Clinical Study on Surgical Outcomes of Endoscopic Dacryocystorhinostomy (DCR) between Powered and Non-Powered Techniques.

Dacryocystorhinostomy (DCR) is a bypass operation for tear drainage system which involves removal of bone adjacent to lacrimal sac and incorporating lacrimal sac with nasal mucosae. The operative approaches to lacrimal apparatus are external and endoscopic. In recent times advances in surgical technique and better standing of anatomy have made several changes in endoscopic DCR all aiming to improve results, reduce complications, and reduce operative time. Both costly powered and cost affective non-powered instruments are commonly used to make bone windows in endoscopic DCR. The aim of this study is to compare merits and demerits of powered instrument (Drill) and non-powered (Kerrison’s punch) DCR. METHODSA randomized comparative study of 60 patients in the age group of 21-70 yrs. who attended our outpatient department regularly and underwent endoscopic DCR procedure at our institution from June 2017 until Aug. 2019 was conducted. Patients were categorised into two groups of 30 patients each, one group which had patients who were operated conventionally by Kerrison’s punch and the group with patients who were operated by powered drill. Operative technique, surgical outcome and complications were compared between the two groups. RESULTSA total of 60 endoscopic endonasal DCRs were performed during the period. Male: female ratio; 1:5. 36 (60%) patients presented with watering of eye. Procedure success rate among Kerrison’s punch group was 93.33 % vs. 90% in powered drill group (p= 0.476). The complications rate in Kerrison’s punch group was 10% compared 20% in powered drill group (p= 0.032). The mean operating time among Kerrison punch group was 33.3 min which was significantly lower than that of powered drill group which was 78.3 min. CONCLUSIONSEndoscopic DCR is keyhole minimal invasive magic surgery. In a comparative study, Kerrison’s punch was found to be better tool for making bony window in terms of cost, operating time and complications when compared to powered drill. In terms of success rate of surgery and other factors, there was no significant difference between the two groups.

Fiberoptics Assisted Lacrimal Surgery

The endonasal laser lacrimal surgery has provided many advantages. However, the success rate of the primary endonasal DCR has been lower than the established 90% or greater success rate of conventional DCR. Endonasal fiberoptics-assisted lacrimal surgeries(108 DCR and 149 CDCR) were performed with conventional lacrimal surgical instruments and endoscope. The thick bone of the anterior lacrimal crest and half segment of the lacrimal sac were removed with Kerrison punch, and silicone tube intubation was performed. After 8 to 33 months(average 15.6 months) of follow up, intranasal mucosal ostium measured 1.85 mm in diameter. Of the 108 eyes with primary endonasal DCR, the ostium of 86 eyes(79.6%) remained patent. After revision of the failed DCR, the success rate was 96.3%(104 eyes). Of the 61 eyes with primary endonasal DCR which were performed during recent 8 to 20 months, 54 eyes(88.5%) were satisfactory. Of the 149 eyes with CDCR, Jones tubes in 141 eyes(94.6%) functioned well.