Problems / Complications, Success Rate ? Endoscopic Dacryocystorhinostomy

Abstract

Purpose: To analyze endoscopic / endonasal dacryocystorhinostomy (endo DCR) cases regarding the problems encountered during the procedure, post operative complications, their management and success rate.

Material and Methods: Endo DCR, done from Jan 2008 to Sep 2011 in eye departments of CMH Kharian and Mardan, were analyzed in this retrospective study. In the initial ten cases, only nasal packing with 5 cc of 2 % xylocaine with adrenaline 1:100000 mixed with 0.5 cc of adrenaline 1: 1000 was done and kept for fifteen minutes. In the next ten cases, after packing, injection of the same solution (2 cc of 2 % xylocaine with adrenaline mixed with 0.5 cc of adrenaline 1: 1000) was given at the operation site (sac area and middle turbinate) and packing was done again for ten minutes. In the rest of the cases, after packing, cautery was done instead of injection. In all the procedures, silastic intubation and application of mitomycin C, 0.5 mg/ml for ten minutes was done.

Results: A total of 32 endo DCR operations were done in 31 patients (a three year boy had bilateral endo DCR) under general anesthesia. 3 were males and 28 were females. Age ranged from three years to sixty years (mean 42 ± 15). Follow up ranged from 6 to 10 months (7.5 ± 1.5). Problems arising during the operation included moderate bleeding in the nose obscuring view through the nasal endoscope during six operations (19%), difficulty in localization of sac area inside the nose in five operations (16 %), mild bleeding on first post operative day after two operations (6%) and persistent watering after five operations (16 %) which required revision. Revised cases were done with endonasal endoscopy and all improved except two.

Conclusion: Problems / complications encountered during Endo DCR can be managed and the procedure has good success rate.