Variation of the minimally invasive CDCR technique

Area of Science:

• Ophthalmology
• Surgical Innovation
• Oculoplastics

Background:

• Traditional (tCDCR) and endoscopic conjunctivodacryocystorhinostomy (eCDCR) are complex procedures with significant drawbacks.
• These traditional methods necessitate general anesthesia, facial incisions, and extensive osteotomies and mucosal flaps.
• Minimally invasive CDCR (miCDCR) techniques aim to simplify these surgical steps.

Purpose of the Study:

• To introduce and evaluate a novel variation of the miCDCR technique.
• This variation utilizes a Naugle-Fleming knurled dilator (NKD) for osteotomy creation and standard catheter kit instruments for Jones' tube placement.
• To assess the safety, efficacy, and outcomes of this modified miCDCR approach.

Main Methods:

• Retrospective chart review of patients undergoing the modified miCDCR technique between 2014 and 2016.
• Inclusion criteria: patients requiring primary or revision CDCR; Exclusion criteria: follow-up loss before six months.
• Primary endpoints included operative time, tube migration/complication rates, and epiphora cessation.

Main Results:

• Sixteen patients (19 cases) were reviewed, with an average age of 66.6 years.
• The procedure was performed under local/MAC with IV sedation in 62% of cases, avoiding general anesthesia.
• Average operative time was 17.4 minutes, with only one case (5%) requiring revision for tube migration; all patients achieved epiphora cessation.

Conclusions:

• The modified miCDCR technique is a safe and rapid surgical option for treating nasolacrimal duct obstruction.
• This technique can be effectively performed without general anesthesia, reducing patient risk and recovery time.
• The study demonstrates a low rate of tube migration and high success rate in resolving epiphora.