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Suryasnata Rath, Anasua Ganguly, Samir Mohapatra, Keswarpu RamaRao; External Transconjunctival Dacryocystorhinostomy: Success without disfiguring scar. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2777.
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External transcutaneous dacryocystorhinostomy (DCR) remains the eternal gold standard in the treatment of nasolacrimal duct obstruction (NLDO) with >95% success. However, a cosmetic blemish from a scar after transcutaneous DCR is a reason for preference of an endonasal DCR. External transconjunctival DCR is a novel technique which has comparable success without a visible scar. In the only previous study describing the technique, the authors converted to transcutaneous DCR in 34% owing to intraoperative difficulties. We describe a modified technique of transconjunctival DCR that was initially performed on cadavers followed by human subjects. We performed this study to evaluate the feasibility and outcome of external transconjunctival DCR in primary acquired NLDO in adults.
Retrospective analysis of all patients after transconjunctival DCR between January and June 2013 was done. Outcome measures included anatomical patency and epiphora at final follow-up and presence of a visible facial scar at the nasal bridge 1 month after surgery.
Transconjunctival DCR was performed in 10 patients. Mean age was 46.8 +/- 12.8 years with an equal gender distribution. Mean duration of epiphora was 33.5 months and 9 patients had regurgitation of purulent material on pressure over sac. Surgery could be performed successfully in 8/10 (80%) patients. Transconjunctival was converted to transcutaneous DCR and dacryocystectomy in 1 patient each because of poor exposure and fibrosed lacrimal sac respectively. Anatomical patency and relief from epiphora was achieved in 9/10 (90%) patients. All patients (100%) who underwent transconjunctival DCR were anatomically patent on syringing and had no epiphora at median follow-up of 3.5 (range 1-6) months. Absence of a visible facial scar at the nasal bridge was achieved in all (100%) patients at one month.
Modified transconjunctival DCR holds promise as an alternative technique in the treatment of NLDO. Absence of a visible facial scar, excellent success rate without the need for endoscope/LASER are significant advantages.
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