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B. R. Mittelstaedt, T. Kietzman; External Dacryocystorhinostomy Under Local Anesthetic and Sedation: A Successful and Cost-Effective Technique. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4263.
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To show the efficacy and minimal complications of EX-DCR for treatment of nasolacrimal duct obstruction (NLDO) using our technique which involves LA of just two nerve blocks, nasal packing and sedation.
We report the data of 61 procedures (60 patients) determined to have NLDO who underwent EX-DCR, all performed by a single surgeon. There were 47 women and 13 men (one bilateral). This technique uses our streamlined protocol of two local nerve blocks/infiltrations, nasal packing and sedation.
100% of our patients had a successful outcome. This was determined by patent syringing of those returning to clinic with symptoms of possible re-obstruction. Using our technique, the need for additional intraoperative pain medications was required only once. Excessive bleeding (over 100ml) was also noted only once. Post-operative complaints included ecchymosis in 14.75% of patients, inability to suture the posterior flap in 4.92%, infection in 3.27%, epiphora in 3.27%, prolapsed tube in 3.27%, POAG requiring trabeculectomy in 1.63% and stoma and common canaliculus fibrosis in 1.63%.
If one is seeking to avoid the GA complications of EN-DCRs or EN-DCRs are simply impractical, then our technique is superior to other external techniques in terms of outcome success and less intraoperative bleeding. In addition, there is no need for hospital stays, which is optimum for many areas of the world. We believe this technique is of great importance to the occasional international missionary/consultant or permanently based surgeon in a poorly resourced surgical center.
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