|
Modified endoscopic dacryocystorhinostomy with
posterior lacrimal sac flap for nasolacrimal duct obstruction
KSC Yuen, LYM Lam, MWY Tse,
DDN Chan, BWC Wong, WM Chan
Department of Ophthalmology and Visual Sciences, The Chinese University
of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
OBJECTIVES. To evaluate a new technique of modified
endoscopic dacryocystorhinostomy involving the creation of a large
posterior flap at the lacrimal sac and to compare its success rate
with that of the conventional endoscopic method of excising the
entire medial lacrimal sac wall as a surgical treatment for epiphora
caused by nasolacrimal duct obstruction.
DESIGN. Retrospective, interventional, and comparative
case series.
SETTING. University teaching hospital, Hong Kong.
PATIENTS AND METHODS. Only adults with primary
nasolacrimal duct obstruction were included. Consecutive endoscopic
dacryocystorhinostomy was performed using two different techniques
from July 1999 to June 2001. The new technique involved the creation
of a large posterior flap at the medial lacrimal sac wall, reflecting
it posteriorly, followed by removal of the remaining small anterior
flap (the LSF group). Other patients had the entire medial lacrimal
sac wall excised (the ELS group).
MAIN OUTCOME MEASURES. Surgical success was defined
by free fluorescein drainage from the conjunctival sac into the
rhinostomy site at least 3 months after silicone stent removal.
RESULTS. Ninety-nine procedures were performed
in 99 patients. The success rate was 89.1% (41/46) in the LSF group
and 71.7% (38/53) in the ELS group. The difference between the two
groups was statistically significant (Chi squared test, P=0.031).
CONCLUSIONS. Our new and modified technique of
endonasal dacryocystorhinostomy has a greater success rate than
conventional endonasal dacryocystorhinostomy. A large-scale prospective
randomised controlled trial to further evaluate the efficacy and
safety of this surgical technique is under way.
Hong Kong Med J 2004;10:394-400
Key words: Dacryocystorhinostomy; Endoscopy; Lacrimal
apparatus diseases
|
