مقايسه نتايج و عوارض جراحي داكريوسيستورينوستومي به دو روش اكسترنال و آندوسكوپيك در انسداد اوليه مجراي نازولاكريمال

Comparison of results and complications of external DCR with endoscopic

ntroduction: Epiphora is one of the most common complaints of patients that refer to I ophthalmology clinics and primary nasolacrimal duct obstruction is the main cause of this problem in adults. Dacryocystorhinostomy (D.C.R) is the surgical treatment of epiphora that can be done by two basic method: external and endonasal ( Microscopic or Endoscopic). The aim of this study was comparison between results and complication of these two methods in treatment of patients with primary nasolacrimal duct obstruction. Materials and methods: This prospective randomized double blind clinical trial study was done in Emam Khomeini hospital of Hamedan university of medical sciences during 1380-1381. According to patientsʹ history, physical examination findings and results of regurgitation and dacryoscintigraphy tests, we divide 50 cases in two groups, randomly. External group was operated by classic DCR skin incision and creation of two lacrimal sac flap, and endoscopic group was operated by intranasal drilling of lacrimal bone, finding of lacrimal sac by lacrimal probe and complete removal of medial wall of lacrimal sac. After surgery all patients were fallowed up in two 4 and 6 month periods and results and complications were studied in each group. Results: In 92% of both groups epiphora was resolved clinically but nasalacrimal duct obstruction in irrigation test were seen in 16% of external group and 8% of endoscopic group (P>0.05). Pain in second week of surgery, hematoma and bleeding was equal in both groups but only 76% of external group were pain free in first week after surgery. In contrast, nasal discharge in endoscopic group was significantly higher than external group. Conclusion: On the basis of our findings, results of endoscopic DCR is similar to external method and because of lack of scar and lower complication rate, this minimal invasive method can substitute classic external method successfully.