[The prevention and treatment of recurrences after dacryorhinostomies]

A total of 1206 dacryorhinostomies carried out from January, 1991 to December, 1997 at Institute of Ocular Diseases of the Russian Academy of Medical Sciences are analyzed. The main causes of relapses were underevaluation of the data of examinations and improper choice of operative access and method of surgery, errors in the technique of operation, and wrong postoperative treatment. For improving the efficacy of surgery, the authors developed a comprehensive method for preventing and treating relapses. X-ray and rhinological data are decisive for the choice of the access and method of operation. Unfavorable rhinogenic factors are removed and measured aimed at suppression of the cicatricial process at the site of anastomosis are carried out in primary dacryorhinostomy. For this purpose the authors for the first time in Russia applied a cytostatic antibiotic mitomycin C to the site of dacryostoma (44 cases) and a polymeric film Diplen with hemostatic and wound-healing effects (87 cases) with good results. Thorough follow-up after surgery detected a threatened relapse sufficiently early to carry out adequate treatment promoting cure.