Comparison of Results between Two Methods in Removal of Lacrimal Sac Medial Wall in Endoscopic Dacryocystorhinostomy

ABSTRACT

PURPOSE: To compare the surgical results between Nd YAG laser and sickle knife, as instruments for removal of the medial wall of the lacrimal sac at the time of endoscopic dacryocystorhinostomy (DCR). METHODS: From June 2001 to January 2002, 70 patients with nasolacrimal duct obstruction were arbitrarily divided into two groups. One group underwent endoscopic DCR using sickle knife (sickle knife group) and the other group underwent endoscopic DCR using Nd YAG laser (laser group). We evaluated the duration of wound healing, complications, and success rates. RESULTS: The duration of wound healing in the sickle knife and laser groups was 3.6 +/- 0.6 weeks and 4.0 +/- 0.3 weeks, respectively (p=0.09). Granuloma formation was statistically different between the sickle knife (45.7%, 16/35) and laser (22.9%, 8/35) groups (p=0.04). There were no significant statistical differences in the membranous obstruction rate, common canalicular obstruction rate, or synechiae formation rate between the two groups. The success rate at postoperative 1 year was 82.9% (29/35) in the sickle knife group and 88.6% (31/35) in the laser group (p=0.49). CONCLUSIONS: The laser group obtained the higher success rate and lower incidence of granuloma formation at the internal ostium than the sickle knife group. Wound healing seemed to be faster in the sickle knife group but showed higher granuloma formation in the sickle knife group. This might suggest that the instrument used in the removal of the medial wall of the lacrimal sac could influence the duration of wound healing as well as granuloma formation at the internal ostium.