Korean J Ophthalmol.  2006 Mar;20(1):1-6. 10.3341/kjo.2006.20.1.1.

Clinical Results of Endoscopic Dacryocystorhinostomy using a Microdebrider

• Yoon SW
• Yoon YS
• Lee SH

• KMID: 1099065
• DOI: http://doi.org/10.3341/kjo.2006.20.1.1

Abstract

PURPOSE: The success rate of endoscopic dacryocystorhinostomy has been increasing with the development of better instruments and techniques. We conducted this study to evaluate the clinical results of endoscopic dacryocystorhinostomy using a Microdebrider, which has also been used for functional endoscopic sinus surgery. METHODS: We selected 76 patients (with a total of 84 affected eyes) who had been diagnosed with a nasolacrimal duct obstruction. These patients underwent an endoscopic dacryocystorhinostomy using a Microdebrider, which removed both nasal mucosa and lacrimal sac mucosa and also trimmed the margins of the ostotomy site. We assessed patients' outcomes on an anatomical basis using a dye test and endoscopy, which were used to define the anatomical success. We also arbitrarily defined functional success as whether the subjective epiphora was absent. At a four to 18 month follow-up, we monitored the clinical course to examine any recurrent episodes. RESULTS: The symptoms were alleviated in 72 eyes, with a primary success rate of 85.7%. On nasal endoscopy, a functional failure was seen in four eyes. In these four eyes, the orifice was narrowed by the presence of either granulation tissue or conjunctivochalasis. By contrast, surgical outcomes were the anatomical failure in eight eyes. In these eight eyes, the orifice was obstructed by the presence of granulation tissue as well as the adhesion of nasal mucosa. CONCLUSIONS: Endoscopic dacryocystorhinostomy using a Microdebrider enabled us to make the large fistula while minimizing the damage of adjacent tissue. It might be the recommended surgery that reduces the complications and enhances the success rate.

Keyword

Endoscopic dacryocystorhinostomy; Epiphora; Microdebrider; Nasolacrimal duct obstruction

MeSH Terms

Treatment Outcome
Retrospective Studies
Miniaturization
Middle Aged
Male
Lacrimal Duct Obstruction/*surgery
Humans
Follow-Up Studies
Female
Equipment Design
*Endoscopy
Debridement/*instrumentation
Dacryocystorhinostomy/*methods
Aged
Adult
Adolescent

Figure

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  Fig. 1 Microdebrider (Hummer, Storz, USA). Right: Handpiece. Left: Various cutters and protection drills.

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  Fig. 2 (A) The nasal mucosa covering the lacrimal fossa was removed using a Microdebrider. A spot of light projected from the lacrimal sac was seen. (B) After the anterior lacrimal crest and lacrimal bone, the medial wall of the lacrimal sac was exposed. (C) The exposed medial wall of the lacrimal sac was removed by the Microdebrider. Then a bicanalicular silicone tube was inserted into the lacrimal sac through the newly formed opening. (D) One week postoperatively, the silicone tube was well-placed in the large bony opening. No damage of mucosal tissue was noted in the adjacent tissue.

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