Endoscopic dacryocystorhinostomy with flap suturing

Area of Science:

• Otolaryngology
• Ophthalmology
• Surgical Innovation

Background:

• Endoscopic dacryocystorhinostomy (DCR) efficacy varies across centers.
• External DCR is often considered the gold standard for nasolacrimal duct obstruction.
• A need exists for an endoscopic DCR technique that replicates external DCR's anatomical principles.

Purpose of the Study:

• To describe a modified endoscopic DCR technique.
• To anatomically simulate external DCR using an endonasal approach.
• To assess the success rates of this modified endoscopic DCR technique.

Main Methods:

• Prospective, nonrandomized, noncomparative interventional case series.
• Included patients with symptomatic, clinical, and radiological evidence of nasolacrimal duct obstruction.
• Modified standard endoscopic DCR by creating wide lacrimal sac exposure and suturing the medial sac wall to the lateral nasal wall using vascular clips or vicryl sutures.

Main Results:

• Twenty patients (11 female, 9 male; average age 56.86 years) were included.
• Primary success rate of 95% and ultimate success rate of 100% for nasolacrimal duct (NLD) block.
• Overall success rate of 82.6% when including common canalicular block cases.

Conclusions:

• The modified endoscopic DCR technique achieves high success rates.
• This minimally invasive approach offers a viable alternative to external DCR.
• Endoscopic DCR, with this modification, can potentially replace external DCR as the standard treatment.