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Gary J. Lelli, Jr., Ashutosh Kacker, Roheen Raithatha, Charles Kim; Lacrimal System Endoscopy Assisted Endonasal Dacryocystorhinostomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1450.
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Endoscopic dacryocystorhinostomy (EDCR) is a well-established method for the treatment of nasolacrimal duct obstruction. Identifying the level of obstruction can be accomplished through a variety of methods, including probing and irrigation, dacryocystography, and dacryoscintigraphy. In this study, we report our experience using intra-operative lacrimal system endoscopy (LSE) to aid in the evaluation and management of patients with NLDO.
Retrospective case series study consisting of six patients (seven cases) who underwent LSE with concurrent EDCR between May 2010 and November 2011. NLDO was confirmed in each patient with probing and irrigation prior to surgery. Primary outcome measures included post-operative epiphora and infection.
A total of six patients underwent seven LSE assisted EDCRs, which was successful in identifying the level of nasolacrimal duct obstruction in all cases.Two LSEs revealed obstruction at the valve of Hasner at the opening of the nasolacrimal duct within the inferior meatus--these patients subsequently underwent EDCR at this level. The remaining cases involved obstruction at more proximal locations in the nasolacrimal duct, necessitating EDCR at the level of the lacrimal sac.Insertion of Crawford tubes was performed in all seven cases. No intra-operative complications were encountered.The majority of patients (4/6) in our study experienced complete resolution of epiphora within 1 month of surgery, with all patients achieving resolution by 6 months.No patients in the study exhibited any signs of dacryocystitis post-operatively.
The evaluation and management of nasolacrimal duct obstruction may be greatly enhanced by the use of LSE, which allows for tailoring of the surgical approach through specific localization of the obstruction.
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