| Abstract: |
SummaryDacryocystorhinostomy (DCR) is a drainage procedure to bypass the site of obstruction in the nasolacrimal duct. DCR is the surgical procedure of choice to deal with this problem. Many modifications have been described to increase the success rate.This study was carried out to evaluate the different tubes in docryocystorhinostomy. It was carried out on 100 patients (107 eyes) complaining of epiphora with or without chronic dacryocystitis, 80 patients were females and 20 patients were males (7 cases were bilateral). The mean age was 37+8 years, left side were more than the right side, and the duration of symptoms was higher between 2-3 years.Full history was taken, clinical ophthalmological examination with special attention to the lacrimal system, and special investigations to determine the cause and the level of nasolacrimal duct obstruction were carried out.Cases in this study were classified into 4 groups according to the operative technique performed. All patients were followed postoperatively for at least 6 months after removal of the tubes.During each visit patients were asked about epiphora, discharge, clinical examination, dye disappearance test and lacrimal irrigation. Dacryocystography and nasal endoscopy were done at the end of follow up period in some cases to assess the patency of the osteum.In group (I) 30 eyes (28.1%) were operated by External classic DCR, the most common and important operative complication was bleeding from angular vein and nasal mucosa. The success rate of this technique was 93.4%.In group (II) 40 (37.3%) eyes, were operated by external DCR with T. tube, less effort to create nasal and lacrimal flaps. The success rate of this technique was 90%.In group (III) 7 eyes (6.5%) were operated by external DCR with nasal catheter, complications similar to those resulting from the external technique. The difficulty was in the position and fixation of the nasal catheter. The success rate was 71.4%.In group (IV) 30 eyes (28.1%) were operated by transcanalicular DCR technique, they were divided into two subgroups A (15 eyes) 14.05%, group B (15 eyes) 14.05%. It was a simple technique. This most common operative complication was canalicular injury. The success rate was 60% in subgroup (A) and 66.7% in subgroup (B). Conclusion:The classic external DCR is still the main surgical treatment for nasolacrimal duct obstruction in adult but time consuming.The external DCR with T. tube technique is a new fashioned technique, used to avoid the difficult step of suturing of lacrimal and nasal mucosa. This effective, cheap and less time consuming .The external DCR with a nasal catheter, soft, non reactive silicone material, the central canal should be lower in the catheter and should be fixed at lower as possible to avoid sump syndrome. This technique is suitable for small scarred lacrimal sac.The transcanalicular DCR is an easy technique, it does not require sophisticated instruments and it is time saving but lower success rate.
|
|
|