Powered Endoscopic Dacryocystorhinostomy: Raising the Bar

Abstract

Purpose: This study was done to assess the efficacy of powered endoscopic dacryocystorhinostomy (DCR) with creation of a large bony ostium exposing fundus of the sac and primary mucosal anastomosis. Methods: The study involved prospective interventional case series with short perioperative follow up. Operative and postoperative data were prospectively collected on 42 patients (15 men and 27 women; mean age, 62.4 years; range 14–91 years) who presented to a lacrimal clinic with epiphora and obstruction of the nasolacrimal system and who consecutively underwent either primary or revision powered endoscopic DCR. All surgeries were done by the same surgeon by standardized surgical technique. Follow-up evaluation included symptom evaluation and endoscopic assessment of the newly created ostium with fluorescein testing at each postoperative visit. Results: The only surgical complication was one case of sub cutaneous emphysema. Thirty nine of the 42 DCRs had anatomically patent naso lacrimal duct after a mean follow-up of 12 months (standard deviation = 5 months), yielding a success rate of 95.7%. Out of three failures, two had closed ostium because of improper use of medications, one patient had granulation tissue at the ostium. Two patients with a patent ostium had functional block and continued to have some symptoms. Conclusion: Powered endoscopic DCR with full sac exposure and primary mucosal apposition has a success rate comparable to that achieved with external DCR.

Keywords

• endonasal dcr
• powered dcr
• dacryocystorhinostomy