Comparing The Outcomes For External Dacryocystorhinostomy (DCR), Endonasal DCR And Canalicular DCR In An Asian Setting.

Tricia Madrid

Purpose: Endoscopic Dacryocystorhinostomy(EndoDCR) is believed to have a lower success rate compared to External Dacryocystorhinostomy(ExtDCR) but some studies have shown that both types of DCR surgeries may have similar success rates. The purpose of the study is to evaluate the success of the different surgeries in our population.

Methods: A retrospective analysis of all the DCR surgeries performed at the National University Hospital between Nov 2000 and Nov 2008 was performed. In the External DCR, a skin incision was made and an osteotomy created with a Kerrison rongeur starting from the suture line between the lacrimal bone and frontal process of the maxilla. Anterior flaps or anterior and posterior flaps were sutured. Endoscopic DCR consisted of an osteotomy that initially started with a Kerrison rongeur after mucosal incision. The superior part of the osteotomy was done with the help of a high speed diamond drill. Flaps were reposited and the nasal mucosa preserved to cover raw bone superiorly and inferiorly. In 4 cases of Primary EndoDCR, MMC were used. Common canaliculus was sharply dissected in addition to DCR in CanaliculoDCR.

Results: Total number of eyes done was 181: Ext DCR 112 (61.9%), EndoDCR 37(20.4%), Canaliculo DCR 32 (17.7%) of which 8% were done endoscopically. Anatomical patency achieved after primary surgery was as follows: External DCR 91%, EndoDCR 86% and Canalicular DCR 75%. Complete Success defined as patients having no symptoms after surgery with anatomical and physiological patency were 80% in ExtDCR, 81.1% in EndoDCR and 66% in CanaliculoDCR. There was a re-operation rate of 9% (17 cases) in the whole group. Repeat procedures performed were ExtDCR (2 out of 17) and EndoDCR (13 out of 17) of which one was combined with septoplasty and 3 combined with balloon dilatation. MMC was also used in 8 out of 13 cases of endoscopic revision of DCR. In 2 cases only balloon dilatation was done. It was noted that 18% failed after Secondary Surgery and 41% still remained with mild tearing.

Conclusions: Complete Success in ExtDCR 90 (80%) vs. EndoDCR 30 (81%). This shows that success is similar in both groups (ExtDCR and EndoDCR). However, ExtDCR is still the most commonly performed surgery in our Institution.