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Dr. Santanu Mitra, DOMS

Postoperative Endoscopic Comparative Analysis of External and Transcanalicular Laser Dacryocystorhinostomy. Dr. Santanu Mitra, DOMS. Disha Eye Hospitals, Barrackpore, Kolkata-700120, INDIA santanu_mitra60@yahoo.co.in. Introduction.

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Dr. Santanu Mitra, DOMS

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  1. Postoperative Endoscopic Comparative Analysis of External and Transcanalicular Laser Dacryocystorhinostomy Dr. Santanu Mitra, DOMS Disha Eye Hospitals, Barrackpore, Kolkata-700120, INDIA santanu_mitra60@yahoo.co.in

  2. Introduction External Dacryocystorhinostomy (E DCR), the gold standard in lacrimal surgery creates an average osteotomy of 15x15 mm. [1] Newer approaches like laser assisted transcanalicular DCR (TC DCR) tend to create a relatively smaller osteotomy, averaging 5x5 mm. [2] 1. Levine MR. Dacryocystorhinostomy. In: Levine MR, ed. Manual of Oculoplastic Surgery. 2nd ed. Boston, Mass: Butterworth-Heinemann; 1996:37-45. 2.Brigita Drnovšek-Olup and Matej Beltram. Transcanalicular diode laser-assisted dacryocystorhinostomy. Indian J Ophthalmol. 2010 ;58:213–17.

  3. Introduction • The success story of DCR surgery by any route has 3 criteria to fulfill : • A marked improvement in tearing • Ability to irrigate the artificial passage • Endoscopic endonasal visualisation of • rhinostomy with free flow of dye through it Purpose of the Study To asses the subjective and objective outcomes of DCR, both external (E DCR) and laser assisted transcanalicular (TC DCR) approaches, and evaluate the role of functional endoscopic transit time (FETT)

  4. Methods # Procedure Prospective, randomised, comparative series of 123 cases. Fig 1 Fig 2 Fig 1. 5% Betadine instilled in conjunctiva Fig 2. Endoscopic view of rhinostomy Fig 3 Fig 4 Fig 3. Free flow of betadine time recorded Fig 4. Patency on irrigation

  5. Results Methods # Results

  6. Results P : <0.05 P value < 0.001

  7. Results

  8. Results # Complications Granulation Tissue: E DCR 03 TC DCR 07 Synechia: E DCR 08 TC DCR 05 Scarring: E DCR 07 TC DCR 22 Final rhinostomy size is not an indication of DCR surgery success

  9. Discussion • FEDT (Functional Endoscopic Dye Test) was extremely useful for understanding rhinostomy function after DCR[3] • Fluorescein Transit Time (FTT) of ≤ 45 sec has a statistically significant association with subjective • success [4] 3. Moore WM, Bentley CR, Olver JM. Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy: Surgical and holmium laser. Ophthalmology. 2002;109:1575–82. 4. Delaney Yvonne M, Khooshabeh Ramona.Fluorescein transit test time and symptomatic outcomes after external dacryocystorhinostomy. Ophthalmic plastic and reconstructive surgery 2002;(18):281-84

  10. Discussion • Endoscopic study found that the mean ostium diameter was only 1.80 mm in successful DCR [5] • Ultrasonographically the osteotomy was much larger, averaging 71mm2 [6] • Digital subtraction macrodacryocystographyshowed the osteotomy as an ellipse, with an average vertical height of 3.5 mm [7] • The FTT provides a quantitative measure of lacrimal drainage function after dacryocystorhinostomy. [4]

  11. Discussion# Pitfalls of the study • Prospective study, insufficient number of cases and follow up; large series with long term follow • up required. • No masking; evaluation performed by the authors. Inherent bias may be possible • No proper control study done with normal subjects. • Direct measurement of ostium size may be erroneous due to technical difficulties. • The study was not age, gender matched or follow up time sequence comparison done

  12. Conclusions • Anatomic patency: no statistical significance between 2 groups • Functional success: significantly higher in the E DCR group • Dye transit time >1 min. associated with more symptomatic ‘watery eyes’ • in the TC DCR group • Rhinostomy size 3 months after operation shows no significant difference • between the 2 groups Other References 5. Linberg JV, Anderson RL, Bumsted RM, Barreras R. Study of intranasal ostium external dacryocystorhinostomy. Arch Ophthalmol. 1982;100:1758–62. 6. Ezra E, Restori M, Mannor GE, Rose GE. Ultrasonic assessment of rhinostomy size following external dacryocystorhinostomy. Br J Ophthalmol. 1998;82:786-789. 7. Yazici B, Yazici Z. Final nasolacrimal ostium after external dacrycystorhinostomy. Arch Ophthalmol. 2003;121:76–80

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