Comparative study between external and endoscopic Dacryocystorhinostomy

Abstract

Background: Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system. Materials and Methods: Study was conducted for 18 months duration in a teaching hospital with 50 cases of endoscopic and 50 cases of external DCR with a follow-up of minimum 9 months. Data regarding surgical outcome and complications were analysed and compared using χ 2 test. Results: Total 100 patients were included in the study with six having bilateral involvement, out of which 10 were male and 90 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (69%) was involved more commonly than left eye (31%). Epiphora was the commonest presenting symptom (81%). Mean duration of surgery was much lengthier in external (mean 90 minutes) than endoscopic (mean 50 minutes) DCR. Most common complication included excessive intraoperative bleeding which was seen in 10(20%) and five cases (10%) of external and endoscopic DCR respectively. Primary surgical success rate was 89% and 97% for endoscopic and external DCR, respectively (P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 97% at third month of follow-up. In endoscopic DCR group, out of 50 cases, 45 cases (90%) demonstrated primary surgical success, which is defined as decreased or absent epiphora and adequately patent lacrimal system in 1 st month of follow-up period. Forty eight (96%) out of 50. cases had patent lacrimal passage and one presented with functional block after 1 month in external DCR group However, at 6 month of followup, success rate was 90% for endoscopic DCR and 94% for external DCR. The difference was not statistically significant (P = 0.609). Conclusion:External DCR is a simple, moderately invasive, day care procedure and had comparable result with endoscopic DCR.