Objective
To compare the outcomes of various techniques of endoscopic dacryocystorhinostomy (DCR).
Study Design
Retrospective case record analysis.
Settings
Tertiary care referral center.
Subject and Methods
Retrospective analysis of case records was carried out pertaining to the period from January 1996 to September 2017 with respect to patients who had undergone endoscopic DCR with either the standard technique or one of its modifications. Case notes showing well-documented preoperative evaluation, operative details, postoperative assessment, and minimum 6-month follow-up were considered. The outcomes were measured on the basis of patients’ postoperative symptoms, clinical examination, and sac-syringing results.
Results
A total of 423 patients were included in the study. Of these, 169 underwent standard endoscopic DCR; 87, endoscopic DCR with stent; 19, endoscopic DCR with mitomycin C; 62, powered DCR; 29, laser-assisted DCR; and 57, balloon DCR. There was no statistically significant difference in success rates, recurrences, or complications of various techniques at 3 or 6 months. Mean operating time was lowest for balloon DCR (mean ± SD, 27.1 ± 3.1 minutes), followed by standard endoscopic DCR (38.2 ± 3.6 minutes; P = .001).
Conclusion
Standard endoscopic DCR and its more sophisticated modifications were equally effective and safe in managing distal nasolacrimal drainage obstruction. Balloon DCR, followed by standard endoscopic DCR, was significantly faster than other techniques.
MRI emerges as the most valuable stand-alone modality improving accuracy of FIGO staging to 96%. Sentinel lymph-node evaluation appears promising in evaluating spread beyond cervix.
Aim:To evaluate the role of intraoperative mitomycin-C application in primary endoscopic endonasal dacryocystorhinostomy (DCR) and compare the results with conventional endoscopic endonasal DCR.Study design: Prospective comparative interventional study.Setting: Tertiary referral hospital.
Materials and methods:Fifty patients in the age group of 16 to 50 years presenting with symptoms and signs suggestive of nasolacrimal duct blockage refractory to conventional medical treatment were included in the study. They were assigned randomly into two groups of 25 patients each. Group A patients underwent endoscopic endonasal DCR followed by application of mitomycin-C. Group B patients underwent endoscopic endonasal DCR without application of mitomycin-C. The two groups were compared with regard to success rate and complications. The main outcome measures for success were the resolution of epiphora and patency with lacrimal irrigation.
Results:After 1 year, 24 patients (96%) in each group had complete relief from their symptoms while one patient (4%) had no relief. Syringing was patent in 24 patients (96%) in each group and blocked in one patient (4%) after 1 year of surgery.
Conclusion:The present study did not show any additional benefit of using mitomycin-C at the stoma site after primary endoscopic endonasal DCR in terms of success rate.
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