Duration 5min, Q&A 3min
There Is No Use Crying Over Failed Dacryocystorhinostomy (DCR): The Management of Unsuccessful Lacrimal Surgery
Prospective and uncontrolled study to assess the success rate of repeat DCR surgery done with Mitomycin C ( MMC ) syringing on first post-operative day.
32 patients(Male 10,Female 22 ) were randomly selected for repeat DCR surgery because of the constant complaint of epiphora and discharge following previous DCR surgery. The primary DCR surgery was done 6 months to 2 years before.The patient's age varied from 22 years to 56 years.. Among 10 male patients, 8 patients had pathology on right side while 2 on the left side. Among 22 female patients, right sided pathology in 13 patients and left side in 9 patients. Exclusion criteria were Acute attack of dacryocystitis , H/O of nasal or orbital trauma , Patients with any nasal pathology causing Epiphora and Patient with Diabetes, Hypertension, Coronary artery disease etc .
Before surgery, a dacryocystogram was done in all the patients, which revealed the cause of failure of the previous surgery and also acted as a guide during repeat surgical procedure.
A skin incision was made through the original scar. Intervening scar tissue was excised and 8mm Arruga bone trephine was used to make osteum in lacrimal bone and passage in nasal mucosa. Methylene blue is used to delineate sac. Remaining medial half of the sac and upper portion of the nasolacrimal duct are removed so that the lateral half of the sac remains as a disc with punctum in its middle(similar to toti's DCR surgery). If the common canaliculus is obstructed, It was Intubated with silicon tube and passed through newly formed passage and secured within the nose. OrbicularisMuscle and tendon are repositioned with an absorbable suture, and the skin is closed with an interrupted nylon sutures. On first postoperative day sac syringing with 1 ml of 0. 4mg/ml MMC was done in newly formed passage and near bone osteum. These patients were followed up for one year. The success criteria were symptomatic relief from epiphora and a patent nasolacrimal duct upon syringing for one year.
Results and Conclusion
Out of 32 patients, 29(90.62%) patients were symptom free and patent on syringing at end of mean follow up period (12 months). Result suggests that our technique had high success rate and reliability in repeat surgery of failed DCR.
[ Keyword ]
failed dacryocystorhinostomy / unsuccessful lacrimal surgery / Mitomycin C ( MMC ) syringing / Arruga bone trephine / toti's DCR surgery
[ Conflict of Interest ]