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K.C. Lee, S.L. Merbs, M.P. Grant, D.C. Garibaldi, N.T. Iliff; Efficacy of a Simplified Approach to External Dacryocystorhinostomy (DCR) . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4251.
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Purpose: Traditional dacryocystorhinostomy (DCR) surgery for nasolacrimal duct obstruction (NLDO) requires the suturing of flaps which can be difficult and time–intensive, especially in cases with lacrimal sac scarring or nasal mucosal disease. A simplified external DCR was described by Dr. Charles Iliff in 1954 and does not require suturing of flaps. Instead, a rubber catheter is threaded over the silicone tubes (used to intubate the lacrimal system) and into the lacrimal sac. It is sutured in place in the sac with a 4–0 chromic mattress suture and is left in place for 3 weeks. This study aims to determine the efficacy of this simplified DCR approach. Methods: After obtaining IRB exemption approval, we performed a retrospective chart review of DCRs performed at Johns Hopkins by SLM and NTI from 2001 through August 2004. Indications for the procedure were symptomatic epiphora and reflux upon lacrimal irrigation or dacryocystitis. There was a minimum follow–up period of 2 months. The main outcome measures were subjective improvement in tearing or objective normalization of the tear meniscus. Patients over 18 years of age and undergoing a primary DCR were included. Exclusion criteria included patients who had thyroid eye disease, had undergone prior DCR or other lacrimal surgery (silicone intubation), had punctal ectropion or canalicular stenosis in addition to NLDO. Results: From 2001 through August 2004, 74 patients underwent primary external DCR. Eleven patients underwent bilateral procedures for a total of 85 procedures. Average age was 62. 48 patients (64.9%) were women, 26 (35.1%) were men, 59 (79.7%) were Caucasian, and 6 (8.1%) were African American. Follow up data were obtained for all patients; the average follow up period was 6.5 months. In 77 of 85 (90.6%) procedures, patients reported an improvement in symptoms or were found to have a normal tear meniscus. Conclusions: We conclude that our simplified external DCR is comparable in efficacy to traditional DCR for nasolacrimal duct obstruction, can be performed in a shorter amount of time and is easily applicable to difficult cases.
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