The authors described a modified technique for external dacryocystorhinostomy (DCR) whereby the lacrimal sac is excised medially along its length using a 15mm blade. Following insertion of silicone stents, the remaining part of the anterior wall of the lacrimal sac is sutured to a U-shaped nasal mucosa flap. No posterior sac-nasal mucosa anastomosis is made. The authors retrospectively compared 57 patients that underwent conventional surgery and 81 patients that had DCR using the modified technique. They found that the modified technique was non-inferior to the conventional DCR with 96.3% success rate at three months and 2.5% re-operation rate. There were no complications in the modified DCR group and in the conventional group 1 patient had postoperative bleeding and one have postoperative infection. The authors theorise that the modified technique reduces the risk of iatrogenic damage to the common canalicular opening and is an easier technique to perform than the conventional way of opening the sac. There are many small modifications that can be made to DCR surgery without impacting on success rate – it is up to the surgeon to decide which works best in their hands.
A modified technique for external DCR
Reviewed by Hetvi Bhatt
Medial lacrimal sac excision versus conventional H-shaped lacrimal sac opening in external dacryocystorhinostomy: a comparative cohort study.
CONTRIBUTOR
Hetvi Bhatt
Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
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