A COMPARATIVE STUDY IN DACRYOCYSTORHINOSTOMY WITH VERSUS WITHOUT SILICON TUBE INTUBATION IN NASOLACRIMAL DUCT OBSTRUCTION IN ADULTS

Abstract

Background: Dacryocystorhinostomy (DCR) has been touted as the standard procedure for treatment of acquired nasolacrimal duct obstruction; it can be performed through a cutaneous incision referred to as external DCR, or via a transnasal approach. Intubation with silicone tubes has been widely used in lacrimal duct surgery. Objective: Toevaluate the role of silicon tube intubation in the clinical outcomes of external and endonasal dacryocystorhinostomy in nasolacrimal duct obstruction in adults. Patients and Methods: This is a prospective, randomized; comparative study included 80 cases of 74 patients who were diagnosed with postsaccal obstruction of the lacrimal pathway. The studied sample was randomly grouped into two main groups (n=40), group (I) undergoneexternal dacryocystorhinostomy (EX_DCR) and group (I) undergoneendonasal dacryocystorhinostomy (EN_DCR), then each group was subdivided into two subgroups (n=20) according to with or without silicon tube intubation. From all patients, full history was taken and they received a complete ophthalmologic examination, ENT and systemic assessment. After undergoing the surgical procedure, patients were followed up at1stpostoperative day, 1week, 1, 3 & 6 months, complications and outcome were assessed. Results: The overall success rate in external DCR was 82.5% (33 cases), however, the overall success rate in endonasal DCR was 77.5% (31 cases) with no significant difference between groups. The success rate was 85% for external DCR with intubation, 80% for external DCR without intubation, 80% forendonasal DCR with intubation and was 75% for endonasal DCR without intubation, with non significant differences among these subgroups (P=0.89). The results showed that DCRs without intubation recorded significantly lower operative time compared to with indubation DCRs. Conclusion: The results of endoscopic and external DCR with silicone intubation were comparable to these result without intubation with non significant differences. Using of silicone tube has no significant beneficial effect in the surgical success of primary DCR, while, it is associated with increasing cost, operative time and complication rate, there is no need for its routine use. Further studies with larger sample size are warranted.