostomy, and 41 eyes (95.3%) revealed astisfactory tear drainge after endonasal conjunctivodacrystorhinostomy and 39 eyes (95.1%) showed good results after conventional conjunctivodacr yocystorhinostomy. In summary, endonasal lacrimal surgery showed no cutaneous scar, less edema and hematoma with short recovery time and similar success rate to the conventional lacrimal surgery. Thus, endonasal lacrimal surgery might be better than conventional lacrimal surgery.