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S. Dragovic, D. Tresley; Effect of Intraoperative Kenalog Injection During Dacryocystorhinostomy (DCR) on Rate of DCR Failure. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3523.
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To determine whether intraoperative injection of Kenalog into surgical site during transcutaneous (external) dacryocystorhinostomy (DCR) decreases the rate of DCR failure.
DCR is the treatment of choice in most patients with acquired nasolacrimal duct obstruction. Second attempts following failed DCR, no matter which approach, have a significantly higher failure rate. Currently there are no recommendations on using intraoperative steroid injections during primary DCR to reduce rate of reobstruction. We performed a retrospective chart review of one oculoplastic surgeon's experience who after 9 years in practice started injecting 0.3ml of Kenalog 40mg/ml intraoperatively into the lacrimal sac during primary external DCR without flaps and with silastic intubation. Similar surgical technique was maintained throughout the years. Inclusion criteria were patients status-post DCR without Kenalog injection that were operated on during 4 years prior to surgeon starting Kenalog use and patients status-post DCR with Kenalog injection thereafter (also a 4 year experience). Successful DCR was defined by symptom relief with partial or complete patency at follow up which ranged from 3 months to 3 years. Exclusion criteria were history of trauma and pediatric cases. Forty-six eyes of patients without Kenalog injection and sixty-eight eyes of patients with Kenalog injection were reviewed and rate of patency, symptom relief and reobstruction were recorded and analyzed for each group.
Rate of successful primary external DCR without flaps without Kenalog injection was 83%, and with Kenalog injection 92%.
Intraoperative Kenalog injection into surgical site during transcutaneous (external) dacryocystorhinostomy significantly decreases the rate of DCR failure and thus minimizes need for additional surgery. Proposed mechanism is by decreasing inflammation and preventing scarring at the level of the lacrimal sac.
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